Carta aberta à Dra. Margareth Chan, Diretora-Geral da Organização Mundial de Saúde

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Carta aberta à Dra. Margareth Chan, Diretora-Geral da Organização Mundial de Saúde

(Copiada ao Comitê Olímpico Internacional)

Carta aberta à Dra. Margareth Chan, Diretora-Geral da Organização Mundial de Saúde (Copiada ao Comitê Olímpico Internacional)

Escrevemos para expressar nossa preocupação com a realização dos Jogos Olímpicos e Paraolímpicos na Cidade do Rio de Janeiro. A declaração da OMS sobre o Zika ser “uma emergência de saúde pública de proporção internacional”, aliada às recentes descobertas científicas que acentuam a seriedade do problema, clama – não pelo cancelamento – mas por um adiamento e/ou transferência da Cidade sede dos Jogos Olímpicos do Rio em nome da saúde pública global.

Nós fazemos essa chamada apesar do fatalismo mundialmente divulgado com a informação de que os Jogos do Rio 2016 são inevitáveis ou “grandes demais para falhar”. A historia nos ensina que essa perspectiva é equivocada: os Jogos de 1916, 1940, e 1944 não foram apenas adiados, mas cancelados. Além disso, outros eventos foram transferidos por causa de doenças, como a Liga Profissional de Beisbol (EUA) em decorrência do Zika, e a Copa das Nações Africanas em decorrência do Ebola.

Atualmente, muitos atletas, delegações, e jornalistas estão se confrontando com o dilema sobre participar ou não dos Jogos Jogos Olímpicos Rio 2016. Nós concordamos com a recomendação do Centro de Controle de Doenças dos EUA, na qual trabalhadores e turistas deveriam “considerar adiar viagens às áreas endêmicas de transmissão pelo vírus Zika” 1. Se este conselho fosse seguido universalmente, nenhum atleta teria que escolher entre o risco da infecção e a participação numa competição para qual muitos treinaram suas vidas inteiras.

No entanto, nossa maior preocupação é com a saúde pública global. Os danos à saúde causados pela cepa brasileira nunca foram antes observados pela comunidade científica. Um risco desnecessário é imposto a 500.000 turistas estrangeiros do mundo inteiro que assistirão aos jogos e que potencialmente serão infectados por uma cepa particular e retornarão a locais que podem ser tornar endêmicos. Se isto acontecer, por exemplo, em países pobres ainda não afetados (i.e., Sul da Ásia e África) o sofrimento pode ser tremendo. ConsiderAmos antiético correr esse risco, já que os Jogos poderiam facilmente acontecer da mesma forma se fossem adiados ou transferidos.

Em nossa opinião, as novas descobertas cientificas exigem que a OMS reconsidere suas recomendações para os Jogos Olímpicos e Paraolímpicos do Rio 2016. Por exemplo:

1. A cepa Brasileira do Zika causa microcefalia2 e é provavelmente associado à síndrome de Guillian-Barré3. Além disso, estudos em seres humanos4, animais5 e in vitro6 indicam que o vírus é neurotrófico e causa a morte celular. Nesse sentido é biologicamente plausível a possibilidade de outros perigos neurológicos, como aqueles existentes em viroses semelhantes como, por exemplo, a dengue. 7

2. Embora o risco do vírus Zika ser considerado baixo para indivíduos, o risco para a população é indubitavelmente alto. Atualmente, o governo brasileiro já identificou 120.000 casos prováveis de infecção por Zika, 8 e 1.300 casos confirmados de microcefalia (e ainda 3.300 casos sob investigação) 9; estes números estão acima dos níveis históricos de casos de microcefalia notificados no Brasil.10

3. O Rio de Janeiro é uma cidade altamente impactada pelo Zika. O governo brasileiro notificou o estado do Rio de Janeiro como o segundo em maior índice de casos prováveis de infeção por vírus Zika no país (32.000) e o quarto maior índice de incidência (195 por 100.000 habitantes) viii.

