The Edmonton Eskimos became the Edmonton Elks, and Confederation Bridge may soon be Epekwitk Crossing. With the fight for social justice that has emerged following George Floyd’s murder at the hands of police officers in Minneapolis come calls to rename schools, streets, and institutions reflecting racist, sexist, or otherwise problematic historical figures and ideologies to reflect current standards and beliefs. This decision seems a straightforward one, as the honouring of an individual in such a manner indicates to some extent, a validation of their actions. However, many worry that treating such action as the end-all-be-all, without further examination of the continued struggles and difficulties faced by minority populations, is nothing more than a novel way for governments and organizations to free themselves of culpability for these issues and skirt any acknowledgement of the injustices still prevalent in modern society. While not nearly as wrought with controversy as the idea of renaming Toronto’s iconic Dundas St — Scottish politician Henry Dundas, its namesake, was staunchly opposed to the abolition of the transatlantic slave trade, the World Health Organization (WHO) decision to rename the decades-old disease formerly known as “monkeypox” to “mpox” following the 2022 outbreak brings to mind many of the same concerns as these more contentious name changes.

The Heart of the “Monkey”

Mpox is a smallpox-like virus transmitted from animals to humans and was initially named for an outbreak amongst lab monkeys in Copenhagen in 1958, though its true animal reservoir is suspected to be small rodents. It has long been endemic (regularly occurring in a relatively controlled manner) to Central and West Africa. In humans, mpox is characterized by a rash and flu-like symptoms, generally appearing within three weeks of exposure. Prior to the 2022 spread of mpox to non-endemic countries such as the United Kingdom, Portugal, Italy, Canada, and the United States of America, occurrence of the disease was rare, and could typically be traced back to close contact with open sores or blisters from infected travelers or transported animals. However, the majority of cases of mpox in non-endemic areas for the current international outbreak have no established connections to travel from endemic areas, and occur in gay or bisexual men who have sex with men (gbMSM).

The removal of the word “monkey” from the name of the disease aims primarily to combat the racist connotations the word carries, given the virus’ endemic nature in several African countries, and concurrently to correct the insinuation that monkeys are the animal reservoir for the virus. Additionally, there is hope that a bland name will reduce the stigma associated with having the disease and avoid discrimination towards the 2SLGBTQI+ community, as was witnessed with the HIV/AIDS epidemic. However, the current mpox outbreak can be arguably traced back to a general neglect within Western medicine of the health of marginalized individuals, such as members of the 2SLGBTQI+ community, and those living in regions considered “far from home,” namely Black Africans. Simultaneously, these individuals are forced to bear a significant portion of the blame for the spread of the disease through biased reporting in Western media outlets. Therefore, this renaming is a crucial first step, but is by no means a definitive solution to the inequalities associated with mpox.

In a Land “Far, Far, Away”

Historical research regarding mpox has been relegated to the category of tropical diseases, which receive less funding and attention than those considered to have a large impact on Western society. Despite the inevitable spread of mpox to Europe and America through travel, there remain an unacceptable number of questions regarding the virus’ epidemiology, diagnosis, and virology. Over the years since the first human instance of mpox, Africa has reported dozens of outbreaks and case numbers in the tens of thousands, all of which have failed to raise alarm outside the continent. The recurrent surges of human mpox in Africa could likely have been arrested if not for the unequal access to vaccines and health care resources faced by those living in the Global South. Meanwhile, a 2003 mpox outbreak in the United States was expeditiously traced back to a shipment of prairie dogs housed next to infected giant pouched rats from Ghana. A ban on the importation of African rodents rapidly followed and the disease was quickly controlled, and subsequently forgotten, with no further efforts made to combat the disease in Africa.

Dr. Dimie Ogoina — the Nigerian physician responsible for the 2017 identification of the first known case of an mpox outbreak in Nigeria (the first case in the country for 38 years), and the first known case of the international mpox outbreak — was summarily told not to worry when he raised alarms that the virus had changed and was now spreading between humans, often through sexual contact. In the intervening five years since Dr. Ogoina’s discovery, international governing bodies could have taken steps to prevent the virus from spreading, not only throughout Nigeria, but to other countries, as we have seen happen over the last year. However, definitive action transpired only when the disease began to affect citizens in Europe and North America. Vaccination efforts for at-risk populations were swiftly mobilized in these continents, leaving Nigerians (and Africa for that matter) in the dust.

