Zika Forum Focuses on Ethics, Communication and Policymaking

With South Florida facing the threat of a second Zika outbreak this summer, the University of Miami Miller School of Medicine’s Institute for Bioethics hosted an April 6 multidisciplinary forum for clinicians, public health professionals and government leaders on “Zika 2017: Where Do We Go Next?”

Florida Surgeon General Celeste Philip, M.D., M.P.H., addresses the forum.

“It is vital for key stakeholders to look at the implications of the Zika virus threat facing our community,” said Kenneth W. Goodman, Ph.D., professor and Director of the UM Institute for Bioethics and Health Policy, and Co-Director of UM Ethics Programs, in welcoming more than 100 attendees to the forum at The Braman Miller Center for Jewish Student Life at the University of Miami Hillel on the Coral Gables campus. Speakers and panelists included faculty members from UM, Texas A&M University and Baylor College, state and federal health policy experts, and representatives from Miami, Miami Beach and Miami-Dade County.

“After last year’s Zika crisis, we wanted to create a venue for better communication across the various stakeholders involved in the public health response,” said Adriane Gelpi, Ph.D., M.P.H., assistant professor of public health sciences, who moderated the daylong discussion.  The Bioethics Institute’s goal was to foster “community brainstorming” to deal with public health ethics issues related to the Zika threat.

Keeping the public informed about the fast-moving Zika health crisis was a difficult challenge, said Celeste Philip, M.D., M.P.H., State Surgeon General and Secretary of the Florida Department of Health. “We had to be nimble in our messaging about such a scary topic,” she said. Reflecting on issues like offering screening tests for pregnant women, sharing data about the location of mosquito traps and concerns about aerial spraying, Philip said, “It was a very fluid situation, but we could have engaged more public discussion before going forward.”

Talking with patients about their individual risks and conveying Zika clinical guidelines to South Florida physicians were two other challenges, said Christine L. Curry, M.D., Ph.D., assistant professor of obstetrics and gynecology in the University of Miami Health System, and Co-Director of the Zika Response Team. “Patients would show me photos of babies with small heads and ask me, ‘Is this happening to my baby now?’ It’s a difficult conversation at any time, but especially when we are still learning about Zika.”

In trying to find the answers to patient questions, clinical researchers have been hampered by gaps in the data. “One-third of babies born to Zika-positive mothers in the U.S. were never tested after delivery,” Curry said, citing a recent report from the U.S. Centers for Disease Control and Prevention. “We don’t know if they were infected or not.”

Language issues and income disparities are also reflected in the data, Curry said. Of the approximately 1,700 Zika patients tested at UHealth and Jackson Memorial Hospital in 2016, 2 percent of English speakers were positive for Zika, compared with 6 percent for Spanish and 6.5 percent for Haitian-Creole speakers. Curry added that only 2.2 percent of women with private insurance were positive, while 8.4 percent of the Zika patients without insurance were positive.

Those disparities are making it difficult for lower-income communities to respond to a public health threat like Zika, said Roderick King, M.D., M.P.H., associate professor of public health sciences, Assistant Dean of Public Health Education, Director of the M.D./M.P.H Program, and CEO of the Florida Institute of Health Innovation.

“We need to reach out to the most vulnerable populations, who may not read newspapers or watch television,” King said. “That might mean giving them information by word of mouth, and recognizing that a health threat like Zika will not be the top concern for a single mom who’s worried about feeding her children.”

In any case, public health campaigns should do more than build awareness of the Zika threat, said Susan E. Morgan, Ph.D., Associate Dean for Research in Communications Studies and Director of the Center for Culture Communication and Change in the School of Communications. “Decide what you want people to do and focus on that action,” she said. “You also have to understand that different audiences have different concerns about a health threat.”

Turning to the private sector, the threat of Zika can cause economic hardships for local businesses, as well as their employees and health care providers, said Steven G. Ullmann, Ph.D., professor and Chair of the Department of Health Sector Management and Policy in the School of Business Administration. “If tourism goes down, businesses may lay off workers, who may lose their insurance and become dependent on Medicaid,” he said. “But fewer tourists means that sales tax revenue falls as well, leaving the state with less money to pay for care.”

Ullmann added that research studies indicate that one in ten women affected by Zika will have a child with microcephaly. Since the average lifetime cost of care for that child is approximately $4 million, hospitals and physicians could be stuck with the bills that insurance doesn’t cover.

In her keynote talk, “Public Deliberation and Ethics for Health Policymaking,” Lisa M. Lee, Ph.D., Executive Director of the Presidential Commission for the Study of Bioethical Issues, said there is a clear process for addressing public health policy dilemmas. First, identify the ethical dimensions, then articulate the issues, bring stakeholders together for public deliberation, determine the best path forward, implement the policy and evaluate the results.

“This process requires mutual respect and discussion,” Lee added. “We have to recognize that reasonable people disagree, try to understand each other’s perspectives, and identify common ground.”

Kata Chillag, Ph.D., Associate Director of the presidential commission, added that deliberation is not easy to do in the midst of a crisis. “It is incredibly important to create opportunities like this forum where we can talk and learn from each other about how to do things better in the future.”

Tags: bioethics, Christine Curry, Kenneth Goodman, public health, state surgeon general, Zika