The Buzz on U.S. - Cuba Diplomacy
In an increasingly borderless world with greater speed, further reach and quicker exchange, both old and new diseases have gone global. Unlike the restriction of other undesirables there is no wall to prevent migrating mosquitoes from freely traveling. As a result, the rise in mosquito-borne diseases such as the Zika virus - along with dengue and chikungunya viral infections- has spread rapidly throughout the Americas. The main culprit is the highly resilient aedes aegypti mosquito that has skillfully adapted to environmental changes.
According to the Pan American Health Organization (PAHO), the regional arm of the World Health Organization (WHO), 22 countries and territories in the Americas have reported transmission of the Zika virus since the first locally acquired cases were confirmed in Brazil in May 2015. In the U.S. there are more than thirty confirmed cases of the Zika virus from people who traveled to countries with known transmission, two from Miami-Dade County, and no locally acquired cases identified at this time.
Cuba, however, remains silent.
Cuba’s year of unprecedented drought, impact of natural disasters, and failing infrastructure of deteriorating water, sewage, and housing systems forms a perfect storm for the reality of a mosquito population explosion. This is especially significant since the aedes aegypti mosquito, which can also transmit yellow fever, dengue, chikungunya and Zika virus, resides in Cuba with ongoing dengue transmission.
As of January 28, 2015 Haiti and Dominican Republic report local transmission of the Zika virus, suggesting it is likely to have also reached Cuba. Although we know Cuba still reports no cases of chikungunya which seems highly unlikely since according to PAHO statistics, all countries and territories in the Hispanic Caribbean, other Caribbean, in additional to Central and most South American countries and the United States have reported imported and local transmission occurrences since late 2013. (Refer to map link provided below)
In my research I interviewed people who traveled to communities in Cuba in November 2015. They shared stories of both dengue and cholera in the Santiago de Cuba province, and well beyond the Holguin region where there have been officially reported cases. No one denies that Cuba conducts active surveillance with proactive community strategies to reduce the mosquito population and promote improved hygiene. Nevertheless when someone becomes ill with dengue or cholera, the Cuban government’s false denial is obvious with the use of euphemistic terms such as a febrile illness or gastro intestinal upset.
In an effort to manage global health security the International Health Regulations of the WHO collects and disseminates disease outbreak information and acts on global public health emergencies. In Cuba, notorious for officially failing to report disease outbreaks in a timely manner, information often leaks out through unauthorized health professionals, independent journalists, or travelers returning home with infections. This is both frustrating and unethical since Cuba has a well-developed disease surveillance system with highly skilled health professionals.
So don’t be fooled into believing that no mosquito- borne diseases exist in Cuba just because Center for Disease Control and Prevention (CDC) is no longer posting any travel health notices for this country. CDC depends upon a country’s official reporting to make an appropriate determination on whether to issue a watch, alert or warning for travelers. Even though it is known that there are countries that fail to accurately disclose information for lack of surveillance and laboratory capabilities, fear of trade and/or tourism declines, or as a function of its own internal politics, clearly this policy needs to change if global health security is to be achieved.
Like Cuba, Venezuela presents the same concerns among health professionals and citizens since its government remained silent for months, and now faces criticism for underestimating their Zika epidemic. Venezuela, following Cuba’s lead, has failed to release up-to-date epidemiologic data on disease outbreaks.
The timing could not be more perfect to make health diplomacy part of the U.S.–Cuba’s redefined relationship. This would mean much more than collaborating on research for drug and vaccine development, since it would also require sharing timely information to protect travelers. This is an absolute necessity with U.S. travel to Cuba expected to continue to increase through charter flights, major airlines and cruise ships.
In the meantime, the U.S. government may need to change its policy on travel notices and seek out other sources for a more reliable rapid reporting to protect travelers. Otherwise, the increased travel to Cuba may come back to bite us.
Note: Map Link. PAHO, Chikungunya Countries/Territories with autochthonous transmission or imported cases in the Americas- EW- 2016.http://www.paho.org/hq/index.php?option=com_topics&view= rdmore&cid= 6917& Itemid =40931 & lang=en
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