JAMA Forum: The Zika Virus and Abortion Politics

Joshua M. Sharfstein, MD

Joshua M. Sharfstein, MD

The lesson of history is that politics and epidemics generally do not mix well. In The Great Influenza, historian John Barry showed that President Woodrow Wilson’s obsession with projecting strength during World War I hampered the US response to the pandemic. In And the Band Played On, journalist Randy Shilts documented how the homophobia of key political leaders undermined the nation’s efforts during the emergence of AIDS.

When the story of the Zika virus is written, how many chapters will be devoted to the politics of abortion and reproductive health?

Noting that it is “unprecedented to [find] a mosquito-borne cause of a birth defect,” Tom Frieden, MD, MPH, the director of the Centers for Disease Control and Prevention, activated the agency’s emergency operations center and assigned hundreds of staff to the response. Critical public health goals include slowing the spread of the virus, minimizing the number of fetal infections, and  developing effective vaccines and treatments. Yet the Republican Congress has yet to fund President Obama’s February request for additional resources for Zika response, leaving the administration to scavenge funding from other programs.

The budget conflict reflects the deep divides in US politics. Indeed, 2016 is a particularly unfortunate year for a virus that interferes with human reproduction to arrive on US shores. Political conflict around 3 issues—fetal tissue research, contraception, and abortion—is undermining the Zika response.

Controversy Over Fetal Tissue Research

In 1988, the Fetal Tissue Transplantation Panel, appointed by President Ronald Reagan, developed a widely supported ethical framework for research using fetal tissue that clearly distinguished such research from abortions themselves. This consensus, however, exists no longer. In the context of unproven allegations about Planned Parenthood,  some in Congress have put fetal tissue research in the context of Nazi experimentation. Several states have prohibited the donation of fetal tissue or banned the research entirely.

Because the Zika virus directly harms the fetus, research on fetal tissue is likely to be central to understanding how this infection occurs. Political interference, if successful in blocking key studies, likely would impede the development of medical countermeasures, including vaccines.

Fights Over Contraception Coverage and Access

Under the Affordable Care Act, employers are required to provide, free of charge, a number of preventive services, including contraception. Although the Obama Administration provided exceptions for religious institutions, other employers sued and successfully argued that the religious beliefs of company owners precluded their directly paying for coverage under the First Amendment. (The litigation’s effects are still unresolved.) Meanwhile, 10 states have cut off funding through the Medicaid program for Planned Parenthood, an organization whose clinics are major access points for contraception. These states most recently include Florida, located squarely in the region susceptible to Zika virus.

Birth control is a critical tool for couples to prevent congenital Zika infection, and, in fact, is recommended as part of travel advisories to Zika-affected countries. It is entirely predictable that reducing access to contraception will lead to greater numbers of children born with the severe complications of Zika infection. Indeed, a recent study of the effect of defunding Planned Parenthood in Texas found that fewer women obtained long-acting contraception, with a corresponding increase in the birth rate.

New State-level Restrictions on Access to Abortion

In recent weeks, Gov Mike Pence of Indiana signed legislation forbidding physicians from performing abortions if aware “that the pregnant woman is seeking the abortion solely because the fetus has been diagnosed … or has a potential diagnosis” of a disability. Gov Rick Scott of Florida signed legislation requiring doctors performing abortions to have hospital admitting privileges, despite the lack of evidence for such a requirement.

Although such provisions are being challenged in the courts, reducing access to abortion makes a difficult situation for couples concerned about prenatal Zika infection even more fraught. It may lead some to seek an early, medical termination of pregnancy rather than wait later in pregnancy to see if the fetus is actually affected by the virus. More broadly, these restrictions threaten to shift the public discourse on Zika from a focus on prevention to a bitter dispute over privacy. It is not unreasonable to surmise that abortion politics might be one reason why Congress quickly funded response efforts for Ebola, but not for Zika.

A successful response to the Zika virus in the United States will, at least in part, depend on overcoming these obstacles. In an election year, this is no small task. Although it is not necessary to reach harmony on abortion and other deep political divides, it is essential to health for public policy on Zika to put prevention first. As others have noted, the Zika virus has not yet registered as a Democrat or a Republican. There is still time for leadership across the political spectrum to step back from partisanship and finger-pointing and to support the public’s health.

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About the author: Joshua M. Sharfstein, MD, is Associate Dean for Public Health Practice and Training at the Johns Hopkins Bloomberg School of Public Health. He previously served as Secretary of the Maryland Department of Health and Mental Hygiene, as the Principal Deputy Commissioner of the US Food and Drug Administration, and as Commissioner of Health for Baltimore. He is a consultant for Audacious Inquiry, a company that has provided technology services and other support to Maryland’s Health Information Exchange. A pediatrician, he lives with his family in Baltimore.

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.



Categories: Health Policy, Infectious Diseases, Pregnancy and Breast Feeding, The JAMA Forum, Women's Contraception, Zika virus

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