Save the Children s Zika response strategy in 11 countries in the Americas focuses on increasing awareness of the virus and its prevention, in part by reaching women such as this Guatemalan mother through our ongoing health programs. Photo: Alex Webb/Magnum Photos for Save the Children. Save the Children s Zika Virus Response: Addressing Education and Personal Protection Needs in the Americas Request for Support March 2, 2016 Contact: Save the Children 501 Kings Highway East, Suite 400 Fairfield, CT 06825 1-800-Save the Children www.savethechildren.org
Executive Summary On February 1, 2016, the World Health Organization (WHO) announced that the recent cluster of neurological disorders and neonatal malformations a condition known as microcephaly in the Americas constitutes a public health emergency of international concern. This came after the agency s International Health Regulations Emergency Committee agreed that a causal link between this cluster and the mosquito-borne Zika virus disease is strongly suspected. As global concern for the spread of the Zika virus gathers momentum the virus has been reported in 31 countries in the Americas, and is expected to increase as the region s rainy season begins and the mosquito population explodes Save the Children and others are taking action. The WHO s recent response strategy for the Zika epidemic identifies us as a key partner in its community prevention efforts. Save the Children has launched a two-phased, regional Zika virus response strategy in 11 countries in Latin America and the Caribbean where we are an established presence, are respected in the communities in which we work, have expert staff and have strong relationships with health ministries. Our principal goal is to reduce Zika-associated microcephaly among newborns through the reduction of Zika transmission. In Phase 1, we will conduct community awareness activities in El Salvador, Bolivia, Guatemala, Ecuador, Nicaragua, Peru, Haiti, Mexico, Colombia, Honduras, and the Dominican Republic. Our country offices will adapt a regional communications kit to the local context and use its messages to educate people about Zika, its prevention and the risks of microcephaly. Messages will also be incorporated into our ongoing development programs reaching marginalized children, women and families. We will also train our staff and partners in Zika and its prevention. We project that this work will benefit 1.6 million people across these 11 countries. In Phase II, we will concentrate our response in five countries we have prioritized because of the current status of the epidemic and the potential risk for its growth: El Salvador, Honduras, Nicaragua, Colombia and Haiti. We will scale up community awareness work done in Phase 1, distribute personal protection items (bednets and insect repellent), and support Ministries of Health in the prevention of Zika and other mosquito-borne diseases such as dengue and chikungunya. We project that 2.2 million people will directly benefit from work in Phase II. We are urgently seeking a minimum of $2.5 million to quickly scale up these phases and provide critical information and materials to populations at risk of contracting the Zika virus and contributing to its spread. This is especially vital to the region s pregnant women. We are racing against the onset of the rainy season in the region and projections that the number of Zika cases will skyrocket, placing even more pregnant women in danger of becoming infected. Your contribution will help to ensure that we 2
have the resources for direct program activities, for expert staff and for strengthening work with partners, and for the program services that will support our strategy. 1 I. Background and Context The Zika virus is transmitted primarily by Aedes Aegypti mosquitos that bite an infected person and then pass the virus to others. The Aedes mosquito also spreads two other diseases, dengue and chikungunya. Recent outbreaks of these diseases in the Americas attest to the tenacity of these day-biting mosquitos, which thrive in densely-populated environments. The larva can live for months without water and hatch once they become wet. They need only small amounts of water to survive. The Zika illness is usually mild and symptoms may last up to seven days. However, the virus remains in the blood stream for up to 10 days afterwards and some researchers have reportedly found the virus in semen and saliva over two weeks after infection. Possible motherto-child transmission, transmission via blood transfusion and male-to-female sexual transmission have been reported and are under investigation. In May 2015 the first confirmed Zika virus infection in the Americas was identified in Brazil. As of February 25, transmission of the virus was occurring in 52 countries and territories worldwide, according to the WHO. The epicenter of the current outbreak is Brazil, which estimates that there are between 500,000 and 1.5 million cases (it has suspended counting cases given the size of the outbreak). Colombia has the second-largest number of reported cases (over 31,500), and the number of cases reported there has increased each week since October 2015. While Brazil and Colombia represent most of the epidemic in the region to date, the number of Zika cases is also increasing rapidly in El Salvador and Honduras, with over 7,000 and 5,000 cases respectively reported to the Pan American Health Organization. Reporting varies widely across the region, with some countries reporting only confirmed