Monkeypox Doesn’t Need to Be Renamed
Since the global crisis started in the spring, efforts to contain the spread of monkeypox have developed in parallel with efforts to change its formal identity. In June, more than two dozen virologists and public-health experts put out a call for a “neutral, non-discriminatory and non-stigmitizing” nomenclature for the virus and its subtypes; World Health Organization Director-General Tedros Adhanom Ghebreyesus responded by announcing a formal process to create one. A month later, with monkeypox still mired in linguistic purgatory, the health commissioner of New York City issued an open letter to Ghebreyesus warning that a “public health failure of words with potentially catastrophic consequences” was imminent. “Words can save lives or put them at further risk,” the letter said. “The WHO must act in this moment before it is too late.”
As a practicing physician—and a gay one at that—I’ve felt devastated by the clumsy public-health response to monkeypox. The delays in rolling out tests, treatments, vaccines, and contact tracing have been a months-long source of frustration. But the name of the disease has never bothered me, let alone engendered premonitions of catastrophe. Sure, monkeypox sounded odd when I first started hearing it in conversation. But that feeling quickly went away as doctors had to deal with the scourge itself, and with a public-health failure of actions. After seeing lives literally put at risk by our government, I have a hard time believing that the word monkeypox can really do the same.
I’ve been told I’m wrong about this point, many times and by many different people. Some say the term is silly, and that it makes a dreadful ailment seem unimportant. Others claim that it’s too scary, and causes panic we don’t need. I’ve also heard that monkeypox is racist, that it’s homophobic, and that, actually, it’s causing harm to monkeys. A single name for a disease is said to be, somehow, the source of all this evil. But medicine is full of terms that sound funny or disgusting or obscene. One can find “hairy cell leukemia” and “fish scale disease” and “cat cry syndrome” on the books. A common viral illness related to monkeypox is termed “molluscum contagiosum,” which seems like a Harry Potter curse; and then there’s “maple syrup urine disease”—much too sweet of a label for a debilitating condition. All these names are weird, but they hardly seem offensive. Why should monkeypox be different?
The name for the current outbreak is, at the very least, inapt. It “genuinely bothers me every time I use it,” Neil Stone, an infectious-disease physician in the United Kingdom, told me. In addition to finding the name unserious and possibly racist, he’s hung up on the fact that monkeypox doesn’t actually have much to do with monkeys. Although the disease was first identified in primates, in 1958, small mammals like squirrels and rats are now thought to be more important viral reservoirs.
The subtypes of the monkeypox virus, called clades, could be even more misleading. These were originally named after the regions in Africa where they’d first been identified, but the present crisis did not emerge from any of those places, Christian Happi, the director of the African Center of Excellence for Genomics of Infectious Diseases in Nigeria, told me. If we were being less hypocritical, he suggested, the 2022 epidemic would be attributed not to the West African clade of monkeypox but to the “European” clade—in reference to the continent where cases were first identified this year. Happi, who was the lead author on the demand for a less stigmatizing nomenclature, also takes issue with some media outlets’ use of archival photos of Africans to illustrate a disease that now is occuring in white men.
Since I spoke with Happi, a group of virologists and public-health experts convened by the WHO reached an agreement to rename the clades. A statement issued Friday said the monkeypox subvariant behind this year’s global outbreak would henceforth fall within “Clade IIb.” That shift will be most significant within the scientific community, but the more pressing question, of what to do about the term on all of our lips, is unresolved. What will monkeypox become?
Surely any change would have to be in line with the “Best Practices for the Naming of New Human Infectious Diseases,” put out by the WHO in 2015. Those guidelines are designed to minimize word-based harm to “trade, travel, tourism or animal welfare,” as well as to “cultural, social, national, regional, professional or ethnic groups.” To that end, they say, names should exclude all stigmatizing references to specific people (e.g., “Creutzfeld-Jakob disease”), occupations (“Legionnaires’ disease”), or places (“Lyme disease”). Animal-based names, such as “swine flu” and “paralytic shellfish poisoning,” are also verboten.
When I talked with Stone, he tossed out “human orthopoxvirus syndrome,” or “HOPS” for short, as a possible alternative for monkeypox. Happi said that “mundopox,” from the Spanish for world, was another. But if the WHO is to follow its own rules to the letter, it should stay away from any implication that the virus is a product of the Hispanophonic world (or, I guess, that hopping rabbits are to blame). Surely global-health officials will be more inclined to fumigate the discourse with another odorless, colorless gas of pseudowords and digits—something in the lifeless spirit of COVID-19. Along these lines, the emergency-medicine physician Jeremy Faust has suggested “OPOXID-22,” short for “orthopoxvirus disease 2022.” Even a bland name, however, might not immunize the WHO against blowback. Boghuma Kabisen Titanji, an infectious-disease doctor, has already criticized Faust’s proposal as incorrectly implying that monkeypox is new to 2022. Call it “IgnoredPox (IPOX)” instead, she suggested, in light of the fact that outbreaks have been neglected for decades.
Granted, monkeypox is not a great name for a disease that spreads between humans, and nothing good can come of potentially racist associations or implications of bestiality. But the WHO’s “Best Practices,” if deployed across the board, would exclude many—maybe most—of the medical terms in use today. Taken in broader perspective, monkeypox isn’t even unusually off-base. Chickenpox has little to do with chickens, for instance, and, unlike monkeypox, it’s not a poxvirus but a herpesvirus. Maybe in a more perfect world, we’d refer to chickenpox as “chicken herpes”; but then again, the herpesviruses—named for the creeping spread of lesions they may produce—are already stigmatizing given their association with sexually transmitted infections. Nearly all of us contract a herpesvirus during our lives, via nonsexual spread. Just the same, I remember telling one patient that he had a disseminated herpesvirus infection only to watch him jump to the erroneous conclusion that his wife must have committed adultery.
