Brazil and the Zika virus: Symptom of a greater ill

Earlier this month, I was in Brazil for two weeks, and one thing really caught me off-guard: Unless I prompted them, no one mentioned the Zika virus. And the only evidence of any public campaign I saw about the epidemic was a sign in a bus-stop shelter that read simply, "One mosquito is not stronger than an entire country."

What? No panic? I know back home in Minnesota you were reading screaming headlines about athletes dropping out of the Olympics and a continent filled with mosquito fears. But it was different in what we think of as ground zero for the Zika virus.

I was in Brazil to attend the 22nd International Union for Health Promotion and Education World Congress. I was excited to return to the country where I had studied abroad for six months in college and to observe and learn about the realities of the troublesome triad affecting Brazil: Zika, the Olympics and corruption.

Believe me, Zika is not Brazilians' biggest worry.

There are at least two reasons why this is the case — and why I was not afraid to get Zika. In the first place, it's winter in Brazil, and there are barely any mosquitoes in the central and southern regions. Vector-borne diseases disproportionately affect the poor, who dwell or work in areas with inadequate water, sanitation and air.

Second, as I spoke to Brazilians throughout my trip — health care professionals, cabdrivers, store owners and friends — I began to understand the problems in Brazil as a pyramid rather than a triad.

At the very broad base is rampant political corruption that has resulted in a leadership crisis and the misallocation of funds.

This was no surprise: If you've ever lived in Brazil, you've come to expect frequent civic demonstrations. But I saw none about Zika.

As a Brazilian Ministry of Health administrator told me: "Zika is not just a health problem — it is an environmental and social problem. It is an infrastructure problem. The government is using Zika as an excuse to cut other areas of public health funding."

One of my cabdrivers explained that "mosquitoes already carry dengue and chikungunya — Zika is the least of our worries."

In fact, Zika is a symptom of their worries. In the eyes of many, Zika is an outcome of poor public infrastructure, and it is less symptomatic than other mosquito-borne fevers. Rather than focusing solely on health education and vector control, it may prove fruitful to tackle infrastructure issues such as water and sanitation.

As you move up that pyramid, the combination of political corruption, economic crisis and the threat of Zika has many people concerned about the 2016 Summer Olympics. As I drove through Rio de Janeiro, construction for the beach volleyball stadium was just beginning, even as the Olympics were barely two months away. There's good reason to worry that Rio won't be ready for the Olympics; for Brazilians, the expected 500,000 visitors won't compare with the million who came for soccer's World Cup in 2014 or who visit for the annual Carnaval. As for Zika, most Olympic tourists will stay in neighborhoods with adequate infrastructure and low incidence of Zika.

But, frankly, the Brazilians I talked to were not all that concerned about the Olympics or Zika. When I asked about the source of their anxieties, almost everyone answered that it's the political situation and its impact on access to health, education and economic opportunity. While some hope that the current Temer administration is better for business, many see its policies as a threat to public institutions. Students are afraid of losing their university scholarships. Citizens fear that the public health system will be dismantled altogether. This is especially concerning given that at least 1.4 million Brazilians who have lost their jobs and private health insurance will be entering the already-underfunded and -underresourced public health system.

What I learned is that the rampant spread of Zika and even Olympic unpreparedness are not anywhere near the top of Brazilians' list of worries. Rather, they are symptoms of a greater ill in the Brazilian government. The Brazilian people know this, and I got the sense that they are ready to act.