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# WHO sets out $56m Zika virus response plan BMJ 2016; 352 (Published 18 February 2016) Cite this as: BMJ 2016;352:i1042 1. Michael McCarthy 1. Seattle The World Health Organisation (WHO) released a report on 16 February outlining its$56m (£39m; $50m) strategic plan to respond to the ongoing outbreaks of Zika virus disease in the Americas. The plan provides a framework for WHO and its partner organizations’ Zika response through to June.1 The mosquito-borne virus, first detected in the western hemisphere in 2014, is now reported to be circulating in 26 countries and territories in Latin America and the Caribbean. Of particular concern are reports linking Zika virus infection to fetal and newborn microcephaly and serious neurologic complications such as Guillain-Barré syndrome. WHO declared the outbreak in the Americas to be a public health emergency of international concern on 1 February. In the new report WHO’s director general, Margaret Chan, noted that in the past Zika virus had been associated with generally mild disease and had been limited to a relatively small geographic area. “The situation today is dramatically different,” she said. “Last year the virus was detected in the Americas, where it is now spreading explosively. Possible links with neurologic complications and birth malformations have rapidly changed the risk profile of Zika from a mild threat to one of very serious proportions.” Brazilian authorities estimate that there have been between 500 000 and 1 500 000 cases of Zika virus disease since the virus was first detected in the country early last year, and up to late January there had been 4180 reported cases of microcephaly, when the annual average has been 163 a year. Of these reported cases, 270 have been confirmed, 462 have been discarded, and 3448 are still under investigation. In only six of the 270 confirmed cases has there been evidence of Zika virus infection, however, and a causal link between the infection and microcephaly has not been established. Other countries with current outbreaks have not reported a similar surge in reports of microcephaly. In its strategic plan WHO said that its efforts would have three main areas of focus: investigation of the outbreak; response to the outbreak; and accelerated research, including the fast tracked development of diagnostics, vaccines, and treatments. An estimated$7.1m will be dedicated to ramping up surveillance efforts to provide more accurate information about Zika virus disease, neurologic syndromes, and congenital malformation. Gaps in laboratory capacity for Zika virus testing in countries affected will be bridged, through provision of laboratory support, materials, reagents, and training. Guidance will be developed on effective surveillance strategies for Zika virus, microcephaly, Guillain-Barré syndrome, and other neurologic syndromes.

Response efforts outlined in the report include support for programs to communicate the risks associated with Zika virus disease to the population in an effort to minimize risks through promoting protective behaviour and mosquito control measures. Funds will also be directed to helping healthcare facilities cope with increased volumes of patients and to developing guidance for the management of women who are pregnant or of childbearing age and for the management of families with children affected by the virus.

Research funds will be directed towards investigating the causes of microcephaly and neurologic syndromes that have been associated with the outbreak and to establishing how long the Zika virus stays alive in body fluids other than blood, such as semen, and the risks of transmission sexually and from mothers to children. An emergency research and development plan has been drawn up to guide research and development of diagnostics, vaccines, and potential antiviral prophylaxis or therapeutics. Support for research into novel means of vector control will also be supported, including “under strictly controlled conditions,” the use of transgenic mosquitoes, slow release insecticide formulations, and insect growth regulators.

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