The public health community has many competencies. Reading room is not one of them.
Experts in the field, responsible for identifying the sources of infectious diseases and preventing their regional and global spread, say monkeypox and its geographically designated variants require a new name, given the unclear origin of the latest worldwide outbreak of the virus.
The World Health Organization (WHO) agrees, saying this week it will immediately start searching for a less offensive name.
“WHO is also working with partners and experts from around the world to change the name of the monkeypox virus, its branches and the disease it causes,” WHO Director-General Tedros Adhanom Ghebreyesus said at a news conference on Tuesday. “We will make announcements of new names as soon as possible.”
His comments come just days after an international group of infectious disease researchers published an open letter calling for “neutral, non-discriminatory and [sic] a non-stigmatizing” naming scheme that avoids the use of the term “monkey pox” and the “West African” and “Central African” or “Congo Basin” clades.
“In the context of the current global outbreak, the continued references and nomenclature of this virus as African is not only inaccurate, but also discriminatory and stigmatizing,” these researchers write.
Their letter specifically objected to the media using photographs of African monkeypox patients to depict the effects of the disease. And while they acknowledge that the origin of the current global outbreak is still unknown, these researchers said that the use of clades with African names obscures the likely fact that “intercontinental cryptic human transmission” has been going on for much longer than expected. .
The name change would counter a possible but unproven “narrative in the media and among the many scientists who are trying to link the current global outbreak to Africa, West Africa or Nigeria,” they write.
Prior to this latest global outbreak, monkeypox most commonly infected humans in Africa, often after they came into contact with infected animals, including both rodents and monkeys. According to the WHO, the first non-African outbreak did not occur until 2003, when infected rodents imported from Ghana to the US led to flash which infected 70 people.
The African origin and predominance of the virus, and the fact that primates can transmit it to humans, may seem to the casual observer to justify sticking with the original monkeypox name and African-specific clades. The rarity of cases outside of Africa may also explain why the media is dominated by images of African monkeypox patients. If images of non-African monkeypox patients were more common, perhaps we would argue about whether African victims of the disease are ignored.
Naming diseases after the places where they were found has been a source of controversy among public health professionals for years. The letter of the above-mentioned researchers mentions WHO document 2015 which outlines best practices for naming emerging human infectious diseases. The document specifically recommends against using places, animals, and activities to refer to new diseases, and cites monkeypox as an example of an ill-named disease.
However, the WHO best practice document also recommends not attempting to rename diseases that already have a common name. This would seem to be a recommendation against breaking up the already well-established monkeypox.
The aforementioned letter from researchers proposes to create the placeholder hMPXV instead of monkeypox and to replace the West Africa and Central Africa clades with the charming names A.1, A.2, etc.
This also contradicts the conclusion of the WHO working group on naming variants of COVID. This group recommended against alphanumeric naming schemes as they “result in complex names that can be misinterpreted and misunderstood”.
The argument that naming options based on geographic location is stigmatizing and discriminatory is also untrue. Researchers say this is inappropriate because we don’t know the origins of this latest outbreak. However, since the origin is currently a mystery, the preemptive name change to avoid associations with Africa also seems premature and, if anything, intended to promote an alternative, also unproven, non-African origin version of this latest outbreak.
Changing the names of viruses and variants to avoid stigmatization of countries and regions did not work too well during COVID. When the new COVID variant was discovered by South African researchers, the Biden White House scrupulously named it not the South African variant but B.1.1.529 or Omicron. He also quickly banned leaving the country.
While geographical names for illnesses may complicate the work of some travel agency officials, they are unlikely to be as damaging to the reputation of a country or region as some public health officials believe. People are still ready to relax in Barcelona, despite the fact that more people have died from the Spanish flu than from the Kaiser.
The sudden worry about monkeypox overlooks its main utility: it sounds funny and therefore memorable. Its uniqueness encourages people to pay attention to the virus, which public health officials should want. The fact that a global, yet relatively minor outbreak has received so much coverage certainly has something to do with the name. If anything, the title encourages people to pay too much attention to the disease – hence all the “don’t panic about monkeypox” articles. Are public health officials suddenly worried about people being overly cautious in the face of an infectious disease?
Finally, the fact that the name of monkeypox is at all a matter of controversy is itself a consequence of a public health failure. The government bureaucracy exists largely to monitor diseases and prevent their global outbreaks. This did not happen with monkeypox, a well-known disease that nevertheless managed to spread throughout the world.
How he did it is still a mystery. Instead of cracking the case, some public health officials seem to be content with playing with words.