Experts can still sign this letter, please send an email to Zika.Games@uottawa.ca with your title (dr., prof, etc), department and institutions.

zikapic


Open Letter to Dr. Margaret Chan, Director-General, WHO

(Copied to the International Olympic Committee)

We are writing to express our concern about the upcoming Olympic and Paralympic Games in Rio de Janeiro. WHO’s declaration of Zika as a “Public Health Emergency of International Concern,” coupled with new scientific findings that underscore the seriousness of that problem, call for the Rio 2016 Games to be postponed and/or moved to another location—but not cancelled—in the name of public health.1

We make this call despite the widespread fatalism that the Rio 2016 Games are inevitable or “too big to fail”. History teaches this is wrong: the 1916, 1940, and 1944 Olympic Games were not just postponed or moved, but cancelled. Other sporting events were moved because of disease, as Major League Baseball did for Zika, and the Africa Cup of Nations did for Ebola. FIFA moved the 2003 Women’s World Cup from China to the USA because of the SARS epidemic, based on the advice from university-based experts, as many of us are.

Currently, many athletes, delegations, and journalists are struggling with the decision of whether to participate in the Rio 2016 Games. We agree with the U.S. Centers for Disease Control recommendation that workers should “Consider delaying travel to areas with active Zika virus transmission”.2 If that advice were followed uniformly, no athlete would have to choose between risking disease and participating in a competition that many have trained for their whole lives.

But our greater concern is for global health. The Brazilian strain of Zika virus harms health in ways that science has not observed before. An unnecessary risk is posed when 500,000 foreign tourists from all countries attend the Games, potentially acquire that strain, and return home to places where it can become endemic. Should that happen to poor, as-yet unaffected places (e.g., most of South Asia and Africa) the suffering can be great. It is unethical to run the risk, just for Games that could proceed anyway, if postponed and/or moved.

In our view, several new scientific findings require WHO to reconsider its advice on the 2016 Olympic and Paralympic Games. For example:

1. That the Brazilian viral strain causes microcephaly3 and probably Guillain-Barré syndrome4. Further, because human5, animal6 and in vitro studies7 demonstrate that the virus is neurotrophic and causes cell death, it is biologically plausible that there are other as yet undiscovered neurological injuries, as exist for similar viruses (e.g. dengue).8

2. That while Zika’s risk to any single individual is low, the risk to a population is undeniably high. Currently, Brazil’s government reports 120,000 probable Zika cases,9 and 1,300 confirmed cases of microcephaly (with another 3,300 under investigation)10, which is above the historical level of microcephaly.11

3. That Rio de Janeiro is highly affected by Zika. Brazil’s government reports Rio de Janeiro state has the second-highest number of probable Zika cases in the country (32,000) and the fourth-highest incidence rate (195 per 100,000), demonstrating active transmission.8

4. That despite Rio’s new mosquito-killing program, the transmission of mosquito-borne disease has gone up rather than down. While Zika is a new epidemic and lacks historical data, using dengue fever as a proxy, cases in Rio from January thru April 2016 are up 320% and 1150% over the same periods in 2015 and 2014, respectively.12 In the specific neighborhood of the Olympic Park (Barra da Tijuca) there have been more dengue cases in just the first quarter of 2016 than in all of 2015.11

5. That Rio’s health system is so severely weakened as to make a last-minute push against Zika impossible. Recently Rio’s state government declared a health sector emergency,13 and Rio’s city government cut funding against mosquito-borne disease by 20%.14 While the virus is the infectious agent of Zika, its real cause is Rio’s poor social conditions and sanitation—factors that lack a quick fix, and that are not helped when shrinking health resources are diverted to the Games.

6. That it is possible to eradicate the Aedes aegypti mosquito, which transmits Zika, from Rio. Actually that mosquito was totally eradicated from Brazil in the 1950s, but came back after control efforts lapsed.15 Thus holding the Games, in the presence of Zika-carrying mosquitoes, is a choice and not necessary.

7. That one cannot count on nature for defense. While lower mosquito activity during Rio’s winter months reduces the individual risk to travelers of infection, that is partly offset when travelers who became infected return home during the northern hemisphere’s summer months and peak mosquito activity, which increases the public health risk that local mosquitos acquire and spread the virus—meaning that both seasons are relevant to the epidemic’s course.16 Also, infection can spread through blood donations and transfusions, particularly in poor countries that lack screening for Zika.17

In sum, the evidence shows: (i) that Brazil’s Zika virus strain has more serious medical consequences than previously known, (ii) that Rio de Janeiro is one of the most affected parts of Brazil, and (iii) that Rio’s mosquito-killing efforts are not meeting expectations, but rather mosquito-borne disease is up this year. It is therefore imperative that WHO conduct a fresh, evidence-based assessment of Zika and the Games, and its recommendations for travelers.

Because Zika is a new emergency, its many uncertainties—of travel flows during the Games, of epidemiology, and of entomology—currently make it impossible for mathematical models to predict the epidemic’s course accurately. Therefore, for now, any decision about Zika and the Games has to be more qualitative than quantitative. If one considers the following options:

(a) Holding the Games in Rio in 2016 as scheduled;

(b) Holding the Games in Rio at a later date after Zika is controlled, and;

(c) Holding the Games at Zika-free sites having Olympic-standard facilities.

It is indisputable that option (a) of holding the Games as scheduled has a greater risk of accelerating the spread of the Brazilian viral strain than the alternatives. Postponing and/or moving the Games also mitigates other risks brought on by historic turbulence in Brazil’s economy, governance, and society at large—which are not isolated problems, but context that makes the Zika problem all but impossible to solve with the Games fast approaching.

