How are new diseases named?

An infamous disease takes its name from some of its first victims, at an American Legion conference in Philadelphia. Another is inspired by a forest in Uganda where it was discovered; a third the quaint Connecticut town where it was first found.

This week it emerged that the World Health Organization was considering giving monkeypox a new label, because it turns out a lot is in a name.

“Naming is important because it can influence what people understand about the disease,” says Samantha Yammine, a neuroscientist and science communicator from Toronto, known as Science Sam on social media. “The real risk, then the stigma that we have around the world.”

Researchers have long struggled with the art and science behind naming a new infectious disease or virus. Many come historically from a place or group of people where it was first discovered (Legionnaires, Zika, Lyme).

It can be difficult to find an accurate tag without ending up with a tag that looks like a Wi-Fi password. And from COVID variants to monkeypox to future emerging pathogens caused by the climate emergency, it’s suddenly a topic burning.

An attempt at fantasy can backfire. For example, in the early 1980s, two researchers discovered a new gene in fruit flies which they called “Sonic Hedgehog”. It was great, Yammine said, until scientists discovered that this gene also played a role in cancer in humans.

A name should never be misleading, Yammine added. This is part of the monkeypox problem.

Tulio de Oliveira, director of the Center for Epidemic Response and Innovation at the University of Stellenbosch in South Africa, is among a group of scientists who have signed a open letter on the urgency of renaming this disease last week. The Director General of the WHO, Dr. Tedros Ghebreyesus responded that the agency is working with partners and experts on this and will make an announcement on a new name soon.

Monkeypox was first discovered in laboratory primates in the late 1950s, but rodents have actually been the primary vector for transmitting the disease to humans in the past, de Oliveira said over the phone from Brazil.

Most transmission in West and Central Africa was animal-to-human, while these new outbreaks in North America and Europe (including more than 150 confirmed cases in Canada) were human-to-human, he added.

There is a two different kinds monkeypox, including the so-called West African clade and Central African (or Congo Basin) clade; many media have used photos of Africans with monkeypox to illustrate stories about outbreaks in Europe and North America.

Naming viruses after countries, regions or groups of people can cause economic damage, but “we also risk that some countries choose not to publicize a pathogen or a new variant because then it gets a negative connotation “, added de Oliveira.

It happened with the Omicron variant – first discovered by a team of South African scientists, including de Oliveira himself – who shared this vital information with the world, only to see the country come up against travel bans.

Also, this variant is only dubbed Omicron because, while the WHO was going through the Greek alphabet to name COVID variants, it skipped two letters: “Nu”, because English speakers would confuse it with “new”. and “Xi”, because it is a common surname (and, coincidence or not, that of the leader of China, Xi Jinping).

“I think renaming viruses with non-discriminatory geographic regions is something that’s overdue,” de Oliveira added.

Imagine if the first cases of the recent outbreak had been discovered in Canada, he said: “Would Canadians be comfortable with us calling it the Canadian smallpox virus?”

Since it was primarily found in Africa, the term monkeypox also has racial undertones, “when you think of how black people like me might be compared to monkeys by someone who is racist,” Dr. Boghuma Titanji, assistant professor of medicine and infectious disease physician and virologist at Emory University in Atlanta.

She’s avoided TV appearances on the subject, despite being an expert, to avoid offering “low-hanging fruit” to trolls, so she’s glad it seems the name is on the point to change, but she is also “a little frustrated that it is only considered” now that rich countries outside Africa are affected.

The World Health Organization has already put in place guidelines on name new infectious diseases, including that they be “short and easy to pronounce” and descriptive, but do not include geographical locations, animals, or “terms that incite undue fear”, including “death” and “fatal”. Unfortunately, “human monkeypox received its name before the current best practices“said a spokesperson in an email.

And it gets complicated.

The spokesperson added that the naming and classification of viruses is the responsibility of the International Committee on Taxonomy of Viruses, a group of global experts focused on this task, which is how the world ended up with SARS-CoV-2 (the virus) and COVID-19 (the disease it causes).

Viruses and diseases can carry their own mark. The Plague, also sometimes called the Black Death, killed millions in the Middle Ages and can still inspire panic, although it can now be treated with modern antibiotics.

It’s ‘quite appropriate’ to think critically about the names of infectious diseases, at a time when the names of schools, streets and other institutions are all under the microscope, says Dr. Fiona Smaill, professor of diseases infectious diseases and microbiology at McMaster. University.

But it’s a “balance,” she said, because you want an easy-to-remember name and “if you give it too many letters and numbers, you’ll lose the ability to communicate.” (The monkeypox renaming open letter uses the possibly unwieldy “hMPXV” placeholder tag, but the scientists also “urge a quick decision and adoption of a new name” .)

Over his 40-year career, Smaill has dealt with many viruses, and each has its own story. “You don’t want to lose the story,” she added.

But she also saw very bad names. In the early 1980s, AIDS was dubbed gay-linked immune deficiency because it first manifested itself in communities of men who have sex with men.

The name HIV (human immunodeficiency virus) now clearly indicates that anyone can catch it.

A good example of this good balance, said Titanji, was the WHO’s decision to replace the character string of the first variants (remember B.1.1.7.?) with letters of the Greek alphabet.

She hopes the attention to monkeypox could lead to reopening discussions about the names of other diseases, such as Ebola – named after a river in the Democratic Republic of Congo – and Zika.

“The powers that be can certainly be much more proactive in renaming other pathogens that are just as problematic,” she said.

“I think there is a window of opportunity here for the WHO to take leadership on this.”

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