4. Embora exista no Rio de Janeiro um programa para controle do mosquito, os casos de doenças transmitidas pelo vetor aumentaram em vez de diminuir. Se empregarmos a dengue como um proxy, dado que a epidemia do zika é fato recente e há ausência de dados históricos, casos no Rio de Janeiro entre Janeiro 2016 e Abril 2016 já subiram 320% e 1150% comparando com os mesmo períodos de 2015 e 2014 respectivamente. 11 No bairro em que se localiza o Parque Olímpico (Barra da Tijuca) foram notificados no primeiro semestre de 2016 mais casos de dengue que na totalidade do ano 2015. xi

5. O sistema de saúde pública do Rio de Janeiro é tão frágil que um esforço emergencial contra o Zika seria impossível. No final de 2015, o governo do estado do Rio de Janeiro declarou um estado de emergência12 na saúde pública e o governo municipal cortou em 20% o orçamento contra doenças causadas pelo mosquito vetor. 13 Embora o mosquito Aedes Aegypti seja o agente infeccioso, a precária condição sanitária e social de muitos bairros cariocas são suas causas reais – fatores que não serão solucionados em curto prazo e cujas condições se deterioram quando recursos já escassos são redirecionados para a realização dos Jogos Olímpicos.

6. É possível erradicar do Rio de Janeiro o Aedes Aegypti, mosquito transmissor do vírus Zika. Na verdade, este mosquito já foi eliminado do Brasil na década de 1950, no entanto, retornou após negligência na política de controle do vetor. 14 Desse modo, realizar os Jogos durante uma epidemia em pleno florescimento é uma escolha e não uma necessidade.

7. A defesa para a realização dos Jogos não pode contar com a natureza. Embora a atividade dos mosquitos – e em consequência o risco de infecção – seja mais baixo durante o inverno carioca, o baixo risco de infecção será parcialmente compensado quando os viajantes infectados retornarem para o hemisfério norte durante o verão, na qual há um pico na atividade dos mosquitos. Portanto, ambas estações são relevantes para que a epidemia se alastre. 15 Além disso, infecções podem ser transmitidas através de transfusões e doações de sangue, particularmente em países onde não há técnicas laboratoriais para identificação do vírus Zika. 16

Em resumo, a evidência demonstra que (i) a cepa brasileira do vírus Zika tem consequências médicas mais graves que anteriormente conhecidas (ii) que o Rio de Janeiro é um dos lugares mais afetados do Brasil, (iii) os esforços de monitoramento e erradicação no Rio não estão atingindo suas metas, ao contrário, a taxa de notificação de doenças transmitidas pelo mosquito vetor tem aumentado no último ano. Então, é imprescindível que a OMS conduza uma nova pesquisa baseada em evidências que tratem do Zika, Jogos Olímpicos e suas recomendações para visitantes e residentes.

O Zika se trata de uma nova emergência em saúde pública, por isso ainda há muitas incertezas – sobre os fluxos de viagens durante os Jogos, sobre epidemiologia e entomologia – fazendo com que atualmente seja impossível, para modelos matemáticos, prever com precisão o curso da epidemia. Nesse sentido, qualquer decisão a ser tomada nesse momento sobre o Zika e os Jogos devem ser mais qualitativos que quantitativos. Se considerarmos seguirmos as seguintes opções:

a) A realização dos Jogos Rio 2016 como programado;

b) A realização dos Jogos Rio 2016 após a epidemia do Zika estar sob controle;

c) A realização dos Jogos Rio 2016 em locais livres da epidemia e com infraestrutura adequada.

A opção (a) sem sombra de dúvidas tem a maior chance de acelerar a propagação da cepa brasileira da Zika quando comparada com as demais alternativas. Adiar e/ou transferir a cidade sede dos Jogos também mitigaria outros riscos ocasionados pela turbulência histórica na economia, política e sociedade brasileira – esses não são problemas isolados, mas contextos que dificultam a resolução do problema da Zika em curto prazo.

Estamos preocupados, pois a OMS rejeita essas alternativas por um conflito de interesse. A OMS se tornou oficialmente parceira do Comitê Olímpico Internacional quando assinaram um Memorando de Entendimento que permanece em sigilo. 17 Entendemos que não há razão para que a OMS quebre o sigilo deste documento, como é uma prática comum em casos de conflito de interesse. Mas, esse é um acordo sigiloso, e por isso, surgem dúvidas sobre a neutralidade da OMS por razoes explicadas em forma mais completa no apêndice.