We are concerned that WHO is rejecting these alternatives because of a conflict of interest. Specifically, WHO entered into an official partnership with the International Olympic Committee, in a Memorandum of Understanding that remains secret.18 There is no good reason for WHO not to disclose this Memorandum of Understanding, as is standard practice for conflicts of interest. Not doing so casts doubt on WHO’s neutrality, for reasons described further in the Appendix.

WHO must revisit the question of Zika and postponing and/or moving the Games. Similar to what FIFA did for SARS and the Women’s World Cup, we recommend that WHO convene an independent group to advise it and the IOC in a transparent, evidence-based process in which science, public health, and the spirit of sport come first. Given the public health and ethical consequences, not doing so is irresponsible.


Signatories follow in alphabetical order, and represent individuals, not their institutions.

Authors: Prof. Amir Attaran (University of Ottawa: aattaran@uottawa.ca)
Prof. Arthur Caplan (New York University, USA: arthur.caplan@nyumc.org)
Dr. Christopher Gaffney (University of Zürich: christopher.gaffney@geo.uzh.ch)
Prof. Lee Igel (New York University, USA: lee.igel@nyu.edu)

240 names – 40 countries

1. Prof. Akira Akabayashi, Department of Biomedical Ethics, School of Public Health, The University of Tokyo Faculty of Medicine, Tokyo, Japan

2. Dr. Joseph Alton, MD, FACOG, FACS, obstetrician and medical preparedness expert; Author of The Survival Medicine Handbook and Zika Virus Handbook, USA

3. Prof. Paul S. Appelbaum, Director, Division of Law, Ethics & Psychiatry, Department of Psychiatry, Columbia University, New York, USA

4. Prof. Kwame Anthony Appiah, Department of Philosophy, NYU Law, New York University, New York, USA

5. Prof. Thalia Arawi, Founding Director, Salim El-Hoss Bioethics & Professionalism Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon

6. Prof. Dr. Pedro Arcos, MD, Ph.D., Director, Unit for Research in Emergency and Disaster, Faculty of Medicine and Health Sciences, University of Oviedo Campus del Cristo, Oviedo, Spain

7. Prof. Amir Attaran, School of Epidemiology, Public Health and Community Medicine and Faculty of Law, University of Ottawa, Canada

8. Ms. Stephanie Augustine, Researcher, Department of Maternal Fetal Medicine, North Shore University Hospital, Manhasset, USA

9. Dr. Patricia Almeida Ashley, Associate Professor, Department of Geoenvironmental Analysis, Institute of Geosciences, Universidade Federal Fluminense, Niteroi, Rio de Janeiro State, Brazil

10. Dr. Pejman Azarmina, Senior Medical Director, CardioDx Inc., California, USA

11. Prof. Robert Baker, PhD, William D. Professor of Philosophy & Director of Ethics Across the Curriculum, Union College, Schenectady, New York

12. Dr. Behnoush Bakhtiari, DDS, Research Assistant at the University of Washington, USA

13. Prof. Francis Barany, Dept. of Microbiology & Immunology, Weil Cornell Medicine, New York, USA

14. Prof. Robert Bass, PhD, Adjunct Associate Professor, Department of Philosophy, University of North Carolina at Pembroke, USA

15. Dr. Alison Bateman-House, Division of Medical Ethics, Department of Population Health, New York University School of Medicine, New York, USA

16. Prof. Dr. Alexander Batthyany, Cognitive Science Program, Dept. of Philosophy, University of Vienna, Austria

17. Prof. Frances Batzer, Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, USA

18. Prof. Angelica M. Baylon, External Relations Director, Maritime Academy of Asia, Kamaya Point, Philippines

19. Mr. Andy Beckmann, Biologist, CEO, German Pest Control Association, Germany

20. Dr. Namiranian Behdad, MD, Our Lady of Fatima University, College of Medicine, Philippines

21. Prof. Solly Benatar, Founding Director, University of Cape Town Bioethics Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa 22. Prof. Cecilia Benoit, Centre for Addictions Research of British Columbia, Department of Sociology, University of Victoria, Victoria, Canada

23. Mr. Edward J. Bergman, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

24. Prof. Kenneth Berkowitz, Department of Population Health and Department of Medicine, School of Medicine, New York University, New York, USA

25. Prof. Ivy Lynn Bourgeault, Canadian Institutes of Health Research Chair in Gender, Work and Health Human Resources Telfer School of Management, University of Ottawa, Ottawa, Canada

26. Prof. Marie A. Bragg, Department of Population Health, New York University School of

Medicine, New York, USA

27. Dr. Joe Brierley, Consultant Critical Care & Bioethics, Great Ormond St Hospital, London, UK; President of the European Society of Paediatric and Neonatal Intensive Care, UK

28. Dr Berit Bringedal, Senior Researcher, Institute for Studies of the Medical Profession, Oslo, Norway

29. Prof. Amy Brown, Maria Fareri Children’s Hospital at Westchester Medical Center, Department of Pediatrics, New York Medical College, Valhalla, USA

30. Prof. Arthur L. Caplan, Division of Medical Ethics, New York University Langone Medical Center, New York, USA

31. Dr. Susan O. Cassidy, MD, JD Founder, CriticalMD, Florida, USA.

32. Dr. Rhyddhi Chakraborty, Researcher, Philosophical Bioethics, Global Public Health and Social Justice, American University of Sovereign Nations, USA.