cases and other countries reporting only suspected cases. As only 20 percent of people who are infected show symptoms, there are likely many more individuals who may be potential carriers of the virus. It is estimated that the virus could infect several million people in the Americas who live in the low-lying tropical areas in which Aedes mosquitos thrive. Through February 29, according to the World Health Organization, 31 countries in the Americas had reported cases of the virus. Cases have also been reported in the United States. Zika s Suspected Association with Microcephaly There is deep concern over the suspected association of Zika with microcephaly in newborns. Microcephaly is a serious congenital disorder characterized by small head circumference and associated with a variety of related problems including developmental delay, intellectual disability, feeding problems, hearing loss, vision problems and seizures. Microcephaly can be 1 10 percent of your generous gift goes to helping our emergency team prepare for and provide critical assistance when and where children need us the most. 3
mild or severe and, depending upon its severity, will affect infants ability to thrive and develop. Microcephaly in its most severe form can result in stillbirth or in death of the infant. Evidence that microcephaly and another disorder, Guillain-Barré Syndrome, are linked to Zika virus infection remains circumstantial, but a growing body of clinical and epidemiological data points towards a causal role for Zika virus. 2 Brazil has reported over 5,000 suspected cases of microcephaly, with other cases of microcephaly believed to be associated with Zika in Honduras and Venezuela. In addition to the health and developmental effects, microcephaly places a significant burden of care on impoverished families and communities. Children born with microcephaly will need supportive medical care, as well as specialized early childhood care and will later need support in the educational system. Many countries in the region are ill-prepared to deal with an increase in the number of children with disabilities. Save the Children is especially concerned that many more pregnant women will be exposed to Zika in the coming months, as the Americas region will enter the rainy season soon, leading to an explosion in the mosquito population. While the region generally has relatively high contraceptive prevalence rates, over half (56 percent) of the births in the region are unintended. Fertility among adolescent girls is nearly as high as in Africa, and it is the only region where births to girls under 15 are increasing. Adolescent births represent one out of five births. An increase in cases of Guillain-Barré Syndrome has been reported in Brazil, Colombia, El Salvador, Suriname and Venezuela, as well as in French Polynesia. Guillain-Barre Syndrome is an autoimmune disorder and can affect people of any age and can be extremely debilitating and last for months. II. Save the Children s Response and the Impact of Your Support While a solid causal link between Zika and microcephaly will not be determined with certainty for several more months, there is an urgent consensus among regional health officials that it is imperative to act immediately to reduce transmission of the virus through community engagement and education around mosquito control, personal risk prevention (especially for pregnant women) and prevention of unintended pregnancy. Save the Children is now initiating a regional response strategy with the goal of reducing Zikaassociated microcephaly among newborns through the reduction of Zika transmission. We are mobilizing action in 11 countries in the Americas. 2 The Colombian Minitry of Health, with assistance from WHO and the Centers for Disease Control and Prevention, is conducting a large cohort study with 5,000 women infected by the Zika virus and a comparison group from the same areas to try to determine causality. Births to these women will take place in June 2016. In Brazil, the Ministry of Health and the Centers for Disease Control and Prevention are conducting a retrospective case-control study of 400 microcephaly cases, which may also help identify factors related to transmission. Evidence also includes recent clinical examinations of Zika-infected fetal tissue in fetuses with severe congenital malformations. 4
In all 11 countries, we will conduct community awareness and education around Zika and its prevention. We have prioritized five countries for a more concerted response because they are at higher risk given the large populations living in poverty and in low-lying areas, the difficulty of conducting mosquito control and where health systems can use our support. The situation in Haiti is of special concern, given the many people at risk, the fragility of the health system and the current transitional government. We estimate that there are over 2.2 million people in the places where we currently work who are at high risk of contracting Zika, including women of reproductive age and pregnant women. It is currently the dry season in most of the region, exacerbated by an El Niño-related drought in many areas. When the rains begin in March and April, it is anticipated that mosquito populations will increase, creating a strong potential for a sharp spike in Zika infections. Save the Children s response to the epidemic is oriented toward prevention and is based on our strong network of country offices and partners within the region. Our extensive experience working directly