The mosquito-borne disease suspected of causing serious birth defects is expected to spread to all countries in the Americas except Canada and Chile and remains a global health emergency, according to the World Health Organization.

The mosquito-borne disease suspected of causing serious birth defects is expected to spread to all countries in the Americas except Canada and Chile, the World Health Organization says.

The mosquito-borne disease suspected of causing serious birth defects is expected to spread to all countries in the Americas except Canada and Chile, the World Health Organization says.

The smell was so bad, it made her eyes water. Georgea Celane, a 34-year-old auditor from northern Brazil, was ordered in March to inspect a warehouse that stored insecticide to fight the ­Aedes aegypti mosquito, which transmits Zika. When Celane opened the door of the warehouse, a cloud of bats flew out, and she discovered more than 100 boxes of expired insecticide covered in mold and animal feces.

“I took some photos and had to get out to breathe,” she said.

The warehouse sits on the banks of the Amazon River in northern Brazil. The global Zika outbreak has struck Brazil harder than any other country, with 100,000 confirmed cases and many more suspected, according to the World Health Organization. Zika can trigger microcephaly, a condition that often causes babies to be born with small heads and severe brain defects.

Brazil’s government has authorized hundreds of millions of dollars to slow the spread of transmissible diseases such as Zika — with $230 million made available to states in the past two years alone. But auditors have discovered that a lot of that money has either been misused by state authorities or not spent.

The reasons vary from mismanagement to cumbersome laws that limit states’ ability to use the federal money for capital investments and long-term projects. For instance, states can easily buy insecticide but not the machines or vehicles needed to spray them, officials say.

A 1-year-old girl, who has microcephaly, at a therapy session in Brazil. The nation has been hit hard by the world outbreak. (Felipe Dana/AP)

Another factor is at work. Zika’s explosive arrival coincided with heightened scrutiny of government spending in the wake of a multibillion-dollar kickback scheme involving the state oil company.

The crackdown has prompted some state officials to be extremely cautious about using federal funds — or not use them at all.

More than half of Brazil’s 27 states left millions of dollars in federal “sanitary vigilance” funds sitting in banks in the past two years, according to government audits made public in September.

“It’s gotten to the point where nobody wants to touch federal resources,” said João Francalino, planning director of the western state of Acre’s health agency. His state left 53 percent of the $3.3 million of “sanitary vigilance” funds in its account untouched. “Everyone is afraid they will end up being sued or investigated.”

[Zika is spreading and remains a global emergency, according to the WHO]

Brazil’s Transparency Ministry has nearly doubled its investigations into the use of federal funds by states and municipalities compared with 2014. The steep increase in inspections comes as Brazil has been shaken by the scandal linked to the oil company Petrobras, which has led to the arrests of dozens of politicians and business executives since March 2014. The ministry says that scandal didn’t directly lead to its stepped-up enforcement actions, but that it did strengthen the public’s demand for accountability.

Earlier this year, the ministry sent dozens of auditors such as Celane to review state use of federal money in the fight against the Aedes aegypti mosquito, which transmits Zika as well as better-known viruses that cause dengue and chikungunya.

In many states, these visits marked the first time health agencies had been audited in nearly 10 years, according to the Transparency Ministry’s records.

What the auditors found shocked them. In nearly a dozen states, they discovered overflowing or expired stocks of insecticide in warehouses, according to government audits. In three Brazilian states, conditions were so horrid that the warehouses themselves had become breeding grounds for mosquitoes, increasing local residents’ chances of getting Zika, the reports show.

In her visit to the warehouse in the northern state of Amapa, Celane said, she found new and expired boxes of insecticide stored together with no clear identification. Both were covered with mold and animal feces.

Amapa’s health department said in a statement that it could not renovate the warehouse because it was on loan from the federal government, and that state authorities are preparing another location for the insecticide. It denied the newer boxes of insecticide were mingled with expired chemicals.

The Zika epidemic first emerged in 2015, when Brazilian authorities reported an unprecedented outbreak of microcephaly cases. Months later, scientists confirmed that pregnant women who were bitten by mosquitoes carrying the virus had an elevated risk of bearing babies with serious neurological damage. Brazil’s government rushed experts and insecticide to affected areas, and mobilized hundreds of thousands of soldiers to spread awareness about the mosquito.

[In the face of Zika, Southeast Asia sees grounds for cautious hope]

Although infection rates in Brazil have dropped in recent months, thanks to colder weather, the looming Brazilian summer is expected to bring another wave of cases.

State officials say they want to do everything they can to prevent Zika but are hamstrung by regulations that limit their ability to act quickly and creatively.

“If you follow the budget rules to a T, you end up freezing health decisions you need to make. It’s a constant battle trying to reconcile the urgency one faces in health agencies with following the law,” said Nelson Tavares, the health secretary of Mato Grosso do Sul. The western Brazilian state’s health agency left 56 percent of available resources to fight the Zika mosquito sitting in the bank, despite suffering one of country’s highest rates of infections transmitted by the mosquito.

Government workers have complained for years that they are restricted to spending the health money only on short-term projects. State officials say they find themselves employing whole teams to determine lawful uses for federal funds.

Regulations aren’t the only problem. State agencies also sometimes lack the staff and expertise to use the health funds well — and wind up spending the money on anything that is within reach. That has contributed to an overabundance of education and pest-control projects at the expense of more difficult but equally necessary investments, such as care for children with microcephaly and rural home inspections, according to medical experts and local health agencies.

Bruno Brandão, a consultant for Transparency International in Brazil, said it was important to continue the anti-corruption campaign, despite the problems it had inadvertently caused.

“We know that there are management problems, but there is a grave corruption problem, too,” he said.

If corruption was consistently identified and punished, the rigorous earmarking of federal money wouldn’t be as necessary, he said. “The government creates controls upon controls to try to solve the problem, but we believe an extensive reform of the justice system, both of its laws and execution, would be a better solution.”

The Transparency Ministry said it is aware of the bureaucratic headaches local managers face and is working to look at budgets more holistically during audits, evaluating what the spending accomplished rather than just what was bought.

As much of this money sits unused in bank accounts, the most vulnerable Brazilians bear the brunt of inaction.

Franicê Barbosa, a fruit vendor from the outskirts of Brasilia who is expecting her third child, said she had low expectations of the government.

“If I get Zika, I won’t have financial conditions to care for a developmentally delayed child, and I know that the public sector won’t help us,” she said. “So I put on repellent every single day. I have to prevent it all on my own.”

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