Monkeypox, a virus transmitted to humans mostly through small
rodents (and less commonly monkeys) was first identified in 1970, and
infections have typically been confined to the parts of western and central
Africa where it is endemic. The disease is usually mild, with symptoms
including fever and rashes clearing within a few weeks.
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This makes the latest outbreak, four-fifths of which
is occurring in Europe, surprising and unusual. Since May, cases have climbed
significantly, tripling in the last two weeks of June to more than 9,000
globally. The virus is currently spreading through person-to-person contact,
and most cases in Europe appear to have originated in gay and bisexual male
communities.
With monkeypox making headlines in the West,
attention has turned to the virus’ name. In mid-June, the World Health
Organization (WHO), which is under pressure to declare the outbreak a global
public health emergency, called for the “monkeypox” moniker to be replaced with
the more neutral sounding MPXV, in line with a WHO policy adopted in 2015 to
avoid giving diseases names that discriminate or stigmatize.
It is reasonable to ask why, in the face of the
rapid spread of a virus, we should be concerned with what it is called —
especially when the virus in question is named after an animal. But there is a
long history in global health of discrimination and the consequences that
follow from the way diseases are named and seen in terms of who they affect.
This can make responding to health crises more difficult.
This was particularly clear during the HIV and AIDS
epidemics in the 1980s and 1990s. The links made between AIDS and particular
groups (especially gay men) or moralizing over behaviors (the idea that infection
was a consequence of promiscuity) explained why funding for the emerging crisis
remained so low for so long, and why donors and national governments were often
reluctant to provide public health messaging that might have helped protect
more people from infection.
Little surprise that, in the face of such damaging and discriminatory ways of talking about the virus, many in Africa saw the disease as a way of perpetuating colonial criticisms of African life and African governments refused to act decisively to curb its spread.
One of the first names given to what would become
known as HIV and AIDS in the US was “Gay-related immunodeficiency”, or GRID,
which created a dangerous assumption that those at risk were gay men, and
linking it to a deeply discriminatory set of public debates around
homosexuality. The recognition that those injecting heroin were also at high
risk in North America contributed to the sense of HIV as a disease of sin in
the popular imagination.
When central and eastern Africa was eventually
recognized as an epicenter of the HIV and AIDS epidemic, new, highly racist
discussions around the virus and African culture and society began to emerge.
Journalists asked deeply offensive racist questions about the origins of the
virus. Little surprise that, in the face of such damaging and discriminatory
ways of talking about the virus, many in Africa saw the disease as a way of
perpetuating colonial criticisms of African life and African governments
refused to act decisively to curb its spread.
When groups become associated with a particular
disease, discrimination easily follows. During the SARS outbreak in the early
2000s, people of assumed Asian heritage faced discrimination and blame for the
outbreak in places like Canada, a phenomenon we also saw in the early months of
the COVID-19 pandemic following its labeling as a “Chinese virus”.
In the US and Europe, Syrian refugees were
incorrectly blamed for an outbreak of “flesh-eating” leishmaniasis in the mid
2010s. In Britain, a rise in tuberculosis in the late 1990s was blamed on
migrants from South Asia rather than on the poor living conditions and poverty
they endured after arriving in the UK — the result of failed government
immigration and welfare policies.
And across the world, people have been attacked and
even murdered for living with HIV, reflecting the deep intertwining of a
narrative of morality in public understanding of the disease.
All of this makes the identification of MPXV with
gay and bisexual men problematic (and why “monkeypox” is offensive). Health
officials are worried that its identification as a “gay disease” will increase
stigma and make the task of responding to the outbreak harder. Public health
officials note that MPXV is spread through close physical contact, not
necessarily only through sex. But the association with sexual identity is
already having a stigmatizing effect.
As a result, people may be less likely to come
forward for testing, especially if they think their sexuality will be
questioned (or assumed) as a result. It also means that those who are not in
the assumed community of risk will be complacent. Health officials face a
delicate balance in ensuring that those most at risk receive the vital
information they need to protect themselves and to identify symptoms, without
reinforcing damaging ideas about the virus.
Names matter, as do the implicit assumptions made
about diseases. Names can worsen discrimination against often already
vulnerable groups. They can contribute to racist and neo-colonial ideas about
other places and people. And they make it harder to respond to health crises.
As Keiji Fukuda, the WHO assistant director who
introduced the agency’s naming policy in 2015, noted, naming conventions “may
seem like a trivial issue to some, but disease names really do matter to the
people who are directly affected”. What we call new viruses is a critical part
of ensuring that diseases do not become more damaging than they already are.
Michael Jennings is reader in international development at SOAS
University of London, where he works on issues related to global health and the
politics and history of global development. Syndication Bureau.
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