Lancet – For Rio 2016, the XXXI Olympics taking place from Aug 5–21 and Paralympics from Sept 7–18, the sporting activity cannot start soon enough. Even by Olympic standards, there has been unprecedented controversy in the lead-up to the games: the Russian doping scandal, Brazil’s economic difficulties, pollution in Rio’s Guanabara Bay, and in a media-fuelled furore concerning Zika virus.
Zika virus has dominated global health and international media coverage this year, after WHO declared the Zika virus epidemic a Public Health Emergency of International Concern 6 months ago (reassessed in a World Report this week). Rio 2016 has therefore been the focus of global health attention ever since. WHO, the US Centers for Disease Control and Prevention, and the Pan-American Health Association, among others, have all issued guidelines for Olympic competitors and to the anticipated 500 000 visitors to the games to mitigate the risk of Zika virus transmission: pregnant women are advised to avoid travelling to the games; visitors are advised to use mosquito repellents and to cover up where possible; and safe sex messaging is being clearly promoted (up to 8 weeks after the games for asymptomatic individuals, or for 6 months if Zika virus disease symptoms have developed).
In a letter in The Lancet published on June 17, Brazilian scientists estimate Zika virus transmission in Rio during August as around one to three per 100 000, suggesting that there could be up to 15 possible Zika cases resulting from attendance at the games. There remains some legitimate concern about the possibility of Zika virus being exported from Rio to vulnerable regions of Africa. But overall, there would seem to be a general consensus that Zika virus, while clearly devastating in its potential to cause microcephaly in pregnancy, does not represent a public health threat at the Olympics.
However, opposition to Rio 2016 because of a perceived Zika virus threat has been resonating in the media for weeks. On May 20, 150 physicians, bioethicists, and public health “experts” published anopen letter to WHO Director-General Margaret Chan in The Washington Post, calling for the Olympics to be postponed. One of the signatories, the lawyer Amir Attaran, from the Institute for Epidemiology and Population Health at the University of Ottawa, Canada, has been leading this movement, most recently in a colourful letter published last week in response to an Editorial in the June issue of The Lancet Infectious Diseases. Attaran criticised the Editorial for its “erroneous reasoning” in suggesting that Zika virus posed little threat, a position he says would “endorse a monstrous externalisation of risk, with indifference and inequity”.
Attaran has pursued important and legitimate issues of human rights and bioethics in the past, several of which have been highlighted in this journal. But Attaran’s latest stance has helped to stoke fear and create exagerated international headlines. Let us repeat: the best available evidence indicates that, with appropriate precautions, Zika virus poses no serious public health danger to those taking part in or attending the Olympics. Furthermore, postponing Rio 2016 would have had a negative effect on Brazil’s economy, with an impact more damaging to the country’s public health system than Zika virus. Media coverage of Zika virus and the Olympics has taken the spotlight away from more important concerns about global health security, including the potential of mass migration to reignite recently halted measles and rubella transmission in Brazil, and to trigger the spread of influenza from Brazil to other countries. Brazil, not long ago an emerging economic powerhouse, has an economy in crisis, compounding well known weaknesses in its sanitation system, which makes water-borne infections a threat to Rio’s visitors and an ongoing health threat to millions of Brazilians long after the Olympics and Paralympics have left town.
Rio, like London in 2012 and every Olympic city before that, will be evaluated for the legacy the games will leave on its host city and nation. For Brazil this should include the impact of the games on a fragile public health system. But, more optimistically, there is an obvious yet often overlooked benefit that the Olympics can bring every 4 years—translating the power of sporting achievement into increased physical activity and health worldwide. This is easy to say, and difficult to achieve, as highlighted in ‘s second Series on this subject, launched on July 28. This Series describes a global pandemic of inactivity and rightly views the global shop window of the Olympics as an opportunity (not a threat) for public health. Consequently, now is the time to halt the misguided Olympics-Zika virus bandwagon, and to get behind Rio 2016, and Brazil.