Assessing Zika Virus Emergence through Upstream and Downstream Drivers and Consequences

Abstract

In light of Zika virus emergence, this thesis asks “What is the role of societal factors on infectious disease emergence?” and finds social dynamics embedded in the upstream factors, downstream factors, and downstream consequences in Zika virus’s most recent emergence. The manuscript focuses primarily on Brazil, but other regions are considered, as necessary. The influence of such factors extends to the realm of disease control in complicating consequences, uncovering control challenges, and highlighting priorities. An explanatory research method tests this hypothesis in a two dimensional framework. The first dimension is the role of societal “upstream” factors in contributing to Zika virus emergence and dissemination. The second dimension focuses on the role of social “downstream” factors as they relate to Zika virus dissemination and consequences. It is found that the “upstream” factors attributable to Zika virus emergence can be traced back to historical institutions and policies. Globalization intensified the legacy of these institutions and policies. The resulting exacerbation contributed to high socioeconomic inequality, high rates of migration and other types of movement, and climate change. Upstream factors, when considered with the biological properties of the virus, increased the likelihood that Zika virus (1) would arrive in Brazil and (2) would be a “fuel source” for Zika virus spread throughout the country and beyond. It was also found that these “upstream” factors flow into the “downstream” factors that directly tied to not only the consequences of the epidemic, but the social nuances of those consequences. This included the perseverance of social inequality impacting microcephaly distribution, prevention, care, and vulnerability. In the end, this thesis makes the case for an approach that integrates the findings on the role of upstream and downstream factors on Zika emergence to guide strategy for control. The downward causal “stream” metaphor is particularly effective as a model to assess the development of response strategy for Zika virus control in that it examines the virus in a way it has yet to be considered: through a whole systems perspective. 4