Phasing out monkeypox: mpox is the new name for an old disease

Since May 2022, the world has faced the unprecedented spread of monkeypox through continuous chains of human-to-human transmission, with nearly 90,000 cases in over 100 countries.¹ Along with a number of uncertainties and scientific issues, the outbreak has also brought to light unfortunate habits of our society: stigma, racism, and discrimination.2, 3, 4

Since the outbreak began, public health experts and researchers around the world, particularly in Africa, have called on the WHO to change the name of the disease.^2,5 Online posts on social media and other forums have been making racist and unacceptable comments associating the name of the disease (“a disease of monkeys”) with African people. Stigmatizing comments have also been posted referring to monkeypox as a “gay disease”, as gay men, bisexuals or men who have sex with men (GBMSM), particularly those with multiple and unknown sexual partners, are the most affected population group worldwide. In addition to all the damage that any stigma entails, when it comes to infectious diseases, stigmatizing population groups adds further damage, as it drives people away from seeking diagnosis, vaccines, and treatment.2, 3, 4 Discriminatory posts make us relive the sad early days of the HIV/AIDS pandemic in the 1980s, which should have been left behind. Fake news also has its share of blame in the movement calling for the name change, as it has led to the death of monkeys in some countries as if they were responsible for the spread of monkeypox.⁶

In response to numerous requests and after consulting experts, WHO announced on November 28 that they will begin to use Mpox to refer to the disease and monkeypox will phase out in one year.^7,8 The new name was an attempt to still refer to poxviruses and the old designation, as well as easy spelling by different languages.

Naming poxviruses and poxvirus-related diseases follow a centuries-old tradition in the field of poxvirus study in which the name of the disease is based on the animal (e.g., monkey) in which the disease was first described. Along these lines, other diseases caused by poxviruses follow similar names, such as swinepox, cowpox, horsepox, camelpox and others, although the true reservoirs are not always the animals that bear the name of the disease.⁹ Therefore, the gradual replacement of names is important because there must be adjustments in the scientific community and in the literature relating 64 years of monkeypox research to the new name Mpox. It is not just a simple name change. In addition, several ongoing clinical trials of monkeypox vaccines and antivirals must update their projects and, more importantly, already licensed vaccines and antivirals must change their labelling and documentation.

Renaming the disease may be a step forward in combating stigma and racism, but our society must take its share of responsibility and severely condemn such unacceptable practices, regardless of the disease name, if we want to live in a sane civilization. The stigmatized and discriminatory actions that took place at the beginning of the HIV/AIDS era are still alive in our memory and no animal is part of the name of the virus or the designation of the disease. Similarly, during the last sylvatic yellow fever epidemic in Brazil in 2017, thousands of monkeys were killed by people who thought they were the origin of the disease, and the word monkey is not part of the names of the virus or the disease in English or Portuguese.¹⁰

On the other hand, there are examples of viral diseases, virus names, and phylogenetic clades of virus groups that explicitly refer to geographic locations or animals without raising prejudicious comments, e.g., the phylogenetic clades of Chikungunya virus, the official designations of Influenza A virus, and several arbovirus-related encephalitis (Eastern equine encephalitis, Venezuelan equine encephalitis, and others). Such references are important for epidemiological studies and for reporting disease prevalence in certain regions. But there are also previous examples of diseases that have their names changed to avoid stigmatization and discrimination with successful results, e.g., trisomy 21, which was previously referred to as Down syndrome and even before as the horrific term Mongolism. In Brazil, leprosy has not been used by the Ministry of Health to designate the disease since 1975, but only in 1995, the term has been officially replaced by Hansen's disease to avoid stigmatization. However, the reference to persons is also not recommended by WHO criteria to name diseases, and others suggest a more neutral name such as mycobacterial neurodermatosis.¹¹ In the end, it is all about being fair and responsible to make our society more respectful of human rights and non-discriminatory towards anyone. Adopting neutral names when discovering viruses and their diseases is the first step, but certainly will not be the final solution unless we change human behaviour.

Declaration of interests

CRD is a member of the WHO Emergency Committee on the multi-country outbreak of Mpox and a member of the ICTV study group on poxviruses. The author declares no competing interests.