The Texas Association of Community Health Centers (TACHC) and a coalition of state and national organizations are raising concern about state preparedness to address the potential for locally acquired Zika cases. In a letter to Texas Health and Human Services Executive Commissioner Charles Smith the organizations warn that vulnerable populations are especially at risk for Zika because they typically lack access to health services and/or insurance coverage, live in poor housing conditions (such as no air conditioning or window screens), may live close to standing water or work in jobs that require long periods of time in mosquito-prone areas, and have scarce financial resources to buy insect repellant or protective clothing.

“Our concern is based on our experience directly serving patients at high risk of being exposed to this virus or as consumer groups that educate on critical health care topics,” they write. “With 65% of Texas’ population living in areas where the Aedes aegypti mosquito can be found and heavy spring rains, at the forefront of concerted state and local efforts should be vector control, widespread education (PSA’s, posters, etc.), contraceptive counseling, and mosquito bite prevention.”

Especially at risk in Texas are pregnant women with and without health insurance, women of child bearing age without coverage, men without health insurance who have female partners, and uninsured children.  The letter notes the risk for birth defects associated with the virus, including microcephaly, “a condition that could have a long term health and financial consequences for the state given the severe health care needs that babies born with this condition will need throughout their lives.

Among their recommendations were that Texas health officials should:

• Add insect repellent as a Texas Medicaid benefit immediately without prior authorization and address barriers to getting an insect repellent prescription from the health care provider.  However, the Texas Medicaid program covers “only a very small subset of the at-risk population” since the state did not expand Medicaid benefits.
• Partner with key relief organizations to organize immediate distribution of insect repellent.
• Post on a public site the list of emergency respondents through the state so trusted community health providers can work with them to develop locally-based plans to respond to Zika incidents.
• Work directly with certified promotoras, community health workers and/or organizations and community members to educate communities about the risks of exposure to Zika.

In addition to TACHC, the letter was signed by Texas Academy of Family Physicians, Children’s Hospital Association of Texas, March of Dimes, Center for Public Policy Priorities, Children’s Defense Fund, and Texans Care for Children.