U.S. Surgeon General Vivek H. Murthy Visits Miller School to Discuss Zika Virus Threat

Although U.S. Surgeon General Vivek H. Murthy, M.D., M.B.A., smiled broadly and said visiting Miami, where he grew up, “felt like coming back home,” he was all business when it came to discussing the Zika virus threat when meeting with administrators, faculty, residents and students at the Miller School of Medicine and Jackson Memorial Hospital on August 12. The two institutions’ chief medical officers — Michael Barron, M.D., of UHealth and Peter G. Paige, M.D., of Jackson — acted as moderators for the discussion.

“The reason I wanted to come back is that I’m very concerned about the Zika epidemic that is taking place in the Americas,” said Murthy. “I was in Puerto Rico yesterday, where there is an explosive spread of Zika virus, including many pregnant women, and we have a lot of work to do there. I’m also very concerned about Florida, because while we are nowhere near where Puerto Rico is, and while I hope we never reach those numbers here in Florida, we do have an outbreak with local transmission. The question now before us is how we prevent more cases in Florida and throughout the rest of the country.”

Murthy was introduced by Laurence B. Gardner, M.D., Interim Dean of the Miller School, who said, “We’re really happy to have him here as someone who can have influence and send back the message about what this community would like to have to help work with him.”

The response to Zika, Murthy said, has several necessary components — the first and foremost being education.

“We have to educate the public about Zika,” Murthy said, “especially women. Zika is different from other viruses, and most people who become infected have no symptoms. But this isn’t just about pregnant women using mosquito repellent and wearing long sleeves and pants, and getting rid of stagnant water around their homes. This is actually about all of us taking steps to protect ourselves from Zika, because through that, we can protect the pregnant women around us.”

But questions arise about how to handle public messaging.

“We need to keep up with the changing landscape,” said Murthy, “but who is the most effective messenger? A doctor in a white coat? Someone from the community? And where do we reach people in order to be most effective?”

The answers to these questions aren’t simple, he noted, and they are the cause of much discussion in Washington.

“I want you to know that we talk about Zika multiple times during the day at Health and Human Services and at the White House,” said Murthy. “It’s an issue of high concern for the President, for the Secretary of Health and Human Services and for leadership throughout the administration. But there’s nothing that beats coming down into communities and understanding what’s really happening and what people need; it’s the reason why I’m here today.”

Health practitioners also need to be informed, he said, about who to test and how to test. It’s not an easy decision because not enough is known yet, and what is known is changing so quickly. In addition, not all doctors get their information in the same way. As an example, he compared his own father and sister, physicians who run a small private practice in Miami-Dade, with those physicians in the room who are part of a large academic health system.

“Who should be tested?” Murthy asked. “Symptomatic or non-symptomatic? What about someone who has symptoms but has not been to Wynwood?”

The subject of testing raises the concern about limited laboratory resources. Florida, Murthy said, has good testing resources, but as more and more doctors order tests for patients, the strain will be felt. Anticipating a continued increase in demand for testing, the Centers for Disease Control and Prevention has offered backup support in its own laboratories.

Another concern, Murthy said, is access to affordable contraception, which, in turn, raises other issues.

“We have recommendations for timing of pregnancies after possible exposure to the virus,” he said, “but these are very personal decisions, and it is not the government’s role to tell people when to get pregnant.”

The real answer, he said, is a vaccine, and there is hope that one will be developed in 12 to 18 months. However, given Congress’s current unwillingness to fully fund the $1.9 billion requested by President Obama for Zika research, Murthy warns that continued delay will push vaccine development further into the future.

“Beyond health concerns, there are some real potential economic concerns for places like Florida, which generates $86 billion in tourism every year,” said Murthy. “People are worried that tourists might get scared about coming to Florida, and it’s going to affect the economy.”

From a political perspective, he said, the real challenge has been to get everyone on the same page when it comes to the resources that are required to fight Zika.

“Why are resources required?” Murthy asked. “Expanding diagnostic capacity takes money. Investing in vaccine research takes money. Right now, we are beginning phase 1 clinical trials on a vaccine candidate, but it turns out that the actual funds being used will run out by the end of August. The money that the CDC has will run out at the end of September. And when I talk about money I’m not talking about money that has been allocated for Zika. I’m talking about money the administration has had to take from other public health accounts, like the Ebola fund and other research funds, because there is no money that has been provided for a Zika fund.

“In a broader sense, we have to think about how to better set ourselves up for responding quickly to disasters or to issues that come up, like Zika. We can’t spend six or seven months trying to haggle for emergency funds while communities like Miami-Dade struggle with trying to figure out how to expand diagnostic testing and how we’re going to educate people in the community who need to get the message.”

Later in the day, four Miller School infectious disease and public health experts — Paola Lichtenberger, M.D., Mario Stevenson, Ph.D., Jose Szapocznik, Ph.D., and David Watkins, Ph.D. — joined Murthy and U.S. Representatives Nancy Pelosi and Debbie Wasserman Schultz at Nova Southeastern University for a roundtable discussion about the Zika virus.

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