In the past, the only excuse for cancelling the Olympic Games has been a world war (Berlin 1916, Tokyo 1940, London 1944). But if this year's Games had been scheduled for somewhere in West Africa two years ago, when the Ebola outbreak was nearing its peak, they would certainly have been called off. So should the Olympic Games scheduled to begin in Rio de Janeiro on 5 August be cancelled, moved or postponed?
The health risk in Brazil's case is the Zika virus, transmitted by mosquito bites, which appeared in the country two years ago. It causes only a mild fever, if any at all, but it has been linked to a huge increase in the number of cases of microcephaly, in which babies are born with small, underdeveloped brains. Some die; most survive, but with moderate to severe learning difficulties.
The 4,700 cases of microcephaly in Brazil since last October (vs. 150 in all of 2014) suggest that the counntry has a big public health problem, but the Zika virus hardly compares with the Ebola virus, which kills half the people who become infected. Yet 152 health professionals from around the world have now signed an open letter demanding that the Brazil Olympics do not go ahead as scheduled.
The letter, addressed to the World Health Organisation (WHO) and the International Olympic Committee (IOC) and published on Friday, was initiated by Prof. Amir Attaran of the University of Ottawa. "Sports fans who are wealthy enough to visit Rio's Games choose Zika's risks for themselves," he said, "but when some of them return home infected, their fellow citizens bear the risk too."
The WHO and the IOC immediately rejected his proposal, the former pointing out that the Olympic visitors, expected to number between 350,000 and 500,000, are only a small fraction of the 6 million visitors to Brazil each year - and and that 9 million Brazilians, potentially already carrying the Zika virus, travel abroad each year. Why focus specifically on the Olympics?
Because, says Dr. Attaran, the Olympic athletes and tourists will include many people from countries whose citizens would not normally visit Rio. Some of those countries have poor public health services and warm climates, but are still Zikafree: "It cannot possibly help to send a halfmillion travelers into Rio from places that would not normally have strong travel connections with Rio and therefore set up new dissemination channels."
Ah, says WHO, but there should be relatively few mosquitoes in Rio in August, which is midwinter in Brazil. Yes, but dengue fever, which is transmitted by the same mosquitoes, is up this year, says Attaran.
Federal troops are spraying for mosquitoes, and neighborhood health inspectors have been tasked with eliminating standing bodies of water where they are known to breed, says the government. Do you really believe that the Brazilian government is capable of eradicating mosquitoes in Rio even temporarily?, asks anyone who has ever had contact with Brazilian bureaucracy. So the argument goes, back and forth, and it's getting ugly.
Prof. Attaran has even publicly accused the WHO of defending the IOC because the two organisations have officially been in partnership since 2010: "It is ignorant and arrogant for the WHO to march handinhand with the IOC." And there is a lot of money on the table.
The Brazilian government is spending $10 billion on the Olympics and there's another $3 billion at risk in various media and service contracts, very little of which will be covered by insurance if the Games are cancelled. So much of the insistence that all will be well is certainly driven by concern about the money that would be lost.
The risk of spreading the Zika virus to some countries that would probably not otherwise get it until much later is real and relevant, because work is underway on a vaccine and a year or two could make a big difference. But let's be realistic: the Rio Olympics cannot be moved in the time that remains and will not be cancelled or postponed. So what should be done?
Dr. Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University, has the answer: "What is urgently needed is for the international community, led by the WHO, to declare an allout war on the mosquito population in Rio." A concerted, wellfunded effort under close international supervision could reduce that population to near zero, at least for the time that the Olympics last.
That has not yet happened, mainly because it would be humiliating for Brazil to admit that it cannot do it on its own. Given the internal political crisis raging in the country, it will be hard to find a senior politician in Brasilia with the guts to ask for that kind of help. But it's time to go looking for one.