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Why it's difficult to take politics out of the naming of diseases

2009 outbreak of swine flu
REUTERS/Daniel Aguilar
Passengers wear protective masks as they ride Mexico City's subway during a 2009 outbreak of swine flu.

Spanish flu. Lyme disease. Middle East respiratory syndrome. Legionnaires’ disease. Ebola.

How these — and many other diseases — got their common names has an “ugly history,” as journalist Laura Spinney recounts in a fascinating article published recently in the nonprofit digital magazine Aeon.

“The name of diseases has always been as much about politics and the human need to identify a scapegoat, as it has been about accurately labeling a new threat to life,” writes Spinney. One prominent example, she explains, is Spanish flu:

The world was at war in 1918, and the belligerent nations censored their press, not wanting to damage their populations’ morale. Spain, however, was neutral in that war, and when the first cases of the flu occurred there, they were widely reported. The disease had been in the United States for two months already, and in France for several weeks at least, but that information was kept out of their newspapers. The world came to see the disease as pulsing out from Spain, a belief that was encouraged by propagandists in other countries whom it suited to shift the blame.

Misnaming a disease can also have other consequences, as evidenced by the name initially given to the human immunodeficiency virus (HIV): gay-related immune deficiency, or GRID. That label “not only stigmatized homosexuals,” says Spinney, but also “led to heterosexuals underestimating the risk of unprotected sex.”

An attempt at a solution

To take politics out of the process of naming infectious diseases, the World Health Organization (WHO) issued a new set of guidelines in 2015.

“Disease names would thenceforth make use of generic descriptive terms,” writes Spinney. “These could include symptoms — respiratory disease, for instance, or watery diarrhea. The name might designate an affected group, but in neutral terms — juvenile for a childhood disease, say, or maternal when mothers are involved. It might refer to a season of the year or a bodily system — cardiac or nervous, to name but two. And it would include the name of the agent — streptococcus A, coronavirus, influenza virus and salmonella come to mind.”

But, no matter how well meaning this effort, not everybody thinks it’s a good idea.

Some scientists have complained that the new names would be too bland. Others say they would be too cumbersome and confusing. (Ebola, for example, could be renamed filovirus-associated hemorrhagic fever 1.)

But one group of critics has put forth a truly provocative objection. They have “attacked the whole ethos of the WHO’s undertaking,” writes the European-based Spinney (with British spellings), “arguing that you can’t depoliticise disease names because diseases are themselves political.”

Removing responsibility

One of those critics is evolutionary ecologist Rob Wallace, who is currently a visiting scholar at the Institute for Global Studies at the University of Minnesota. In his 2016 book, “Big Farms Make Big Flu,” he describes how agricultural practices have contributed to the threat of zoonotic diseases (human diseases that have their start in animals). By removing geographical labels from diseases, Wallace says, we essentially let agribusiness off the hook for its central role in the development of those diseases.

Here is part of Spinney’s summary of Wallace’s position:

Wallace acknowledges that the origins of disease are often complex, and makes a distinction between the absolute and relational geography of a disease. The first cases of Ebola were identified in the River Ebola region of what is now the Democratic Republic of Congo. It was named for its absolute geography, in other words, which he agrees was unhelpful. But its relational geography is informative. Ebola emerged where it did in part because of increased contact between humans and the virus’ natural reservoir, bats — the result of deforestation carried out to facilitate logging and mining operations. The situation might have been exacerbated by the dismantling of public health services in the region following years of structural adjustment. Follow the money generated by those operations, trace the structural adjustment loans back to their lenders, and you end up in the world’s financial capitals: London, New York and Hong Kong. “Those are the true Ebola hotspots,” he says.

In masking the relational geography of disease, Wallace argues, the WHO is deflecting discussion of the relationship between the reorganisation of primary industries — particularly food production — and the emergence of new zoonoses. That discussion is an essential precursor to another, about the need to reform our food-production model to prevent future pandemics. “It’s a slow industrial accident that we are witnessing,” he says, “and that we are refusing to do anything about.’ 

Wallace uses similar reasoning with the naming of the so-called swine flu pandemic of 2009. In the media, the disease was sometimes called the “Mexican flu” because the first cases were reported in Mexico. But there’s more to the story, as Spinney explains: 

According to Wallace, it was no coincidence that [that particular influenza virus] emerged at that time and in that part of the world. It was a direct result of the North American Free Trade Agreement (NAFTA), signed in 1992, that abolished protective tariffs to create a free-trade zone in North America. This enabled larger faming concerns to force smaller ones out of business, or drove them to merge, accelerating consolidation and the erosion of genetic diversity in pig herds. There would have been no 2009 flu pandemic, he believes, had there been no NAFTA. The pandemic should therefore have been called the ‘NAFTA flu’.

Addressing the real causes

As Spinney also points out, domesticated birds — not wild birds — are now the greatest threat to humans as a source of emerging bird-flu strains.

“The WHO must reinforce the message — in the minds of decision-makers as well as those of the general public — that humans shape their own disease ecology,” she argues. “One way it can do so is through names, because names have the power to influence human behaviour, and sometimes they are the last vestige of an event that we retain in our collective memory. Those names shouldn’t avoid revealing the origins of the epidemic, but they should do so as precisely as possible. To give a simple example, the WHO could stop talking about “bird flu,” and start talking about “poultry flu.”

As I indicated, it’s a fascinating — and provocative — article.

FYI: You can read Spinney’s article on the Aeon website. Her latest book, “Pale Rider: The Spanish Flu of 1918 and How It Changed the World,” has just been released by the British publishing house Jonathan Cape (now part of Random House).

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