Zika (12 page)

She had long followed environmentalists' efforts to get Roundup banned or labeled as a carcinogen, she said, and Monsanto was fighting back with “bullying” tactics, such as suing Hawaiian farmers who complained about its genetically modified seeds blowing into their fields.

Northeast Brazil, she said, had huge sugarcane and soybean fields where Roundup was used, “and I keep wondering whether the virus is being blamed for something that is actually being caused by the pesticide, which would really suit Monsanto.”

Her hope, she ended, was that “the
Times
starts paying as much attention to the dangers of Roundup as it does to the dangers of a new virus.”

Roundup also raised the GMO bogeyman because it worked differently from earlier herbicides. Like them, it killed broad-leaved plants, including most weeds, but did not kill plants genetically modified to resist it. Farmers using it had to buy Monsanto's “Roundup Ready” (meaning Roundup-resistant) seeds, creating a dependency that environmentalists found especially pernicious.

But the argument's weakness was that Roundup had been used all over America and much of the world since 1974 without triggering anything like what was happening in Brazil. Like all agricultural chemicals, it can be toxic at high enough doses. Farmworkers must take precautions, such as wearing gloves and not inhaling the spray mist.

But it had been sprayed on millions of acres for decades. Also, the Brazil victims were generally not workers on the giant farms of the northeast. They were students, ice-cream sellers, masons, bakery cashiers. Actually, many of them were residents of urban slums, where there was no space to grow anything and not an ounce of Roundup for miles around.

When I mentioned to Dyan Summers, the nurse-practitioner, that I was reporting this rumor, she burst out laughing. She has a twangy, sardonic way of wise-cracking that sounds like a young Dolly Parton. “My dad was a Roundup salesman,” she said. “He used to come home reeking of the stuff. And I may be a little trailer park, but I am
definitely
not microcephalic.”

The rumor about a larvicide came from a different source, though the Monsanto specter was raised again. It started when a group of Argentine doctors calling themselves the Physicians in the Crop-Sprayed Towns released a “report” blaming pyriproxyfen, a chemical that Brazil had been spraying into drinking water since 2014 to fight dengue. The report called Sumitomo, the Japanese chemical giant that made pyriproxyfen, among dozens of other products, a “Monsanto subsidiary,” which it is not, although the two companies had collaborated on some research in the past.

Mark Ruffalo, an actor most famous for playing Dr. Bruce Banner and his alter ego the Hulk in
Avengers
movies, and also an environmental activist, was one of those who retweeted the Argentine report, helping it go viral.

Unlike some mosquitoes, female
Aedes
mosquitoes prefer to lay their eggs in clean water. (That may be how they got to the New World from Africa, by laying eggs in the drinking water stored on slave ships.)

It was true that some Brazilian states and cities had used pyriproxyfen for months or years to fight dengue, and that they sprayed it, or dropped pellets of it, into drinking water—into big holding tanks on hilltops and into personal rain barrels at the end of roof downspouts.

But pyriproxyfen is registered as safe for exactly that purpose. It's a chemical mimic of an insect hormone that signals larvae to stop growing. Insect hormones generally don't hurt humans, and vice versa. Creatures with internal skeletons, like us, diverged from exoskeleton creatures so long ago in the evolutionary past that each evolved different sets of signaling proteins. Bugs and humans both have legs, but they get very different chemical signals. That's why children in the American South in the 1950s could chase spray trucks, playing in the sweet-smelling clouds of DDT, while bugs flying through them instantly went into spasms and died twitching. DDT mimics the chemical that tells insect muscles to contract.

Moreover, local Brazilian officials said, some cities with microcephaly didn't use pyriproxyfen. They used alternatives like temefos, or they used nothing. And some cities that did use pyriproxyfen had no microcephaly.

Also, pyriproxyfen had been used in the United States since 2001. Under brand names like Nylar, Sentry, and Flee, it is still sold as a dog and cat flea treatment and as an antiflea carpet spray. For 15 years, American babies have been crawling in it and putting their hands in their mouths.

