The World Health Organization (WHO) mostly works to reduce the physical toll of disease. But last week it turned to another kind of harm: the insult and stigma inflicted by diseases named for people, places, and animals. Among the existing monikers that its new guidelines “for the Naming of New Human Infectious Diseases” would discourage: Ebola, swine flu, Rift Valley Fever, Creutzfeldt-Jakob disease, and monkey pox. Instead, WHO says researchers, health officials, and journalists should use more neutral, generic terms, such as severe respiratory disease or novel neurologic syndrome.
Many scientists agree that disease names can be problematic, but they aren’t sure the new rulebook is necessarily an improvement. “It will certainly lead to boring names and a lot of confusion,” predicts Linfa Wang, an expert on emerging infectious diseases at the Australian Animal Health Laboratory in Geelong. “You should not take political correctness so far that in the end no one is able to distinguish these diseases,” says Christian Drosten, a virologist at the University of Bonn, Germany.
Naming diseases has long been a fraught process. Badly chosen names can stigmatize people, as did gay-related immune deficiency, an early name for AIDS. They can also lead to confusion and hurt tourism and trade. The so-called swine flu, for instance, is not transmitted by pigs, but some countries still banned pork imports or slaughtered pigs after a 2009 outbreak. More recently, some Arab countries were unhappy that a new disease caused by a coronavirus was dubbed Middle East respiratory syndrome.
Although “it’s usually scientists who come up with these names … the WHO gets the diplomatic pressure” if someone takes offense, Drosten says. The new guidelines, released 8 May, aim to smooth the process. “The WHO had to do something to take itself out of the firing line,” Drosten says.
Given that news of a new pathogen often spreads quickly, “it is important that an appropriate disease name is assigned by those who first report” the disease, WHO's guidance notes. Following the guidelines, it adds, could “minimize unnecessary negative impact of disease names on trade, travel, tourism or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional or ethnic groups.”
To that end, new disease names should not include geographic locations; the names of people, occupations, animals, or food; or “terms that incite undue fear” (such as unknown, fatal, and epidemic). Instead, the names should use generic descriptions of symptoms (respiratory disease or watery diarrhea) and specific terms describing patients, epidemiology or the environment (juvenile, maternal, seasonal, summer, coastal), as well as pathogen names and arbitrary identifiers (alpha, beta, 1, 2, 3).
The group that came up with these recommendations met “more than a few times” over the course of a year, says Kazuaki Miyagishima, director for food safety, zoonoses, and foodborne diseases at WHO, and a member of the panel. Among the ideas they discussed: naming diseases after Greek gods, using a system similar to the one used to name comets or alternating male and female names as is done with hurricanes.”But while naming a hurricane Katrina may not offend people, if we do it for a disease, it’s not just a hurricane for 1 week. It will make its way into the history of human suffering," Miyagishima says.
The guide is well intentioned, but goes too far, says Ian Lipkin, a virologist at Columbia University. “I don’t see how it will be helpful to eliminate names like monkey pox that provide insights into natural hosts and potential sources of infection,” he says.
It could also become harder to easily distinguish diseases. For instance, under the new rules, Marburg disease (named after a city in Germany) might have been called filovirus-associated haemorrhagic fever 1, while Ebola (named after a river) might have been filovirus-associated haemorrhagic fever 2. Such bland names “lose something that is more than just quaint,” says Howard Markel, a medical historian at the University of Michigan in Ann Arbor. Drosten adds that geographic names are sometimes justified. It was clear that MERS, for example, was associated with the Middle East. “Would it have been better if we had named it novel betacoronavirus clade C, type 1?” he asks.
The new rules make for more difficult names, Miyagishima admits. “But we think we have left a fairly large area for freedom. We do not want to kill the creativity of researchers completely.”
Linfa Wang knows all about the difficulty of naming diseases. Two decades ago, he named a virus and the disease it causes after Hendra, a suburb of Brisbane, Australia; he still gets angry calls from residents complaining that the name has hurt property values. These days his strategy is to “go small.” Recently, he named a new henipavirus isolated in a neighborhood called Cedar Grove simply Cedar virus.
Virologists encountered other sensitivities with Norwalk virus, named for a city in Ohio. The pathogen is the only species in the genus Norovirus and usually that name is used. In 2011, however, a Japanese individual asked for a change because many people in Japan carry the surname Noro. The International Committee on Taxonomy of Viruses recommended using "Norwalk virus” instead.
Acronyms are another good solution, says Ab Osterhaus, a virologist at Erasmus MC in Rotterdam, because they keep names short (another WHO recommendation) and people often forget what the letters stand for. But even acronyms can cause controversy. In 2003, WHO officials coined SARS (severe acute respiratory syndrome) to describe a novel pneumonia spreading in Asia, partly to avoid a name like “Chinese flu.” SARS did not go down well in Hong Kong, however, which is officially known as Hong Kong SAR, for special administrative region.
Giving new diseases a number may be the only way to avoid such issues, researchers say. There is precedent. Growing up in China in the late 1960s, Wang remembers that diseases had digits. “I was really scared of number 5 disease,” he recalls. “I don’t know why, you just really did not want to get disease number 5.”