33. Prof. Theeraphap Chareonviriyaphap, Department of Entomology, Kasetsart University, Bangkok, Thailand

34. Dr. Wiboon Chongrattanameteekul, Associate Professor, Department of Entomology, Kasetsart University, Bangkok, Thailand

35. Prof. Cheryl Cline, Office of Bioethics, Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Canada.

36. Dr. Wayne Conlan, Principal Research Officer, Vaccines Program, National Research Council, Canada

37. Dr. Catherine Constable, Instructor, Department of Medicine, New York University Langone Medical Center, New York, USA

38. Prof. Glenn Cohen, Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics, Harvard Law School, Cambridge, USA

39. Prof. Aleksandar Damjanovic, Clinic for Psychiatry, Clinical Center of Belgrade, Serbia

40. Dr. Aimée Dechter, Ph.D., Research Coordinator, Department of Sociology, University of Washington, USA

41. Prof. Patrick Derr, Chair, Department of Philosophy, Clark University, Worcester, USA

42. Prof. Débora Diniz, Faculty of Law, Universidade de Brasília, and Bioethics Program, FIOCRUZ, Brasília and Rio de Janeiro, Brazil

43. Prof. Ames Dhai, Director, Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

44. Dr. Hasan Erbay, MD. PhD., Department of Medical Ethics and History of Medicine, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey

45. Dr. Ferenc Falus, MD, Forer Chief Medical Officer (CMO) of Hungary, Hungary

46. Prof. Eric Feldman, Health Policy and Medical Ethics, University of Pennsylvania Law

School, Philadelphia, USA

47. Dr. Holly Fernandez-Lynch, Executive Director, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics, Harvard University, USA

48. Prof. Juan Ramon Fernandez Torres, Professor of Administrative Law, Universidad Complutense of Madrid, Spanish solicitor, Madrid, Spain

49. Prof. Dennis V. Ferrero, International Public Health Consultant, University of the Pacific, Department of Biological Sciences, California, USA

50. Prof. Chris Feudtner, Department of Pediatrics and Department of Medical Ethics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA

51. Ms. Anna Fiastro; MPH, Master of Environmental Management (MEM); Social and Behavioral Science Yale School of Public Health, Yale School of Forestry and Environmental Studies; Yale University, USA

52. Prof. Donald Forthal, Professor of Medicine and Molecular Biology & Biochemistry Chief, Infectious Diseases, University of California, Irvine, USA

53. Prof. Samuel R Friedman, PhD, Director, Institute of Infectious Disease Research, National Development and Research Institutes, New York, USA

54. Dr. Christopher Gaffney, Department of Geography, University of Zürich, Zürich, Switzerland

55. Dr. Javier Gomez Garcia Yanes, PhD, Molecular Biologist and Immunologist, Freelance Science Writer and Reporter, Madrid, Spain

56. Prof. William Gardner, Children’s Hospital of Eastern Ontario Research Institute, Faculty of Medicine, University of Ottawa, Ottawa, Canada

57. Prof. Robert P. George, McCormick Professor of Jurisprudence, Princeton University, Princeton, USA

58. Dr. Karena Ghaus, Academic Research Fellow, Neonatal Medicine Imperial College, UK

59. Prof. Grover Gilmore, Dean, Applied Social Sciences, Case Western Reserve University, Cleveland, USA

60. Miguel Górgolas, MD, MSc, DTM&H, PhD, División of Infectious Diseases, FJD. Autonomous University of Madrid, Spain

61. Prof. Moti Gorin, Director, Jann Benson Ethics Center, Colorado State University, USA

62. Prof. Linda Granowetter, Department of Pediatrics, New York University Langone Medical Center, New York, USA

63. Dr. Michele Grundstein, Board Certified Family Physician, Plantation, Florida, former assistant professor of medicine University of Miami Miller School of Medicine and Medical Director of Miami Dade Fire Fighter Wellness Center, USA

64. Dr. Sigurdur Gudmundsson, MD, Ph.D., Former Medical Director of Health (Surgeon General) in Iceland; Former Dean of the School of Academic Health Sciences, University of Iceland; Professor of Medicine, University of Iceland; Consultant in Infectious Diseases, University Hospital, Reykjavik, Iceland

65. Prof. Abhik Gupta, Ph.D., Professor and Dean, School of Environmental Sciences, Assam (Central) University, Silchar, India.

66. Prof. Sally Guttmacher, College of Global Public Health, New York University, New York, USA

67. Prof. Negin Hajizadeh, Department of Medicine, Hofstra Northwell School of Medicine, Hofstra University, Hempstead, USA.

68. Mr. George Halvorson, Chief Executive (Retired) Kaiser Permanente, and Chair, InterGroup Understanding, Sausalito, USA

69. Prof. Deborah S. Hamm, Department of Psychiatry, Columbia University Medical Center, New York, USA

70. Prof. Samuel K. Handelman, Assistant Professor (Research), Department of Molecular Virology, Immunology & Medical Genetics, Ohio State University Wexner Medical Center, USA

71. Prof. Alice Herb, Division of Humanities in Medicine at State University of New York, Downstate Medical Center, New York, USA

