A term, “monkeypox” which “takes on racist connotations”, which “can rekindle these feelings especially against blacks and other people of colour, as well as against members of the LGBTQI community”: with these considerations, last July, the New York City has asked the World Health Organization (WHO) to change the name of monkeypox. The aim, according to what had been proposed, was “to avoid the discrimination that would lead those who fall ill to isolate themselves instead of seeking the necessary treatment”. Now, four months later, WHO has decided: following a series of consultations with global experts, it will start using the new term “mpox” as a synonym for monkeypox. Both names will be used concurrently for one year while “monkeypox” is phased out.
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“Racist and stigmatizing language”
As the monkeypox epidemic broke out in early 2022, some communities reported to WHO “the online use of racist and stigmatizing language”. And, in the course of various meetings, both public and private, the knots came to a head: some countries expressed concerns and asked the WHO to propose a solution to change the name.
It must be said that the assignment of names to new diseases and, exceptionally, to existing ones, is the responsibility of the World Health Organization: it is foreseen pursuant to the International Classification of Diseases (ICD) and the Family of WHO International Health Classifications and should be implemented through a consultative process that includes Member States of the Organization.
Consultations with experts
We have moved on this track. WHO, in accordance with the ICD update process, has held consultations to gather the opinion of experts, as well as countries and ordinary people, inviting suggestions, i.e. new names to choose from. At the end of the discussion, which also involved the director general of WHO, Tedros Adhanom Ghebreyesusthe choice has been made.
The decision provides for the adoption of the new English synonym “mpox” for the disease, which, after a transitional period of one year, will replace the definition “monkeypox”. This should serve to mitigate concerns raised about the confusion caused by a name change in the midst of a global epidemic. And at the same time it ensures the margin to complete the process of updating the ICD and updating WHO publications.
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The name replacement procedure
Therefore, the definition “mpox”, in the coming days, will be included online in the ICD-10. It will be part of the 2023 official version of ICD-11, which is the current global standard for health data, clinical records and statistical aggregation. However, the term “monkeypox” will remain searchable in the ICD, to match historical information.
But what were the recommendations that led to the replacement of the virus name? There has been talk of “scientific adequacy”, “extension of current use”, “pronounceability”, “usability in different languages”, “absence of geographical or zoological references” and “ease of retrieval of historical scientific information”.
Accelerated the name change process
It should be emphasized that while the ICD update process can normally take several years, in this case, it has been expedited, while still following the standard steps. In particular, various bodies were heard during the consultation process, including experts from the medical-scientific and classification and statistics advisory committees, made up of representatives of government authorities from 45 countries.
The question of the use of the new name in various languages was widely discussed, and the term “mpox” seemed to fully respond to this purpose. Therefore, WHO will adopt it in its communications and encourages doing the same “to minimize any negative impact during the procedure”.
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The name of the disease
Human monkeypox received its name in 1970 (after the disease-causing virus was discovered in captive monkeys in 1958), before the publication of WHO best practices in disease naming in 2015. According to the latter, the new disease names should be given with the aim of minimizing the unnecessary negative impact of the names on trade, travel, tourism or animal welfare and avoid causing offense to cultural, social, national, regional, professional or ethnic.
The group of experts convened by the WHO
Last August, a group of experts convened by WHO agreed on new names for variants of monkeypox virus, as part of ongoing efforts to align the definitions used for the disease, virus and variants of monkeypox monkeys – or clades – to current best practices. Thus, consensus was reached to refer to the former Congo Basin (Central African) clade as Clade one (I) and the former West African clade as Clade two (II). Finally, it has been agreed that Clade II consists of two subclades, IIa and IIb.
The virus continues to hold back
Meanwhile, the epidemic continues to slow down. According to the latest update from the World Health Organization, 1,090 infections were recorded in the world in the week between 14 and 20 November, 3.7% less than the previous week, when there were 1,132. Overall, since the beginning of the emergency, there have been 80,646 cases distributed in 110 countries; 53 deaths. In the week under review, more than 90% of infections (1,041) occurred in the Americas; 46 occurred in Europe with a 45% decrease from the previous week, 3 in the WHO Western Pacific region.
No changes in the type of infections are reported: “With the exception of West and Central African countries, the current mpox epidemic continues to affect primarily men who have sex with men who have reported recent sex with one or more partners – emphasizes the World Health Organization -. There is currently no signal to suggest sustained transmission outside these networks.”