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The Social Geography of Zika in Brazil

by Richard Meckien - published Jul 27, 2016 11:15 AM - - last modified Jul 29, 2016 04:00 PM
Rights: Original version in Portuguese by Sylvia Miguel.

Jeffrey Lesser
Jeffrey Lesser studies science and social history in the metropolises

Seen as a threat to global health, the Zika virus can be an indicator of the inequality that persists in Brazil, since its impact is greater in poorer areas. The topic has been discussed in the article The Social Geography of Zika in Brazil, by Jeffrey Lesser, a professor at Emory University and visiting professor at the IEA-USP. The article is co-authored by Uriel Kitron, head of the department of environmental sciences at Emory, and has been published in the 48th issue of the NACLA Report on the Americas.

Samuel Candler Dobbs Professor and Chair at Emory's Department of History, Lesser specializes in Brazilian Studies and is the author of several books published in Brazil, including three for which he has won international awards: A Discontented Diaspora: Japanese Brazilians and the Meanings of Ethnic Militancy, 1960–1980 (Duke University Press, 2007; Editora Paz e Terra, 2008), Welcoming the Undesirables: Brazil and the Jewish Question (University of California Press, 1994; Imago Editora, 2005; Tel Aviv University Publishing Projects, 1997) and Negotiating National Identity: Immigrants, Minorities, and the Struggle for Ethnicity in Brazil (Duke University Press, 1999; Editora UNESP, 2001).

While taking a sabbatical year from Emory, Lesser is conducting research on a project entitled Metropolis, Migration and Mosquitoes: Historicizing Health Outcomes in São Paulo, Brazil. His most recent book is Immigration, Ethnicity and National Identity in Brazil (Cambridge University Press, 2013; Editora UNESP, 2015).

Approaches to public health in Brazil, the attitudes of the population on how to contain the mosquito that primarily transmits the Zika virus (Aedes aegypti), government campaigns on the insect and the socioeconomic conditions of the areas that Lesser has visited for his research are some of the topics covered in the article. The analysis combines interdisciplinary methods of history, anthropology and epidemiology, as proposed in the project financed partly by Emory and partly by the IEA-USP.

When São Paulo was still undergoing the impacts of the most critical drought in its history in March 2016, Lesser visited the Capão Redondo neighbourhood in the company of health officials in charge of orienting the population and fumigating possible sources of the mosquito. At that time, most part of the city was supplied by tanker trucks. The problem was that the water stored by families usually ended up turning into breeding sites of mosquito larvae due to very poor storage conditions.

Mosquito Aedes Aegypti
Aedes aegypti is not the only vector of the Zika virus, which causes microcephaly in newborns

According to Lesser, the community residents (with an average monthly income of about two minimum wages and a half) had few resources to repair the water tanks or buy equipment to seal the storage tanks. In a region where most of the civil works is semi-finished and access to basic services such as garbage collection and sewage treatment is irregular or non-existent, the population ends up with an unequal burden to carry.

Poor and pregnant women living in areas where there is an outbreak of fever caused by Zika are also more penalized, both in relation to men and in relation to women who can afford private medical care or even leave the danger zone while pregnant. "Health officials recommend that women at risk areas should prevent pregnancy and avoid sexual intercourse, but generally ignore the men's role in this matter," says the author.

Government campaigns showing "monster mosquitoes" with fangs and bad guy expressions can be "remnants" of educational materials used in the 19th century, as analyzed by Lesser. This type of image has been criticized by experts, since it can lead people to believe that any type of mosquito can be an imminent danger.

Furthermore, the way to conduct mosquito containment campaigns assumes widely paternalistic characteristics, as in the past. The use of the military in public health operations also brings distrust of a population that is used to dealing with the police force especially in confrontational situations. Many people end up seeing health workers as state social agents responsible for monitoring individuals rather than prioritizing the community's health.

A revolta da vacina - charge de Leonidas
"The Vaccine Revolt", by Leonidas, published in the O Malho magazine in 1904

Such approaches of government campaigns and "brigades" against the mosquito resemble the practices of the 19th and early 20th centuries, which led to episodes that culminated in clashes, as the Vaccine Revolt, held against compulsory vaccination for smallpox in Rio de Janeiro in 1904.

Crucial factors for transmission

The concentration of people in poor areas, public health planning by managers attuned to the past century policies and the uneven distribution of water, which makes the poor more dependent on storage in water tanks, are three crucial factors for the transmission of Zika as evidenced in the survey.

These factors show that the geography of inequality in Brazil persists, making the poor more susceptible to a problem that is not new, since the epidemics caused by mosquitoes date back to the "age of discovery" of America, concludes Lesser.

In March, same month of the article's publication, it was discovered that the Culex quinquefasciatus, known as the southern house mosquito, can also transmit the Zika virus, which causes microcephaly and malformations in babies. The discovery of biologist Constância Ayres, from the Fiocruz Pernambuco, has the potential to provide a leap in knowledge about the virus and radically change the Brazilian strategy of prevention, since there are no Culex control strategies in Brazil.

Unlike the Aedes, the Culex is more active at night, which would imply in awareness campaigns on the use of repellents and long clothing also at this period of the day, especially for pregnant women. In addition, the mosquito prefers to lay its eggs in extremely polluted places such as sewers, drains and channels. Thus, basic sanitation measures can be even more urgent to prevent the spread of cases of Zika and microcephaly in more precarious neighbourhoods.