Stoning, poisoning and stigma: Why experts want to rename monkeypox

Are monkeys spreading monkeypox to humans?

Researchers say the answer is no. But recently in Brazil, the unfounded fear that monkeys transmit the virus to people has spurred an outbreak of violence against marmosets and capuchin monkeys, leading to the death of at least seven animals, according to Brazilian officials.

The stoning and poisoning of wild primates in Brazil is an especially lurid example of how an inaptly named disease can have real-world implications.

Just as the so-called Spanish Flu of 1918 was not born on the Iberian Peninsula, the spread of monkeypox has little to do with monkeys. In fact, scientists say that rodents are the most likely animal reservoir for the virus, which is a cousin of smallpox that made its first recorded leap to humans decades ago in Congo. But in 1958, when Danish scientists first identified the virus in a colony of lab monkeys, they decided to bestow the naming honour on their captive primates.

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[ Monkeypox: Ignore the misinformation on social media. Here are the key things you need to know ]

In the three months since the first cases of monkeypox were reported in Europe and the US, public health experts have been urging the World Health Organisation (WHO) to come up with new nomenclature that might help to clear up any confusion and reduce the shame and stigmatisation associated with a disease that has been spreading largely among men who have sex with men.

“Names matter, and so does scientific accuracy, especially for pathogens and epidemics that we are trying to control,” says Tulio de Oliveira, a bioinformatician at Stellenbosch University in South Africa who has been among those pushing the WHO.

In June, de Oliveira and more than two dozen other scientists from across the African continent published an open letter urging the organisation to move quickly. Failure to do so, they warned, risked hamstringing efforts to contain the disease.

The letter also condemned media coverage of the outbreak, noting that some western outlets had been using photos of lesion-pocked Africans to illustrate an outbreak that was almost entirely affecting white men. Many articles have also been wrongly describing the virus as “endemic” to Africa, they wrote. In fact, before the current global outbreak, human-to-human transmission in Africa was relatively uncommon, with most infections occurring in rural areas among people who had direct contact with wild animals. “In the context of the current global outbreak, continued reference to, and nomenclature of this virus being African is not only inaccurate but is also discriminatory and stigmatising,” the authors wrote.

The WHO has acknowledged the problem. In June, director general Tedros Adhanom Ghebreyesus said the organisation would work with experts to find a new name, and last week, it issued a public call for suggestions. But many experts have grown impatient, saying the process has been too plodding given the disease’s rapid advance, which has now reached 92 countries, according to the WHO.

In a news conference last week, officials reported a 20 per cent jump in cases over the previous week, recording 35,000 cases, with the vast majority of infections concentrated in the Americas.

Many scientists have taken matters into their own hands and have begun using abbreviations such as “hMPXV” and “MPV” when writing or talking about the disease. There has been some progress in one aspect of the monkeypox nomenclature: A group of experts convened by the WHO agreed to rename two monkeypox virus variants, or clades, replacing geographical references – Congo Basin clade and West African clade with Roman numerals (Clade I and Clade II).

Monkeypox is more than just a misnomer. Many experts say the word evokes racist stereotypes, reinforces offensive tropes about Africa as a perilous, pestilence-filled continent and abets the kind of stigmatisation that can prevent people from seeking medical care.

Western literature through the ages is replete with ugly comparisons of black people to primates, and throughout the 19th and early 20th centuries, illustrations rendering African Americans as having simian features were a staple of popular American newspapers and magazines. Such racist sentiments have not entirely faded. President Ronald Reagan, when he was governor of California, was caught on tape calling African diplomats “monkeys”. Over the decades, racist slurs and imagery involving apes have repeatedly been hurled against black people, including prominent politicians and celebrities.

Dr Ifeanyi Nsofor, a public health expert in Nigeria, says the dynamic with monkeypox was reminiscent of the early days of the Aids crisis, when Africa was unfairly implicated in the global spread of the disease and many people hid their illness and did not seek medical help. “I still remember all the people dying unnecessarily,” says Dr Nsofor, who is senior vice-president for Africa at the Human Health Education and Research Foundation.

The fact that most of those recently infected with monkeypox are men who have sex with men only reinforces the fear and shame, especially in countries where homosexuality remains taboo and, in some cases, illegal.

Stigmatisation surrounding a disease, he adds, can have other insidious repercussions: National governments, worried about the impacts on tourism or foreign investment, can conceal outbreaks within their borders. African exchange students living abroad can be shunned or ridiculed.

The naming of diseases has long been contentious and not just in Africa. In the first months after its emergence in China, the illness we call Covid-19 was unofficially dubbed “the Wuhan virus”, a designation that gained currency on social media before finding its way into the mainstream. What happened next was not entirely surprising: Violence against Asians surged in the US and other countries. Business at Chinese restaurants evaporated. President Donald Trump repeatedly referred to the disease as “the China virus”, long after the WHO had given the disease its current, banal-sounding moniker.

[ Hundreds at high risk of monkeypox to be offered vaccine ]

The virus naming process, established in 2015, seeks to “minimise unnecessary negative impact of disease names on trade, travel, tourism or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional or ethnic groups,” the WHO wrote at the time.

But these so-called best practices for naming new infectious diseases do not affect existing names that critics say have negative associations with actual places and people, like Rift Valley Fever, Middle East respiratory syndrome and Ebola, the haemorrhagic fever named for a river in Africa.

Changing existing virus names is another matter. The International Committee on Taxonomy of Viruses, which has a painstaking process for categorising the multitude of known viruses, is responsible for assigning formal, scientific names. These are distinct from the common names of viruses.

Elliot J Lefkowitz, a professor of microbiology and genetic bioinformatics at the University of Alabama at Birmingham and the organisation’s data secretary, says it could likely take a year before the group’s members considered possible new names for the species into which monkeypox virus would be classified. Any new species name, he says, was likely to incorporate elements of the existing name to maintain a link with the past, a process separate from suggesting a new common name for the virus. “I don’t know of any virus name that’s actually been changed after it’s been used for years,” he says.

For Dr Perry N Halkitis, an infectious disease epidemiologist and dean of the Rutgers School of Public Health in the US, the debate surrounding the name monkeypox stirs up painful memories of another virus that arrived in the US from overseas and prompted widespread fear, shame and finger-pointing. In the summer of 1981, the virus that we now know as HIV first revealed itself through cancerous purple lesions on the bodies of gay men. Researchers called the disease GRID, or gay related immune deficiency. Although the name was never official, it gained traction, and in the years that followed, thousands of gay men would perish, many of them dying alone after being shunned by their families.

“Words carry weight, words carry value,” says Dr Halkitis, who lost many friends during the early years of the Aids epidemic. “The problem with those kinds of terms is that they attribute blame, and when you attribute blame your create stigma, which emboldens hate and undermines the wellbeing of people.” – This article originally appeared in The New York Times.