Even though monkeypox is being used to harass people right now, bad actors who truly wish to deepen victims’ shame will always find a way to do so. Earlier this month, two gay men in Washington, D.C., are alleged to have been berated, then beaten, by teenagers who included monkeypox among a string of homophobic slurs. If that particular word had been unavailable, I’ll bet the others would have sufficed. Tone of voice and body language can, by themselves, turn a good word bad; and there’s little reason to think that any term for a disease, no matter how generic it might seem, cannot be wielded for ill purposes. “The name per se is not a major issue,” Mike Ryan, the executive director of the WHO Health Emergencies Programme, said last month. “It’s the weaponization of these names. It’s the use of these names in the pejorative.” Indeed, HIV is no longer called “gay-related immune deficiency,” but gay men are still frequently ostracized over the condition. Connotation outlives denotation. Even COVID-19—a disease name that was designed from the very start to be as inoffensive as possible—can easily be turned into a slur. “Covidians” and “Covidiots” abound.
Perhaps episodes of hate would occur less often if the WHO naming guidelines were universally adopted. Maybe the name monkeypox, which already sounds something like an insult, has a way of loosening the bigot’s tongue. Social scientists have struggled to assess the size of this effect. A number of preliminary studies suggested that the initial, China-centric framing of the new coronavirus in 2020 worsened bias against Asians and Asian Americans. But other research found no effect on anti-Asian sentiment; and one study concluded that the Trump administration’s effort to “scapegoat outgroups” actually backfired. Meanwhile, an increased level of anti–Asian American discrimination seems to have persisted for years. Any incremental consequences of the name monkeypox for anti-gay and anti-Black sentiment seem equally hard to predict.
In any case, cruelty is nothing if not creative. Last month, the Fox News host Tucker Carlson ran a segment on the monkeypox-naming controversy in which he proposed a slew of other offensive names, including “Schlong COVID”—a term that manages to insult the victims of two diseases at once. The problem, as always, is people. The illness is new and mysterious to most of us, visibly apparent, and comes on the heels of the divisive coronavirus pandemic. It’s not the name; it’s the vibes. And the vibes are bad. Strangers are publicly accusing one another of having monkeypox. Medical influencers are playing up the possibility that monkeypox easily spreads through the air or will become common in children. Old political arguments over COVID have been rehashed.
Bad vibes don’t wash off easily in medicine. In 2011, a rare form of blood-vessel inflammation called “Wegener’s granulomatosis” was renamed because it turned out that the condition’s namesake was a Nazi. Unfortunately, the disorder’s new name (“granulomatosis with polyangiitis”) is a mouthful. Doctors still prefer the shorter Wegener’s more than a decade later. Medical textbooks must awkwardly refer—Prince style—to the disease “formerly known as Wegener’s.” Will monkeypox also hang around?
Consider the illness with the worst vibes of all: cancer. The name for these cellular growths brings to mind suffering and inevitable death. Yet many cancers diagnosed today are so small as to be practically harmless. Some doctors have been campaigning to remove the “cancer” label from such tumors, hoping to reduce fear and unnecessary treatment. But studies find that calling some mild breast and prostate tumors “lesions” or “abnormal cells” instead of “cancer” seems to have only a small impact on patient anxiety and overtreatment. A monkeypox rebrand may not do much more.
Of course proponents of the name-change argue that getting rid of monkeypox wouldn’t have to save the world to be worth doing. “Nobody thinks changing the name is going to instantly end all stigma of people with the disease,” Gavin Yamey, a global-health professor at Duke, told me. It might still lower the social temperature, he said, and represent a proactive and important step to protect marginalized communities. For Osmundson, to assume that nothing whatsoever can be done to combat prejudice is giving in to nihilism.
But a campaign to change the language of disease, based on the urge to do something, could be counterproductive. At worst, it could make semantics seem like the most important tool for addressing social wrongs. The American Medical Association, for example, recently declared that “a consideration of our language” is central to the work of improving health equity. “Pursuing equity requires disavowing words that are rooted in systems of power that reinforce discrimination and exclusion.” I don’t think that I’ve ever avowed allegiance to a word. Regardless, disavowing a particular word does nothing by itself to uproot injustice.
Whatever we decide to call this Clade IIb virus, society has made plain which lives it values less: In the U.S., monkeypox is already spreading along the same racial, sexual, and economic fault lines as other sexually transmitted infections. An August 8 presentation from the Georgia Department of Public Health noted that most monkeypox patients in the state were young gay men; 82 percent were Black; and 67 percent were also HIV positive. Our actions, not our nouns, determine who will get sick.
In 1993, Harvard scientists discovered a crucial gene for the growth of embryos. They decided that it would be fun to name it after the video-game character Sonic the Hedgehog. Other researchers at the time derided this choice as unserious. But today, the scientific literature is full of dry sentences like “Sonic Hedgehog plays a role in cell growth, cell specialization, and the normal shaping (patterning) of the body.” Words, like viruses, evolve as they move from host to host; and words, like viruses, may become more or less noxious over time. If the name monkeypox strikes listeners as funny or offensive right now, that could change in the future—irrespective of any committee.