A OMS deve reconsiderar o problema do Zika para o adiamento e/ou transferência dos Jogos. Recomendamos que a OMS convoque um grupo independente para assessorá-la, bem como que haja transparência nas decisões do COI. As provas produzidas pela ciência, a saúde pública e o espírito esportivo devem vir em primeiro lugar. Dada as consequências éticas e de saúde pública, não fazê-lo seria irresponsável.

As assinaturas estão em ordem alfabética e representa indivíduos, e não instituições.

Apêndice e referências estão localizadas no fim do documento.

Autores: 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)

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

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

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

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

5. 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

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

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

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

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

10. Prof. Robert Baker, Bioethics Program of Clarkson University & The Icahn School of Medicine at Mount Sinai, Schenectady, USA

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

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

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

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

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

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

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

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

19. Prof. Solly Benatar, Founding Director, University of Cape Town Bioethics Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa 20. Prof. Cecilia Benoit, Centre for Addictions Research of British Columbia, Department of Sociology, University of Victoria, Victoria, Canada

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

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

23. 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

24. Prof. Marie A. Bragg, Department of Population Health, New York University School of Medicine, New York, USA

25. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

44. Prof. Eric Feldman, Health Policy and Medical Ethics, University of Pennsylvania Law School, Philadelphia, USA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

59. 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

60. 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

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

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

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

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

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

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

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

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

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

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

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

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

73. 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

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

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

76. 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.

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

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

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

80. 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

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

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

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

84. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

124. 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

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

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

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

128. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

157. 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

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

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

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

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

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

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

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

165. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

181. 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

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

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

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

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

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

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

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

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

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

191. 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

207. 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

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

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

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

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

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

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

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

215. 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

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

217. 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

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

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

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

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

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

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


Apêndice: Parceria entre OMS e COI

A OMS mantém há décadas uma parceria de alto nível com o Comitê Olímpico Internacional. Em 2010, quando a parceria foi reafirmada, o Diretor Geral da OMS e o Presidente do COI assinaram um Memorando de Entendimento secreto, pois nenhuma das partes revelou seu conteúdo. 18

Inadequadamente, a OMS não vê o seu papel apenas como o de promover aconselhamento em saúde pública. Também estabeleceu um “Grupo Consultivo Interdisciplinar Virtual”, cujo “importante ponto a promover”, segundo a OMS é “que o Grupo pode ajudar na licitação de grandes eventos (como os Jogos Olímpicos)”. 19 Este pode ser considerado um claro conflito de interesses, pois a OMS deve também avaliar e fazer recomendações sobre viagens olímpicas durante uma emergência de saúde pública de importância internacional (PHIEC).

O relacionamento estreito entre a OMS e o COI é evidente nos comentários do Diretor Executivo da OMS responsável pela Zika, poucos dias depois de ter sido declarado uma PHIEC:

“O Brasil vai ter um fantástico e bem-sucedido Jogos Olímpicos, e o mundo está indo para lá. Meu desejo era estar lá, mas não haverá muitos problemas”.20

Esta é uma declaração preocupante. A OMS não pode avaliar com credibilidade os riscos de saúde pública associados ao Zika e Jogos Olímpicos quando a neutralidade é deixada de lado. A declaração “vai ser uma Olimpíada bem-sucedidas e o mundo vai estar lá” implica que a OMS tem dado aos Jogos Olímpicos um sinal verde incondicional. No entanto, sem levar em conta as evidências médicas, entomológicas e epidemiológicas que rapidamente emergem e dos quais devem ser consideradas para avaliar se este evento em massa poderia acelerar a disseminação global da cepa brasileira do vírus Zika. Assim, antecipar que “não haverá muitos problemas” antes de rever as evidências torna-se uma conduta extremamente inadequada por parte da OMS, e sugere que uma mudança na liderança pode ser necessária para restaurar sua credibilidade.


REFERÊNCIAS

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3 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.

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11 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.

12 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.

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17 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/.

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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.