The rumors blaming it on vaccines were routine. The antivaccine lobby is a constant presence and blames almost everything on them. Vaccine opposition is sometimes mistakenly assumed to have begun with the rumors about measles vaccine and the wave of autism that began in the 1980s. Actually, it goes back centuries. When Dr. Edward Jenner, sometimes considered the father of vaccines, published the results of his 1796 experiments, many respectable doctors were repulsed. He had stuck a lancet into a blister on the hand of a milkmaid with cowpox—a mild infection of the udder that humans can catch—took out some of the pus and pierced the arm of a young boy named James Phipps, deliberately giving him cowpox. After James recovered from cowpox, Jenner deliberately exposed him to smallpox, and he didn't get sick.

Jenner's discovery stands as a medical milestone, but in those days, most people still believed diseases were caused by bad air or an imbalance of humors. The “germ theory”—that disease was caused by creatures too small to be seen—was new, counterintuitive, and controversial, and many people rejected it. And the idea of deliberately sticking diseased pus into a child offended many average people, including many clergy, who railed against it as disgusting in itself and as defiance of God's will.

Blaming vaccines has become so routine that those rumors largely fell on deaf ears this time. There was no evidence that Brazil had bought bad rubella vaccine, because there had been no rubella outbreak nine months earlier. It was true that Brazil had relatively recently introduced a new diphtheria/tetanus/pertussis shot. But that was a change many countries, including the United States, had made years before. The new “acellular” component—made from broken-up pertussis bacteria instead of weakened whole-cell bacteria—was developed because the old vaccine had been blamed for occasionally causing seizures. It had nothing to do with microcephaly.

The rumor that it was all just an overcount was the tough one.

I'm not sure how it started—probably among scientists in Brazil, because some of them, even at the Cruz Foundation, definitely believed it.

I heard it first from Jeffrey R. Powell, a highly respected Yale professor of evolutionary biology who, among other pursuits, studies the genetics of
Aedes
mosquitoes. His lab did research in Brazil and had just shifted its focus to include Zika.

On January 28, he sent Simon Romero and me a draft op-ed piece he had written arguing that the microcephaly epidemic was a fiction.

The editors had declined it, he said, but he thought we might be interested in his thinking.

It was clearly a scientist's work, concise and packed with evidence. It noted that the virus had been in Africa and Asia for decades, apparently without ever causing a microcephaly surge. It noted that Zika antibody tests were unreliable in anyone who had had dengue or yellow fever, which many Brazilians had. And its core tenet was that the Brazilian health ministry had, in the middle of its counting process, expanded its definition of a microcephalic head from one of 32 centimeters or less in diameter to one of 33 centimeters or less.

“This change in definition,” he wrote, “increases by five-fold what is classified as microcephaly.” His piece ended, “If we are lucky, in a year or so we may look back and conclude that the panic now occurring, most acutely in Brazil, was not warranted.”

If he was right, Simon and I and the
New York Times
would look pretty stupid. We had been featuring the epidemic on the front page for a month, pushing it harder than other media outlets.

Even when they turned something down, the op-ed editors sometimes mentioned provocative ideas like that to newsroom editors. Also, submissions they rejected on occasion ended up in the
Wall Street Journal
or elsewhere. One way or the other, I was going to get quizzed about this.

A month earlier, when I'd started on the story, I'd read all the PAHO reports. I thought I remembered reading that Brazil's health ministry had changed its definition in mid-investigation. But what I remembered was that it had been changed in the
opposite
direction.

I dug through old reports until I found what I remembered, and sent Dr. Powell a note: “Unless I am misreading this WHO/PAHO page, the change in definition of microcephaly that Brazil made last December was in the opposite direction: Previously, newborns with heads less than 33 centimeters were considered microcephalic, now they must be below 32 cm. Normally, that would mean that far fewer children would be found to be microcephalic, no?”