Since the outbreak, Western media outlets such as The Independent and CNBC have sensationalized the disease, whether intentionally or not, as an African disease, through the use of imagery depicting mpox blisters on Black skin, even when referring to the spread of the disease amongst their own country’s primarily white population. Propagating the message that Africa is undeveloped and to blame for the current mpox outbreak is overtly damaging to already underserved populations. Such an approach overshadows more important news, such as the root causes for the current outbreak, and is counterproductive to the overall goal of curbing the disease’s spread.

The Here and Now

Current measures to address the spread of mpox are wrought with worry on how to increase awareness without also increasing the stigma and discrimination faced by gbMSM individuals, those currently at the highest risk for mpox infection. Mpox is known to be prevalent in gbMSM communities — a result of coincidence, owing to rapid spread at Pride events in Europe. In addition, its known methods of transmission — close contact with respiratory secretions, skin lesions, and recently contaminated objects, goes hand in hand with sexual intercourse. Public health institutions are reluctant to directly address this, fearful of providing fuel for homophobes or further traumatizing gbMSM. In this instance, the singular fixation on avoiding stigma has backfired, gravely undermining community-based efforts to increase awareness. Shuttering gay establishments and discouraging attendance of 2SLGBTQI+ events will not stop the transmission of the disease. Rather, we must increase awareness of its presentation and encourage self-examination for symptoms to prevent transmission by infected individuals. Reducing stigma towards gbMSM individuals does not begin and end with a name change; more research is needed to explore the impact of mpox-related attitudes on individuals’ willingness to seek out testing for a suspected mpox infection.

It is crucial for public health bodies to explicitly acknowledge the link between the current mpox outbreaks and gbMSM communities — not only to ensure adequate education, but also to address the increased risk of mpox infection faced by people with advanced HIV infection, many of whom in the current outbreak are gbMSM. Rather than the typical pimple or blister-like lesions found in mpox-infected individuals, those with a low CD4 cell (infection-fighting white blood cell) count who are HIV positive experience large flesh-eating patches with the potential of causing secondary infections in the lungs and other organs. While the overall mortality rate of mpox in the current outbreak is less than 0.1%, a study conducted in Mexico found that of 179 mpox-infected patients with a CD4 cell count of fewer than 200 cells per microliter (500 being the typical amount), 27 died, a 150-fold increase from the norm.

Since the onset of the outbreak, advances have been made in the treatment and prevention of mpox. While there is currently no specific treatment for mpox, antivirals developed for the treatment of smallpox are being used to treat severe mpox infections. Additionally, the 2-dose JYNNEOS vaccine is approved for protection against mpox and smallpox infections, and is safe for immunodeficient individuals such as those who are HIV positive. However, similar to the need to prioritize additional resources for African communities, it is essential to ensure the appropriate distribution of treatment and preventative vaccines in 2SLGBTQI+ communities, especially those in less affluent countries.

A Fairy Tale Ending?

The rebranding of Ryerson University as Toronto Metropolitan University does not negate the egregious involvement of Egerton Ryerson in the Canadian residential school system, nor the system’s continued traumatic impact on Indigenous communities in the present. Likewise, removing five letters from the name “monkeypox” will not miraculously cure the systemic injustices responsible for the current outbreak, nor will it alleviate the continued stigmatization of at-risk communities. HIV/AIDS, MRSA, and COVID-19 — in each of these instances, despite leveraging scientific nomenclature, vulnerable groups still became the target of misplaced blame and misconstrued responses. Therefore, this name change must serve as a springboard to explore the factors and determinants that have led to the perpetuation of mpox in African countries and the relative inaction on the research and intervention fronts that precipitated its eventual spread to non-endemic regions. Concurrently, informed and thoughtful care must be taken to ensure that gbMSM populations are not scapegoated for the outbreak’s continuation, and that all at-risk communities have access to the requisite education and clinical treatments to effectively navigate mpox.


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