72. Mr. Robert L Hirsch, Ph.D., Hirsch BioPharma Consulting, LLC, USA

73. Prof. Brian Hjelle, M.D., Dept. Of Pathology, University of New Mexico Health Sciences Center, Albuquerque, USA

74. Dr. David Hoke, Attending Physician, Department of Emergency Medicine, Union Hospital, Elkton, MD, USA

75. Prof. Søren Holm, Centre for Social Ethics and Policy, School of Law, University of Manchester, UK

76. Prof. Dr. Praparat Hormchan, Dept. of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok, Thailand

77. Prof. Lee H. Igel, Tisch Institute for Sports Management, Media, and Business, New York University, New York, USA

78. Prof. Judy Illes, Canada Research Chair in Neuroethics, Department of Medicine, University of British Columbia, Vancouver, Canada

79. Prof. Rosario Isasi, MPH, Research Assistant Professor, Dr. John T. Macdonald Foundation, Department of Human Genetics, Institute for Bioethics and Health Policy, John P. Hussman Institute for Human Genomics, Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, USA

80. Dr. Mahmood-uz- Jahan, M.D., PhD., Director, Bangladesh Medical Research Council, Dhaka, Bangladesh

81. Prof. Dale Jamieson, Chair, Department of Environmental Studies, New York University, New York, USA

82. Prof. Yeremias Jena, M. Phil., M.Sc, Professor of Medical Ethics at Atma Jaya School of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.

83. Prof. Steven Joffe, Vice-Chair, Department of Medical Ethics and Health Policy, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA

84. Prof. Ken Johnson, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Canada

85. Prof. Nora Jones, Associate Director, Center for Bioethics, Urban Health and Policy, Lewis Katz School of Medicine, Temple University, Philadelphia, USA

86. Prof. Therese Jones, Associate Director, Center for Bioethics and Humanities, Director, Arts and Humanities in Healthcare Program, University of Colorado Anschutz Medical Campus, Denver, USA

87. Prof. Jernej Jorgačevski, PhD, University of Ljubljana, Faculty of Medicine, Institute of Pathophysiology, Slovenia

88. Prof. Matthias A. Karajannis, Division of Pediatric Hematology/Oncology, New York University Langone Medical Center, New York, USA

89. Prof. Douglas I. Katz, Department of Neurology, Boston University School of Medicine, Braintree, USA

90. Prof. Ralph V. Katz, Professor of Epidemiology, Fellow of the American College of Epidemiology F.A.C.E.), and Founding Chair, Department of Epidemiology and Health Promotion, New York University, New York, USA

91. Ms. Lisa Kearns, Research Associate, Division of Medical Ethics, New York University Langone Medical Center, New York, USA

92. Prof. Fazlollah Keshavarzi, PharmD, MPharm Lecturer, Clinical Pharmacy Department, Faculty of Pharmacutical Sciences, UCSI University Kuala Lumpur, Malaysia

93. Prof. Aaron Seth Kesselheim, Division of Pharmacoepidemiology & Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, USA

94. Dr. Abbas Kharabi, University of Malaya, Kuala Lumpur, Malaysia

95. Dr. Erwin Khoo Jiayuan, Department of Paediatrics, School of Medicine, International, Medical University, Kuala Lumpur, Malaysia

96. Dr. Azarmindokht Khosravi, MD, City of Hope National Medical Center, California, USA

97. Dr. Armin Khosravi, Dental Branch of Isfahan Azad University, Oral and Maxillofacial Surgery Department, Iran

98. Dr. Jörn Klein, Associate Professor, University of Southeast-Norway, Norway

99. Dr. Robert Klitzman, Professor of Psychiatry, Director, Masters of Bioethics Program Columbia University, New York, USA

100. Prof. Craig Klugman, Chair, Department of Health Sciences, DePaul University, Chicago, USA

101. Prof. Georgy Koentges, Ph.D., Laboratory of Systems Biomedicine and Evolution, School of Life Sciences, University of Warwick, UK

102. Prof. Adam Kolber, Center for Health, Science, and Public Policy, Brooklyn Law School, Brooklyn, USA

103. Prof. Craig Konnoth, Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania Law School, Philadelphia, USA

104. Prof. Ralph A. Korpman, School of Medicine, Loma Linda University School of Medicine, Loma Linda, USA

105. Dr. Ronald L. Krall, Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, USA

106. Prof. Sheldon Krimsky, Department of Urban and Environmental Policy & Planning, Department of Health and Community Medicine, Tufts University, Boston, USA

107. Dr. Andrew R. Lai, MD, MPH, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California, USA

108. Dr. Sara Landolt, Department of Geography, University of Zürich, Zurich, Switzerland

109. Prof. John Lantos, Director of Pediatric Bioethics, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, USA

110. Prof. John Last, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada

111. Prof. Stephen Latham, Director, Interdisciplinary Center for Bioethics, Yale University, New Haven, USA

112. Dr. Carole Lieberman, M.D., Psychiatrist and Author, Clinical Faculty of the Neuropsychiatric Institute of UCLA, USA.

113. Dr. Thuy Le, Oxford University Clinical Research Unit, Oxford University, Ho Chi Minh City, Vietnam

114. Prof. Arthur Leader, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Canada

115. Mr. Leonard leBlanc, Research Fellow, Eubios Ethics Institute, Japan

116. Prof. Trudo Lemmens, Scholl Chair in Health Law and Policy, Faculty of Law, University of Toronto, Toronto, Canada

117. Prof. Betty Wolder Levin, School of Public Health and Health Policy, City University of New York, New York, USA

118. Prof. Bruce Levin, Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA

119. Ms. Guiomar Levi-Setti, Geneva Academy of International Humanitarian Law and Human Rights, Geneva, Switzerland

120. Prof. Ariane Lewis, Department of Neurology and Department of Neurosurgery, New York University Langone Medical Center, New York, USA

