Concerns about stigma are driving the push to rename monkeypox, but the process is slow



CNN

Since the outbreak of monkeypox, scientists and activists have pushed to change the name of the virus and the disease to “non-discriminatory” and “non-stigmatizing”.

Public health experts worry that the stigma could keep people from getting tested and vaccinated. They say a new name could slow the spread of the disease, but it must come quickly.

Worldwide, nearly 60,000 cases have been identified, and the name “monkeypox” has been placed on individuals’ medical files. The World Health Organization’s chief executive promised in June that the name change would come “as soon as possible”, and the WHO said it was working with experts to change the name of the virus, its variants and the disease it causes.

But that was months ago.

Usually, the scientist who isolates a virus suggests a name. Species naming is the responsibility of the WHO International Commission on Taxonomy of Viruses.

Scientists have been calling this virus “monkey pox” for 64 years.

In 1958, researcher Preben von Magnus and his team in Copenhagen, Denmark, discovered two outbreaks of a “pox-like disease” in a colony of crab-eating macaque monkeys used by their laboratory for polio vaccine production and research.

It wasn’t until the 1970s that the first human case of the monkey was documented. Scientists found a case of a 9-month-old child in the Democratic Republic of Congo. The child recovered from the monkey infection, but died of measles six days later. After that, cases of the painful disease were documented in West and Central Africa.

Cases elsewhere were almost all travel-related, according to the CDC. But in 2018, the agency noted that more human cases had been reported in the previous decade in countries that hadn’t seen the disease in decades. This outbreak, he said, was a “global health security concern.”

The global push for the name change began this year when an outbreak broke out in countries where monkeypox was not common.

The naming process was already underway to review the names of all orthopoxvirus species, WHO said in an email to CNN, including cowpox, horsepox, gamelupox, raccoonpox and skunkpox, as well as monkeypox.

According to Colin McInnes, a member of the WHO Taxonomy Committee, the panel “is mandated to bring the nomenclature of virus species into line with the way most other life forms are named”.

Traditionally, poxviruses were named after the animal in which the disease was first observed, but that created some inconsistencies, he said.

Monkeypox probably did not start in monkeys. Its origin is still unknown. The virus can be found in other types of animals, such as giant Gambian rats, flowers and a couple of squirrel species.

McInnes, who is deputy director and chief scientist at the Moredun Group, which develops vaccines and tests for livestock and other animals, researches the squirrel, which may also be in for a name change. He has been studying the feasibility of producing a vaccine against the virus, which can be fatal to red squirrels in the UK.

The current species known as the “monkey virus” and others “would be renamed orthopoxvirus ‘something,'” he told CNN in an email.

“It’s a ‘something’ that’s being debated today,” McInnes wrote.

He said some scientists would prefer to keep the name monkeypox to maintain a link to 50 years of published research. Others would prefer a completely different name.

The WHO committee has until June 2023 to suggest changes.

In August, the WHO announced that a team of experts had come up with new names for the monkey’s clades, or variants. Before more modern naming conventions, scientists would name a variant for the region it was created and circulating.

Now, to remove any stigma attached to naming a region or country a disease, the Congo Basin clade will be referred to as clade I. The former West African clade is clade II. One subvariant, clade IIb, is the one that is mainly circulating in the current outbreak.

Many scientists say that WHO needs to work more urgently.

in JulyAfter weeks of inaction, New York’s health commissioner sent a letter to the WHO, urging them to “act before it is too late.” “There is growing concern about the devastating and stigmatizing effects of monkeypox messaging on these already vulnerable communities.”

Since the outbreak has affected gay and bisexual men and other men who have sex with men, stigma has been a constant concern for WHO Director-General Tedros Adhanom Ghebreyesus.

“Stigma and discrimination can be as dangerous as any virus.” said Tedros in July when the monkey was declared a global health emergency.

In the US, the virus disproportionately affects blacks and Hispanics, according to the CDC. Local public health data also show that fewer members of both communities are getting the monkeypox vaccine.

Experts are concerned that, in addition to barriers that make it difficult to access any type of health care, some people may not get vaccinated or get tested because of the stigma associated with the disease.

At the WHO’s 2015 naming conventions, the organization encouraged disease namers to avoid places, names, professions and animals because of stigmatization.

In August, WHO encouraged people who want to propose new names for monkeypox to submit suggestions to its website. More than 180 ideas have been proposed, some with a wide mix of creative explanations.

Some – like lopox, ovidpox, mixypox and roxypox – had no explanation.

A handful — like rodents, bonopox, and alaskapox — can be unsightly.

Johanna Vogl, who introduced “greypox”, wrote that the name “refers to the phenotypic mark of the disease, the gray blisters and is not related to the color of the human skin nor to the location, group or animal”.

Other suggestions come with stronger scientific explanations. Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston and a professor of emergency medicine at Harvard, suggested changing the name to opoxide-22.

“Although the simian virus causing the current outbreak is not a new pathogen, because of its designation as a public health emergency of international concern, I propose that a name change is warranted,” Faust wrote in his proposal. He added that while this particular lineage of the virus appears to have originated before 2022, using this year “may limit confusion”.

Opoxid-22 reflects what is known about the virus while dropping the “monkey” from the name.

Faust said he was troubled by the inaccuracy of the monkey’s name and the stigma it conveyed. But he said he submitted the name when he was waiting for the completion of other works.

“Honestly, I was procrastinating,” Faust said.

He said if the WHO chose his name, it could help more people seek treatment, testing and care.

“This is important,” Faust said. “The right name should be dry, technical, boring, people aren’t afraid to say they have that problem, right?”

Rossi Hassad, a professor of research and statistics at Mercy College and a fellow of the American College of Epidemiology, came up with a few names, including zpox-22, zopox-22, zovid-22, hpox22 and hpi-22.

His proposal says that given the uncertainty of where the virus originated, a more general name derived from a zoonosis – meaning a disease that can be transmitted from animals to humans – would eliminate the word “monkey” and be more inclusive.

The addition of “22” would reflect the year scientists became aware of “this unusual and alarming outbreak of human-to-human transmission,” the proposal says.

Hassad said he was motivated to submit the names because the word “monkey” can have many negative connotations.

“It has been used in race and racism against certain groups. I think it would be unreasonable not to recognize the damage that word has done,” he said. “It is not even scientifically correct. It’s a wrong name. If we want to be scientific, we must be correct.’

Some US health departments are not waiting for the WHO, but the change is inconsistent.

The San Francisco Health Department calls it MPX. Chicagoans call it the MPV. Other cities hit hard by the outbreak, including Houston, New York and Philadelphia, have stuck to their traditional names, as has the CDC.

Daniel Driffin, an HIV patient advocate and consultant for NMAC, a national organization working for health equity and racial justice to end the HIV epidemic, said he hopes the name will change. At the same time, he is disappointed that it wasn’t until this outbreak, when people outside of Africa were heavily affected, that the push for change did not begin.

“It is a name full of racism. It’s a day late and a dollar short. But I support the change and I think it will help,” Driffin said. “Think about the populations that will continue to be disproportionately affected by this disease. It’s been black and brown people, so if we can remove oppressive racist tendencies from the nomenclature, I think we need to do that.” .