with national and local governments, communities and with community-based partners will enable us to rapidly mount a response effort. We are urgently seeking a minimum of $2.5 million for the two phases of our strategy. Your contribution, pooled with other resources will provide the funds we require for 10 of our Americas country offices to conduct awareness-raising, and for five to scale up this and other work to directly reach at-risk populations. Our specific objectives are to: Strengthen communities and individuals capacity to prevent Zika through community education and mobilization related to mosquito control, personal risk prevention and disease identification and care, with emphasis on pregnant women. Increase access to supplies for mosquito control and personal protection (insect repellent and mosquito nets). Improve knowledge about and referrals for contraceptives to reduce the number of unintended pregnancies among women of reproductive age, especially adolescents, and access to care to ensure that Zika cases are identified and referred appropriately. Enhance the engagement and commitment to the Zika epidemic response among decision makers and communities through advocacy and communications designed to dispel myths and stigma related to the disease. Although it is not one of the central objectives of our Zika response, our efforts to help reduce mosquito-borne transmission should also contribute to a reduction in the transmission of dengue and chikungunya in the region. Both diseases are also spread by the Aedes mosquito and have seen an increase in cases in recent years. Phase I: Eleven Countries, 1.6 Million Projected Beneficiaries In Phase I of our response, we will focus on prevention of the Zika virus through community mobilization and education, as well as mosquito-control messages. This initial phase will be undertaken by 10 Save the Children country offices in the Americas: El Salvador, Bolivia, 5
Guatemala, Ecuador, Nicaragua, Peru, Haiti, Mexico, Colombia, Honduras, and the Dominican Republic. The country offices will receive funds to implement community mobilization and education activities within existing programs or in selected affected areas. A regional communications kit of print materials, radio spots and materials to support training is being developed. This basic kit includes materials for raising awareness within the general population; it also includes specialized materials to be incorporated into ongoing Save the Children programs that reach pregnant women, children ages 6-12 and adolescents. In this phase, support for country offices will be provided to train trainers in the use of the communication materials. Training modules will be developed for our field staff and partners. Trainings will include information on personal risk prevention, sanitation and other vector control measures and reproductive health. The training will focus special attention to counselling and support to pregnant women and their families. Other activities for mosquito control and personal protection will also be funded during Phase 1 in selected countries. The initial implementation of activities focused on special protective measures for risk population will also be part of the first phase. The activities, in particular the community awareness education, are expected to reach approximately 1.6 million beneficiaries in the 11 countries, of whom an estimated 534,000 are women of reproductive age (ages 15 44). Phase 2: Five Countries, 2.2 Million Projected Beneficiaries Save the Children will scale up our initial response in five high-risk countries to reach most-atrisk communities. This scale-up in El Salvador, Honduras, Nicaragua, Colombia and Haiti is aimed to intensify community mobilization and education efforts beyond existing projects. These five countries have been selected based on populations at risk, chikungunya and dengue outbreaks, current status of the Zika epidemic, our operational capacity and our relationships with Ministries of Health. Planned Country-level Responses in Phase 2 Colombia (target beneficiaries: 1 million) Colombia has the most rapidly advancing epidemic in the region. The number of cases has grown exponentially since October 2015 and there are currently over 30,000 suspected cases, including over 5,000 pregnant women who are suspected for being infected with Zika. Save the Children is coordinating with the Ministry of Health in the affected regions (10 municipalities in the region of the Caribbean coast and the Pacific) and is working to assist the Ministry in expanding its community education and mobilization. In addition, we plan to support the Ministry in distributing bednets and repellents, as well as providing sex education to adolescents and working with local partners to increase access to contraception. We plan to refer pregnant women to Ministry-run health centers for prenatal care and ultrasound followup if Zika is suspected. 6