Dr. Powell's first reply was that it contradicted what he had heard from Brazil, and he wanted to double-check. He later wrote back saying, graciously, “Well, seems I was wrong, and I thank you very much, Donald, for correcting me.”

But it didn't end there. Wherever it had begun, the rumor was off and running. I was actually in California at the time, seeing my stepmother, who was declining from bone marrow disease, and then taking a break by driving down the coast. I was harder than usual for the desk to reach.

Then, on February 3, Brazil released the results of its first analysis of thousands of reported microcephaly cases. Another colleague in Brazil, Vinod Sreeharsha, covered it.

The results looked pretty damning:

Since the previous October, 4,783 cases of microcephaly had been reported.

The health ministry had thus far investigated 1,113 of them.

Of those, only 404 had been confirmed as microcephaly.

Of those 404, only 17 had tested positive for the Zika virus.

One might easily conclude that the skeptics were right: it was all a miscount.

I emailed Vinod. He was unhappy—his usual beat was business and political stories and, as a stringer, he lacked clout with the desk. Editors had read the report and worried that the earlier rumor was right. He had felt pressured to be cautious and emphasize the possibility that Brazil had overreported cases. Other news outlets were being even more emphatic in saying the numbers implied it might all be a mistake.

Vinod had explained—correctly—how Brazil had tightened its microcephaly definition and had quoted both a Brazilian and an American expert calling that a medically sound decision. But those paragraphs were down near the end of the story, after a lot of copy stating an overcount was possible. Overall, the story served as a brief for the doubters.

The headline emphasized the skepticism: “Birth Defects in Brazil May Be Overreported Amid Zika Fears.”

The next morning, Dr. Powell wrote me again, saying the article was exactly what he had suspected. Ambiguous microcephaly definitions and bad testing, he said, had “conflated to set off the whole hullabaloo.”

And that was where things stood, for a while. The data was the data. The WHO had declared a global emergency just two days before. If the skeptics were right, it too would look foolish.

But I was sure the microcephaly was real, for one simple reason: in order to believe it was just a counting error, one had to assume that all the neonatal intensive care clinicians in at least four cities in Brazil's northeast were mistaken. In interviews that Simon and Sabrina had sent, and many others I'd read, they had all said the same thing: For years they had been seeing at most two or three microcephalic babies a year. Now they were caring for a dozen at a time in their wards. No neonatal specialist just fails to notice a deformed head. Also, the babies in the pictures didn't have heads just a centimeter or two below normal. They were truly tiny, and there were many pictures of them.

In retrospect, the Brazilian health ministry may have erred in reporting the results of its investigation so early. It was a public relations disaster. The ministry was opting for transparency, but the small percentage of confirmed cases and tiny number with detectable Zika virus made it look as if the agency had cried wolf.

A couple of weeks later, the ministry compounded its PR problems when it stopped reporting the number of unconfirmed cases. It made the change in an effort to squelch the rumors, but it looked like a cover-up.

Since then, the confirmed count has climbed to over 1,400.

It was no doubt true that Brazil had historically underreported microcephaly. With a population of 200 million people, it reported an average of 163 a year. In Europe and the United States, prevalence rates were at least two and maybe four times higher, depending on what definition of microcephaly you used.

Even so, that didn't come close to accounting for what had happened. Northeast Brazil, which is more sparsely populated than the south, normally reported 40 cases a year, a quarter of the national total. In just the six months from October 2015 to March 2016, the northeast states together reported 876 confirmed cases, nearly 90 percent of the national total.

And there was a sensible explanation for why the virus was found in only 4 percent of the confirmed cases. Most of the mothers would have been infected in their first trimesters, six to nine months earlier. Antibodies usually wipe out live virus within two weeks. I was surprised there was live virus in
any
babies. It has since been noted, in blood tests on women and in the work on pregnant monkeys by Dr. O'Connor at the University of Wisconsin, that it sometimes does persist. How it does so is another medical mystery.

Those were the rumors as of early February 2016—and the answers. People would have to wait for more evidence, and then decide whether they found it persuasive.