121. Dr. Ana Lita, Director, Global Bioethics Initiative, New York, USA

122. Prof. Julian Little, Director, School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada

123. Prof. Sergio Litewka, Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, USA

124. Prof. Alex John London, Director, Center for Ethics and Policy, Carnegie Mellon University, Pittsburgh, USA

125. Prof. Samuel R. Lucas, Department of Sociology, University of California-Berkeley, USA; Faculty Affiliate, Institute for Research on Poverty, University of Wisconsin-Madison, USA

126. Prof. Darryl Macer, Ph.D., Hon.D. President, American University of Sovereign Nations, Arizona, USA; Director, Eubios Ethics Institute, Christchurch, New Zealand

127. Prof. Tim Mackey, Director, Global Health Policy Institute, Department of Anaesthesology and Public Health, University of California at San Diego, San Diego, USA

128. Prof. Ruth Macklin, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Yeshiva University, New York, USA.

129. Prof. Cheryl Macpherson, Bioethics Department, St George’s University School of Medicine, True Blue, Grenada

130. Dr. Charles J. Macri, MD, Obstetrician Gynecologist, Charles J. Macri Clinic, Washington, USA

131. Prof. Sonia Malik, PhD, Universidade Federal do Maranhão, Centro de Ciências da Saúde, Brazil

132. Prof. Brian Martin, Director, Graduate Program in Public Health, Eastern Virginia Medical School, Old Dominion University, Norfolk, USA

133. Dr. Jan Marzinek, Department of Biological Sciences, National University of Singapore,

134. Prof. Raymond Sanchez Mayers, Ph.D., Associate Professor, Director, Latino/a Initiatives for Service, Training, and Assessment (LISTA), Rutgers University School of Social Work, New Jersey, USA

135. Prof. Thomas Mayo, Southern Methodist University Dedman School of Law, University of Texas Southwestern Medical School, Dallas, USA

136. Mr. Michael Mawadri, Emergency Coordinator with Action for Development (AFOD) in South Sudan, South Sudan

137. Dr. Meghan May, Associate Professor of Microbiology and Infectious Diseases, University of New England College of Medicine, USA

138. Prof. James McCartney (Reverend, Order of St. Augustine), Department of Philosophy, Villanova University, Villanova, USA

139. Prof. Martin McKee, MD, Founding Director of the European Centre on Health of Societies in Transition; Research Director of the European Observatory on Health Systems and Policies; London School of Hygiene and Tropical Medicine, London, UK

140. Prof. John Merz, Department of Medical Ethics & Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA

141. Jennifer Miller, PhD., Department of Population Health. NYU School of Medicine; President, Bioethics International, New York, USA

142. Mr. Alan Milstein, Sports Attorney, Sherman, Silverstein, Kohl, Rose & Podolsky, Moorestown, USA

143. Prof. Christine Mitchell, Executive Director, Center for Bioethics, Harvard Medical School, Boston, USA

144. Prof. Salimeh Pour Mohammad, PhD, Researcher in System Studies, University of Hull, UK

145. Dr. Hadi Mohseni, MD, MRCPCH(UK), Baylor-Malawi Paediatric Mentorship Program, Zomba, Malawi

146. Prof. Jonathan D. Moreno, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

147. Prof. Dr. Martin Müller, Department of Geography, University of Zürich, Zurich, Switzerland

148. Prof. Carin Muhr, Department of Medical Science, Uppsala University, Uppsala, Sweden

149. Prof. Christian Munthe, Professor of Practical Philosophy, Department of Philosophy, Linguisics and Theory of Science, University of Gothenburg, Sweden

150. Dr. Frederick Naftolin, M.D., Professor of Obstetrics and Gynecology and Environmental Medicine, Director, Reproductive Biology Research, New York, USA

151. Dr. Itamar Netzer, Department of Gynecology and Obstetrics, Rambam Healthcare Campus, Israel

152. Prof. Anna Nolan, Department of Environmental Medicine , Department of Medicine, New York University Langone Medical Center, New York, USA

153. Dr. Sean O’Donnell, JD, MPH, PhD, Department of the History of Science, Harvard University, Cambridge, USA

154. Prof. Stjepan Oreskovic, Andrija Stampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia

155. Prof. Jesus Ricardo Parra Unda, Facultad de Ciencias Químico Biológicas, Universidad Autonoma de Sinaloa, México

156. Prof. Brendan Parent, Division of Medical Ethics and Co-Director NYU Sports and Society Program, New York University, New York, USA

157. Prof. Shamina Parvin Lasker, Head of Department of Anatomy, Samorita Medical College; Secretary General, Bangladesh Bioethics Society, Dhaka, Bangladesh.

158. Dr. Eva Patalas, Clinical Associate in Pathology, Massachusetts General Hospital, Boston, USA

159. Prof. Pasquale Patrizio, Division of Reproductive Endocrinology & Infertility, Yale School of Medicine, New Haven, Connecticut, USA

160. Prof. André F. Pilon, Associate Professor at the School of Public Health, University of São Paulo, Brazil

161. Prof. Sean Philpott-Jones, Department of Bioethics, Clarkson University, Schenectady, NY

162. Dr. Carolyn Plunkett, Division of Medical Ethics, New York University Langone Medical Center, New York, USA

163. Dr. Catherine Pound, Assistant Professor of Pediatrics, University of Ottawa; Consulting Paediatrician, Children’s Hospital of Eastern Ontario, Canada