El Salvador (target beneficiaries: 238,000) Most of El Salvador s population of 6.4 million lives in tropical and sub-tropical zones where the Aedes mosquito can be found. The country has had recent outbreaks of dengue and chikunguya and is considered at high risk. Over 7,000 cases of Zika have been reported. Save the Children has extensive health programs in the country and works closely with the Ministry of Health. It has developed a strong response plan, which includes helping municipalities develop prevention plans and community mobilization, including house-to-house visits. We will support the Ministry by training community-level health personnel in Zika prevention activities and mobilizing community volunteers to conduct community clean-up and mosquito control activities. They will also support the government s fumigation efforts. Haiti (target beneficiaries: 200,000) As the poorest nation in the Latin America and Caribbean region, Haiti has a minimal health infrastructure. Although only 330 suspected cases of Zika have been reported to date, the potential for a widespread Zika outbreak is of great concern. A large proportion of the population lives in crowded sub-tropical conditions with inadequate sanitation. The recent cholera epidemic was controlled only with great difficulty, and dengue and chikunguya are endemic. Haiti is also in the middle of a political transition, which is limiting government capacity to respond. Save the Children has met with the World Health Organization and other actors to coordinate actions. We will focus our response on community mobilization and education around controlling mosquitoes, with a strong focus on sanitation. Our staff will also be training community health personnel. Honduras (target beneficiaries: 200,000) Honduras currently has over 4,590 suspected Zika cases. The country has one of the weakest health systems in the region, according to the Pan American Health Organization, and has also experienced recent dengue and chikunguya outbreaks. A large proportion of the population lives in tropical lowlands where the Aedes mosquito can be found. Save the Children has a strong relationship with the government and is planning to provide supplies and materials to the Honduran Ministry of Health, as well as conduct training for community health personnel. We will provide support to the Ministry through the purchase of fumigation equipment and support of transportation costs for fumigation and other mosquito control activities. We also plan to assist in the distribution of bednets and insect repellent to pregnant women and conduct community education and mobilization. Nicaragua (target beneficiaries: 537,500) Many Nicaraguans live in low-lying tropical areas. There have been 66 confirmed cases of Zika. Save the Children has ongoing programs in the areas of Leon and Matagalpa, where dengue and chikunguya have been problematic. We work closely with the Ministry of Health on a largescale rural children s health program and will be supporting the Ministry s Zika prevention efforts, including community sanitation campaigns to eliminate places where mosquitos breed. Our community education and mobilization activities will include house-to-house awareness- 7
raising visits and training of health personnel and community health workers. We also plan to distribute bednets to pregnant women and adolescents. We will make a special effort to reach families of chronically malnourished children, as Zika could be detrimental to children s health. III. Our Distinguishing Difference Save the Children is uniquely positioned to deliver on our commitment to educate large numbers of people in the Americas about Zika, thereby contributing to a reduction in its spread, and to increase pregnant women s protection from the virus and the potential detrimental impact it could have on their children. These key factors differentiate us from others: We are a respected international nongovernmental organization in the countries where we will be working, with expert staff, on-ground resources and relationships with government ministries. Our trained international health experts can be deployed as needed to bolster the work of our national staff. We will have a regional communications package on Zika that our country offices can customize to the local context an efficient use of resources. Our country offices have ongoing programs in which to integrate these key messages. We have pre-positioned bednets in Panama and Nicaragua ready to be distributed. Save the Children has been a member of the region s Risk, Emergency and Disasters Task Force of the Regional Inter-Agency Standing Committee for many years and, through it, works in partnership with other international organizations and UN agencies responding to regional emergencies. We have the capacity to advocate that governments, donors, and communities maintain their commitment to take action to reduce the transmission of Zika; to call for greater reproductive health education; and to call attention to protection issues related to children and adolescents in the epidemic. We are using lessons learned from our large-scale community awareness interventions in West Africa during the recent Ebola outbreak to inform our work in response to this epidemiological emergency. Conclusion As health agencies and those investigating the link between the Zika virus and microcephaly continue their research, Save the Children is heeding the call of health officials in the Americas to act now to help reduce transmission through community engagement and education around mosquito control and personal risk prevention, especially for pregnant women. We have designed and are initiating a two-phased regional response strategy through which we will seek to reach a total of 3.8 million people across 11 countries. Your contribution will accelerate our rolling out and scaling up of this critical work and our ability to help those most at risk avoid acquiring and then transmitting the virus through education, partnerships with health ministries and material support. We are grateful for your generosity. 8