Misinformation and Monkeypox

To start with, there is that name, Monkeypox. Just say the name and miscommunication has begun.

“It got its name, monkey pox, not because it’s particularly associated with monkeys, not because monkeys are the primary host,” explained Dr. Bruce Y. Lee of the CUNY School of Public Health. “But they happened to find it in monkeys that were in a laboratory.”

This was in Denmark, in 1958.

“It was just that. That’s how it got that name. And unfortunately that name stuck, because no one decided to rename it.”

The problem is pretty obvious of naming a disease that is endemic in West and Central Africa after monkeys (even though its actual animal reservoir is probably among African squirrels and rodents).

This is no doubt why the African Foreign Press Association asked news organizations to stop running pictures of Africans with their stories about how the disease is now spreading rapidly in Europe and The United States, disproportionately among men of all races who have sex with men.

Mayor Eric Adams and others have asked the World Health Organization to rename the virus. But that’s unlikely to make much difference in the immediate crisis of communicating about this new epidemic, which the Biden administration declared a public health emergency Thursday.

Repeating Mistakes

Lee was speaking at a symposium on “how communications can prevent misinformation and stigma” around Monkeypox. Or to say it another way, how to avoid repeating the mistakes made around HIV/AIDs and COVID-19.

“Unfortunately, Monkeypox is yet another example of an infectious disease that could lend itself to the quick spread of misinformation as well as stigmatization of demographic groups and communities,” warned Dr. Ayman El-Mohandes, dean of the CUNY School of Public Health. “Our ability to deal with the spread early and effectively should not be deterred with misinformation and stigmatization that could disenfranchise victims and discourage them from seeking care. Concerted efforts to prevent and stem out any misinformation leading to unwarranted and unfair stigmatization is part and parcel of any effort to confront this new epidemic.”

El-Mohandes was convening the symposium, a presentation of the Pandemic Response Institute, a joint project of CUNY and Columbia University to better prepare the city for future health challenges, or in this case to respond better to a new and very immediate crisis.

The symposium clearly illustrated the dilemma, as participants wrestled with how to talk honestly about a disease that was currently spreading through networks of gay and bisexual men without propagating the idea that this is a “gay disease.”

“We went through this with HIV,” said Donald R. Powell, senior director of Exponents Inc, which supports HIV/AIDS patients and those struggling with substance use and other issues. “HIV was laid squarely at the door of the gay community. For 30, 40 years we’ve been trying to live this down. So now here comes this thing.”

Avoid Stigmatization

Public health officials described a fine line they had to tread to avoid stigmatization while also creating rules to ration scarce vaccines, tests and treatments to those at highest risk.

For example, Powell noted “pushback” when, in arranging vaccine appointments, he asks a question required by the health department about sex partners in the past 14 days. Multiple sex partners appears to be a risk factor, even though, as Lee noted, Monkeypox is not considered a sexually transmitted disease, as such.

“Monkeypox is not the same as gonorrhea,” Lee explained. “It’s not the same as chlamydia. It’s not the same as other sexually transmitted infections that are exclusively transmitted via sex ... exchange of bodily fluids during different types of sex. Here we are talking about a virus that can spread via close physical contact. That can be any type of close physical contact. Like if you happen to be a caregiver for someone. Or you happen to be in the same apartment or roommates. Monkeypox really spreads through a close social network, any close social network.”

Researchers say the virus spreads through prolonged skin-to-skin contact, as well as through bedding and clothing and, sometimes, through large droplets traveling short distances.

“It is important to say that anyone of any sexual orientation or gender identity can be infected with Monkeypox,” said Dr. Julian L. Watkins, health equity adviser to the New York Department of Health and Mental Hygiene. “With this increasing spread of Monkeypox in the general community we really do want to emphasize that anyone can get it.”

“Skin-to-Skin Contact”

Indeed, the first person ever diagnosed with Monkeypox outside Africa was a three-year-old Wisconsin girl who got it in 2003 from her pet prairie dog, who contracted it from a rodent from Ghana kept in the same cage by a Texas animal distributor. The prairie dog died, but the little girl recovered.

Having made the point that anyone can get it, Watkins described the present reality when asked for a definition of close physical contact.

“That’s a great question. Close physical contact is really skin-to-skin contact. What we are seeing from some of the case investigation internationally and even in the United States – we’ve seen that a lot of folks have gotten them in certain places with crowded, cramped conditions. A lot of folks were in places where clothing may have been optional. So close physical contact meaning skin-to-skin contact, prolonged.

“We don’t think this is something that can be spread through a casual handshake, or touching a door knob or brushing against someone. One of the closest forms of physical contact is sexual contact. So I think that’s why we are seeing spread through that mode of transmission is most common. But there are multiple things that can reach the definition of close physical contact.”

Lee pointed out that most public health departments don’t have the resources to invest in better communications to explain complicated situations like Monkeypox and head off stigmatization before it takes hold.

“If this had started in any other group then it could be associated with that group,” he said, stressing that “right now we are seeing more cases among men who have sex with men, but that might be just a social network effect.”

“It just happened to spread more extensively within one particular social network, but it shouldn’t be just associated with that network.”

Businesses, he noted, plan far ahead for communicating their release of a new product. But public health officials don’t prepare in advance their messaging for the inevitable arrival of new pathogens.

“We as a society really have to start investing further in this type of communications strategy,” he urged.