164. Prof. Stephen G. Post, Department of Family, Population & Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, USA

165. Dr. Maja Potokar, Research Fellow, University of Ljubljana, Faculty of Medicine, Slovenia

166. Prof. Kathleen Powderly, Director, John Conley Division of Medical Ethics and Humanities, SUNY Downstate Medical Center, Brooklyn, USA

167. Prof. Duncan Purves, Environmental Studies and Bioethics, New York University, New York, USA

168. Prof. Vojin Rakic, Founding Director, Center for the Study of Bioethics, Head of the European Division of the UNESCO Chair in Bioethics, University of Belgrade, Serbia

169. Prof. Dina Reveh, Ph.D., Professor (emerita) of Genetics, Department of Life Sciences, Ben Gurion University of the Negev, Beersheba, Israel

170. Prof. Vardit Ravitsky, School of Public Health, Université de Montréal, Montreal, Canada

171. Elliot J. Rayfield, MD, Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, USA.

172. Prof. Avad Raz, Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Be’er-Sheva, Israel

173. Dr. Mary Redmond, MD FRCSC, GenSurg CVT Surg, Chronic Pain Management Specialist, Ottawa, Canada

174. Prof Kathleen Reeves, Director, Center for Bioethics, Urban Health, and Policy, Lewis Katz School of Medicine, Temple University, Philadelphia, USA

175. Prof. Michael Ristow, M.D., Professor of Energy Metabolism, ETH Zurich (Swiss Federal Institute of Technology), Switzerland

176. Prof. Donald R. Roberts, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, USA

177. Dr. Philip Rubin, Principal Assistant Director (Retired), Office of Science and Technology Policy (OSTP), Executive Office of the President of the United States, New Haven, USA

178. Prof William Ruddick, Founding Director, Center for Bioethics, New York University, New York, USA

179. Prof. Sergio Ponce-de-Leon, Teaching Director, Instituto Nacional De Ciencias Medicas Y Nutricion, Mexico

180. Prof. Maya Sabatello, Department of Psychiatry, Columbia University, New York, USA

181. Dr. Mojgan Saleuhipour, Faculty of Biomedicine, South Baylo University, CA, USA

182. Prof. Judit Sandor, Director of the Center for Ethics and Law in Biomedicine, Central European University, Budapest, Hungary

183. Prof. Pamela L. Sankar, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

184. Prof. Arthur Schaefer, Founding Director, Centre for Professional and Applied Ethics, University of Manitoba, Canada

185. Prof. Doris Schroeder, Centre for Professional Ethics, College of Health, University of Central Lancashire, UK

186. Prof. Udo Schuklenk, Ontario Research Chair in Bioethics, Department of Philosophy, Queen’s University, Kingston, Canada

187. Prof. Evan Selinger, Department of Philosophy, Rochester Institute of Technology, Rochester, USA

188. Dr. M. Selvanayagam, Professor, Dean of Research and President of India Association of Bioethics, India

189. Prof. Seema K. Shah, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA

190. Dr. Lucio Sibilia, già Docente di Psichiatria e di Psicologia Clinica – Sapienza Università di Roma; Presidente della Società Italiana di Medicina Psicosociale (SIMPS), Rome, Italy

191. Prof. William S. Silvers, University of Colorado Denver School of Medicine, Denver, USA

192. Prof. Peter Singer, University Center for Human Values, Princeton University, Princeton, USA; and School of Historical and Philosophical Studies, University of Melbourne, Melbourne, Australia

193. Dr Amar-Singh HSS, Senior Consultant Paediatrician, Head Paediatric Department, Hospital RPB Ipoh, Perak, Head Clinical Research Center Perak, Malaysia

194. Prof. Maria Fiatarone Singh, Chair of Exercise and Sport Science, Faculty of Health Sciences, Sydney Medical School, University of Sydney, Australia

195. Prof. Dominic A. Sisti, Ph.D., Director, The Scattergood Program for Applied Ethics of Behavioral Health Care; Assistant Professor, Department of Medical Ethics & Health Policy, Perelman School of Medicine at the University of Pennsylvania, USA

196. Dr. Urska Sivka, Post-Doctoral Researcher, Omega D.O.O., Slovenia

197. Prof. Daniel Skinner, Assistant Professor of Health Policy, Department of Social Medicine, Ohio University, Dublin, USA

198. Raquel R. Smith, Ph.D., Prof. Of Clinical Psychology, American University of Sovereign Nations, Arizona, USA; Community Emergency Response Team (FEMA) Instructor and Manager

199. Prof. Robert Smith?, Department of Mathematics and Faculty of Medicine, University of Ottawa, Ottawa, Canada

200. Prof. Jeremy Snyder, Faculty of Health Science, Simon Fraser University, Burnaby, Canada

201. Prof. Robert W. Snyder, Esq. Attorney at Law, Professor of Healthcare Management and Finance, American University of Sovereign Nations School of Medicine, USA

202. Prof. Alissa Spielberg, JD, MPH, Women’s & Gender Studies, Wellesley College, United State

203. Dr. Thomas H. Steinberg, Ph.D., Courtesy Research Associate, Institute of Molecular Biology, University of Oregon, USA

204. Prof. Martin Strosberg, Bioethics Program of Clarkson University & The Icahn School of Medicine at Mount Sinai, Schenectady, USA

205. Prof. Eileen Sullivan-Marx, Dean, School of Nursing, New York University, New York, USA

206. Norman K. Swazo, Ph.D., M.H.S.A., Professor of Philosophy and Public Health, School of Humanities & Social Sciences, School of Health and Life Sciences, North South University, Dhaka, Bangladesh

