A group of scientists from Africa and elsewhere are urging the scientific community and world health leaders to drop the stigmatizing language used to differentiate monkeypox viruses, and are even advocating renaming the virus itself.
In a position paper published online on Friday, the group proposed abandoning the existing names for monkeypox virus clades — West Africa and Congo Basin — and replacing them with numbers, saying the current names are discriminatory.
“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 stigmatizing,” the more than two dozen scientists wrote.
Christian Happi, director of the African Center of Excellence for Genomics of Infectious Diseases at Redeemer’s University in Ede, Nigeria, was one of the main drivers of the proposal.
“If SARS-CoV-2, for instance, was not named the Wuhan virus … then the question is, why do we have a virus or a clade named after a specific geographical location in Africa, and then by extension that extends to the people in those areas,” Happi told STAT. “If we have to go by geographical location, then we should name all viruses by geographic location.”
Happi also expressed anger at the way the outbreak is being portrayed in the mainstream media, noting that photos of African children with monkeypox lesions were being used to illustrate articles about an outbreak that was spreading among men who have sex with men in countries of the global north.
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“We find that very discriminatory, we find that very stigmatizing and to some extent … I find it very racist,” he said. “The mainstream media, instead of showing pictures of people that are presenting with the lesions, which are white men, they keep putting forward pictures of children in Africa and Africans. And there’s no connection.”
An official of the World Health Organization, which would be involved in any recasting of clade names, indicated Saturday that the agency is amenable of the idea.
“There is broad support for this,” said Maria Van Kerkhove, who heads the emerging diseases and zoonoses unit in the WHO’s Health Emergencies Program.
The WHO and the scientific community can effectively rename the clades by agreeing on replacement terms and starting to use them — in official statements, scientific papers and in interviews with journalists. This is how a cumbersome naming process for SARS-CoV-2 variants was replaced by a system of assigning variants the name of a letter in the Greek alphabet, such as Alpha and Omicron.
Happi said the group behind the call has consulted broadly on the idea, and hasn’t met any objections. “There is a buy-in from the global community,” he said. “I think that it is high time for us to make that move.”
Renaming the virus itself, though, is not the purview of the WHO. That power rests with an organization known as the International Committee on Taxonomy of Viruses, which also gave SARS-CoV-2 its name. The WHO on the other hand, came up with the name of the disease that virus causes, Covid-19.
Van Kerkhove said an ICTV subcommittee focused on the poxvirus family is “discussing renaming pox viruses in the coming months.”
Using geographic names (think: Rift Valley fever) or the names of individuals (think: Epstein-Barr virus) for viruses has been frowned upon for quite some time. Even as far back as 1976, the scientists who investigated a mysterious and deadly outbreak in a place called Yambuku in the Democratic Republic of the Congo (then Zaire) decided against naming the virus that caused it after the settlement, because it would be stigmatizing.
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Today even their compromise — Ebola, after a nearby river — might be deemed as running afoul of best practices guidance on naming diseases that the WHO published in 2015 in conjunction with the United Nation’s Food and Agriculture Organization and the World Organization for Animal Health.
Monkeypox infections have historically been restricted to West and Central Africa, where the virus is endemic in some animals. Until recently, cases seen outside of those countries have been rare and have been travelers or their close contacts.
But in mid-May, health authorities in the United Kingdom announced they had detected a number of cases in people with no travel history to the endemic countries. Since they sent out that alert, more than 1,500 cases have been detected in more than 40 countries where monkeypox viruses are not typically found. The current unprecedented spread in those areas — and the media coverage that has followed — pushed the scientists to call for a change in how the viruses are described.
“This was this was spearheaded by the colleagues from Africa, so both South Africa and Nigeria, who felt that we need a new set of names that neutrally and objectively can be used to refer to these different genotypic variants of the virus,” said Richard Neher, an associate professor at the University of Basel in Switzerland. Neher, whose field is viral evolution, was a signatory to the proposal.
The genomic epidemiology of monkeypox virus. (Nextstrain)
They suggested that viruses belonging to what is now known as the Congo Basin clade — typically found in several Central African countries — be known as clade 1. The current West Africa clade would be divided into two designations, with the large multi-country outbreak that is currently underway belonging to what would be known as clade 3. Further, they suggest that an “h” be affixed to the front of the short form of the virus — MPXV — to signify that viruses in clade 3 are transmitting from person to person. In the endemic countries in Africa, it is more common for monkeypox to spread from animal to person, with limited person-to-person transmission, mainly among household contacts.
“The hope is that just having this neutral 1, 2, 3 [system] we’d have a more accurate breakdown that isn’t tied to where this was sampled in the past,” said Neher, who also expressed confidence the new names will take hold.
This story has been updated with additional comment.