207. Prof. Zbigniew Szawarski, The National Institute of Public Health, Warszawa, Poland

208. Prof. Leonore Tiefer, Ph.D., Department of Psychiatry, NYU School of Medicine, New York, USA

209. Dr. Mitra Tavakoli, Senior Lecturer in Medicine University of Exeter, Medical School Exeter, UK

210. Prof. Edwin van Teijlingen, Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK

211. Prof. Henk ten Have, Director, Center for Healthcare Ethics, Duquesne University, Pittsburgh, USA

212. Dr. Jordan Tesluk, Postdoctoral Fellow, National Core for Neuroethics, Department of Sociology, University of British Columbia, Canada

213. Dr. Tatsuhito Tonooka, Former Director of Health, Otaru Care Center, Otaru, Japan

214. Ms. Ananya Tritipthumrongchok, General Manager, International Peace and Development Ethics Centre, Kaeng Krachan, Thailand

215. Prof. Duunjian Tsai, M.D., Ph.D., Professor, Taipei Medical University, Taiwan

216. Dr. Johan Ullman, M.D., Anaesthesiology & Intensive Care, and Occupational Medicine, Navy Medical Officer (res) Sweden

217. Prof. Connie Ulrich, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, USA

218. Prof. Erick Valdés, Universisad del Desarrollo, Chile

219. Prof. Robert M. Veatch, Kennedy Institute of Ethics, Georgetown University, Washington DC, USA

220. Prof. J. David Velleman, Professor of Philosophy and Bioethics, New York University, New York, USA

221. Dr. Andreas Vilhelmsson, Department of Clinical Sciences Division of Social Medicine and Global Health, Lund University, Sweden

222. Dr. Ford Vox, Brain Injury Medicine, Shepherd Center, Atlanta, USA

223. Dr. Gary I. Wadler, Past Chairman, World Anti-Doping Agency (WADA) Prohibited List Committee, Recipient of the International Olympic Committee’s President’s Prize in 1993, Manhasset, USA

224. Prof. Maria Wanderleya de Lavor Coriolano Marinus Professor collaborator Of Pos graduation program Health Child and Adolescent, Federal University Of Pernambuco, Brazil

225. Prof. Jeanette Ward, Ph.D., Adjunct Professor, Nulungu Research Institute, Broome, WA, Notre Dame University, Australia

226. Mr. Wendell Wallach, Lecturer, Yale Interdisciplinary Center for Bioethics, New Haven, USA

227. Dr. Juan N Walterspiel, MD, FAAP, Pediatric Locum Ukaia Valley Medical Center, CA, USA

228. Dr. Nacy Walton, Associate Professor at the School of Nursing, Ryerson University, Toronto, Canada

229. Prof. Vivian Welch, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada

230. Prof. Bruce Wilcox, Faculty of Public Health, Mahidol University, Bangkok, Thailand

231. Prof. Benjamin Wilfond, Director, Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Department of Pediatrics, University of Washington, Seattle, USA

232. Prof. Bryn Williams-Jones, PhD, Professeur titulaire / Full Professor, Director; Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal; Editor in Chief, BioéthiqueOnline, Montreal, Canada

233. Dr. Chris Willmott, Department of Molecular & Cell Biology, University of Leicester, UK

234. Dr. Loren Wissner Greene, MD MA (Bioethics), Clinical Professor of Medicine (Endocrinology) and ObGyn, Associate Faculty of Division of Medical Ethics and NYU Center for Bioethics, New York, USA

235. Prof. Wendy L. Wobeser, Division of Infectious Diseases, Queen’s University, Kingston, Canada

236. Prof. Paul Root Wolpe, Asa Griggs Candler Professor of Bioethics and Director, Center for Ethics, Emory University, Atlanta, USA

237. Dr. Elizabeth Wrigley-Field, Robert Wood Johnson Foundation Health and Society Scholar, Columbia University; Assistant Professor, Sociology, University of Minnesota, USA

238. Prof. Sanni Yaya, School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada.

239. Prof. Boris Yudin, Department of Humanitarian Expertise and Bioethics, Institute of Philosophy, Russian Academy of Sciences, Moscow, Russia

240. Dr. Diana Zuckerman, President, National Center for Health Research, Washington DC, USA

 

 


Appendix: WHO and IOC in Partnership

WHO has a decades-long, high-level partnership with the International Olympic Committee. That partnership was last affirmed in 2010 at an event where the Director General of WHO and President of the IOC signed a Memorandum of Understanding, which is secret because neither has disclosed it.17

Inappropriately, WHO sees its role as not just providing public health advice. It established a “Virtual Interdisciplinary Advisory Group”, whose “important promotional point,” according to WHO is “that the Group can help in bidding for major events (like the Olympic Games)”.19 That is a clear conflict of interest, when WHO must also evaluate and make recommendations about Olympic travel during a Public Health Emergency of International Concern (PHEIC).

The overly close relationship between WHO and the IOC is apparent in the comments of WHO’s Executive Director responsible for Zika, just days after it was declared a PHIEC:

“Brazil is going to have a fantastic Olympics and it’s going to be a successful Olympics and the world is going to go there. I just wish I was going there, but there’s not going to be a lot of problems there by then.”20

With respect, this is a troubling statement. WHO cannot credibly assess the public health risks of Zika and the Olympics when it sets neutrality aside. Declaring that “it’s going to be a successful Olympics and the world is going to be there” implies that WHO has given the Olympics an unconditional green light, without regard to rapidly emerging medical, entomological, and epidemiological evidence—all of which must be considered in assessing whether this mass gathering could accelerate the global spread of the Brazilian strain of Zika virus. To prejudge that “there’s not going to be a lot of problems” before reviewing this evidence is extremely inappropriate of WHO, and suggests that a change in leadership may be required to restore WHO’s credibility.


REFERENCES

1. FIFA, “SARS: FIFA executive decides to relocate FIFA Women’s World Cup 2003,” press release of May 3, 2003. Available at: http://www.fifa.com/news/y=2003/m=5/news=sars-fifa-executive-decides-relocate-fifa-women-world-cup-2003-87152.html.

2. Centers for Disease Control and Prevention, “CDC and OSHA Issue Interim Guidance for Protecting Workers from Occupational Exposure to Zika Virus”, April 22, 2016. Available at: http://www.cdc.gov/media/releases/2016/s0422-interim-guidance-zika.html.

3. Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika Virus and Birth Defects — Reviewing the Evidence for Causality. NEJM 2016; DOI: 10.1056/NEJMsr1604338.

4. Cao-Lormeau V-M, Blake A, Mons S, et al. Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet 2016; 387:1531-39.

5. Mlakar J, Korva M, Tul N, et al. Zika virus associated with microcephaly. NEJM 2016; 374:951-58.

6. Cugola FR, Fernandes IR, Russo FB, et al. The Brazilian Zika virus strain causes birth defects in experimental models. Nature 2016; DOI:10.1038/nature18296. See also Miner JJ, Cao B, Govero J, et al, Zika Virus Infection during Pregnancy in Mice Causes Placental Damage and Fetal Demise. Cell 2016;165:1081-91.

7. Garcez PP, Loiola EC, Madeiro da Costa R, et al. Zika virus impairs growth in human neurospheres and brain organoids. Science 2016; DOI: 10.1126/science.aaf6116. See also Tang H, Hammack C, Ogden SC, et al. Zika Virus Infects Human Cortical Neural Progenitors and Attenuates Their Growth. Cell Stem Cell 2016; 18(5):587-90.

8. Carod-Artal FJ, Wichmann O, Farrar J, Gascón J. Neurological complications of dengue virus infection. Lancet Neurology 2013;12(9): 906-19.

9. Ministério da Saúde, Secretaria de Vigilância em Saúde. Boletim Epidemiológico 2016;47(20). Available at http://portalsaude.saude.gov.br/images/pdf/2016/maio/17/2016-016—Dengue-SE16-publica—-o.pdf.

10. Ministério da Saúde. Informe Epidemiólogico #26/2016: Monitoramento dos dos de microcefalia no Brasil. Available at http://portalsaude.saude.gov.br/images/pdf/2016/maio/18/Informe-Epidemiol–gico-n—26–SE-19-2016–16mai2016-19h00.pdf.

11. Ministério da Saúde. Ministério divulga boletim epidemiológico sobre microcefalia. Available at http://portalsaude.saude.gov.br/index.php/o-ministerio/principal/secretarias/svs/noticias-svs/20929-ministerio-divulga-boletim-epidemiologico-sobre-microcefalia.

12. The Prefeitura da Cidade do Rio de Janeiro publishes monthly datasets of dengue by neighbourhood at http://www.rio.rj.gov.br/web/sms/exibeconteudo?id=2815389.

13. Agence France Presse, “Rio governor declares health sector emergency ahead of Olympics”, December 24, 2015. Available at http://sports.yahoo.com/news/rio-governor-declares-health-sector-emergency-ahead-olympics-183710439–oly.html.

14. Carina Bacelar, “Ministro da Saúde diz que não há expectativa para aumentar recursos da area” O Globo May 13, 2016. Available at http://oglobo.globo.com/rio/verba-para-combate-dengue-caiu-20-de-2014-para-2015-19243518.

15. Severo OP. Eradication of the Aëdes aegypti mosquito from the Americas. (1955). Yellow fever, a symposium in commemoration of Carlos Juan Finlay, 1955. Paper 6. Available at http://jdc.jefferson.edu/yellow_fever_symposium/6.

16. Messina JP, Kraemer MUG, Brady OJ, et al. Mapping global environmental suitability for Zika virus. eLife 2016;10.7554/eLife.15272. See also Monaghan AJ, Morin CW, Steinhoff D, et al. On the Seasonal Occurrence and Abundance of the Zika Virus Vector Mosquito Aedes Aegypti in the Contiguous United States. PLoS Currents Outbreaks 2016; doi: 10.1371/currents.outbreaks.50dfc7f46798675fc63e7d7da563da76.

17. Musso D, Stramer SL, et al. Zika virus: a new challenge for blood transfusion. Lancet 2016;387:1993-4.

18. WHO. WHO and the International Olympic Committee sign agreement to improve healthy lifestyles. July 21, 2010. Available at http://www.who.int/mediacentre/news/releases/2010/ioc_20100721/en/.

19. WHO. Global Forum on Mass Gatherings. Rome, Italy, 26-29 October 2009. Available at http://apps.who.int/iris/bitstream/10665/70616/1/WHO_HSE_GAR_SIH_2011.1_eng.pdf.

20. Tribune news services, “Zika virus will be ‘way down’ before Rio hosts Olympics, U.N. predicts” Chicago Tribune, February 19, 2016. Available at http://www.chicagotribune.com/news/nationworld/ct-zika-olympics-brazil-20160219-story.html


To sign this letter, please send an email to zika.games@uottawa.ca with your title (dr, prof, etc), department and institutions.

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