Why Scientists Should Not Name Diseases Based On Location

May 12, 2021

When the world should have been banding together to fight a pandemic, stereotypes drove people apart. As COVID-19 began to circle the globe, so did the term "Chinavirus," perpetuating derogatory attitudes against the country, its customs and its people. While associating the disease with its suspected origin in Wuhan may have been necessary for initial surveillance, the derisive misnomer soon became fuel for conspiracy theories and increased racially-charged bias. A hashtag appeared on social media among those of Asian heritage: "IAmNotAVirus." Following news reports of tragic hate crimes, the White House issued a memorandum  in January 2021 condemning COVID-19 based racism, stating the rhetoric "defied the best practices and guidelines of public health officials" and "stoked unfounded fears and perpetuated stigma." These were the very things the official names SARS-CoV-2 and COVID-19 were designed to avoid.

Disease names often incorporate geography, referencing place of discovery or suspected origin, areas of high risk or major outbreak sites. While identifying a disease by location may seem harmless —maybe even helpful — these types of names can tarnish cultures and communities, particularly if those connections are not accurate. This is true in many cases: Marburg virus did not originate in GermanyWest Nile virus is not restricted to Africa and though Valley Fever (coccidioidomycosis) refers to a 1930s outbreak in the San Joaquin Valley of California, the first case was reported in Argentina in 1892. To minimize such misinformation and its socioeconomic impact on communities, the World Health Organization (WHO) issued new best practices in 2015 advocating more generic, descriptive terminology. However, in the era of social media, "viral" names created outside the scientific community tend to stick.

Examples of diseases with names based on location.
Examples of diseases with names based on location.
Source: CDC , WHO

How Viruses and Diseases Are Named

Dr. Stanley Perlman, a microbiology professor at the University of Iowa who has studied coronaviruses for over 38 years, serves on the International Committee on Taxonomy of Viruses (ICTV) subcommittee responsible for naming the virus causing the current pandemic. The virus, SARS-CoV-2, was named solely due to its genetic similarity to the virus that causes Severe Acute Respiratory Syndrome (SARS), Perlman said, explaining that referencing the genetic makeup helps researchers develop diagnostics and tests. The ICTV is independent from the International Classification of Diseases, which serves to standardize health records among care providers, researchers and medical insurance companies. WHO manages ICD following guidelines developed with the World Organization for Animal Health and the Food and Agriculture Organization of the United Nations. The selected public-facing disease name, COrona VIrus Disease, refers to symptoms and its year of discovery, while attempting to disassociate from the public fear and stigma associated with the SARS outbreak in Asia in 2003.

Perlman also served on the ICTV when Middle East Respiratory Syndrome (MERS) was named in 2011. The term was never meant to be pejorative, but did raise some thought questions among the committee, according to Perlman. At the time, the name made sense, he said, as the disease had only been reported in that area. However, those who were infected with MERS were reluctant to seek treatment, and Perlman suspects this was likely because of guilt and stigma. "There is a long history of naming diseases after places, but no one would do that today—if there’s a risk (of alienating a culture), why would you do it?"

What are the consequences of this type of naming? Associating a location with a disease or pathogen puts the onus on the country or government to "do more." Local economies, especially those dependent on tourism, can be devastated once associated with a disease, as was the case with the pig farming community in Kampung Sungai Nipah, Malayasia. Devastating rural farmers, the "Nipah" virus resulted in the slaughter of over 1 million pigs and Singapore placing a ban on pig imports from Malaysia - which is still in effect despite the absence of the virus from the area since 1999. In addition, the way diseases are named can invite miscommunication about transmission and prevention. For instance, pigs merely served as a passthrough host for the Nipah virus; the true reservoir is bats.

Maps of ongoing transmission versus origin for 6 diseases.

A History of Name Shaming

Cepheid Senior Director of Medical Affairs Dr. Michael Loeffelholz has published multiple articles on "Taxonomic Changes for Human and Animal Viruses," covering periods of time before and after the 2015 WHO guidelines. The COVID-19 related racism is somewhat of an anomaly, he said, perhaps a manifestation of the political climate and the U.S. relationship with WHO at the time. "Unfortunately, people are politicizing these names... in an attempt to put the blame on others and say it’s someone else’s fault instead of focusing on the important issues, such as addressing a pandemic"” he said, emphasizing the preference for names based on physical structure or genetic makeup rather than geography. However, the latest pandemic is not the first time this politicization of disease has occurred.
Perhaps the best-known disease misnomer is the "Spanish flu," which despite its name, may have originated in the U.S. before spreading worldwide. The pandemic struck a world in the midst of an international war (World War I), during which many other European countries were subject to news blackouts that censored out stories about the flu to keep morale high. As a neutral country with a free media, Spain was the first to report on the outbreak, causing many to falsely believe the flu had originated there. (Interestingly, the flu was called “French flu” in Spain.) Similarly, the term "German measles" arose from inconsistent terminology following its initial description by its German discoverers as Rötheln (red). The corresponding virus, (now called rubella) has no relation to Germany, nor the actual measles virus. Despite this, the U.S. renamed the disease "liberty measles" to stoke anti-German sentiment and strengthen U.S. patriotism during World War I.

Conversely, there are incidences in which disease names have been specifically selected to avoid placing stigma on a given community. Taking lessons from stigmatization of the Lassa virus, scientists named Ebola virus for a nearby river to mitigate impact on the village where it was discovered. Likewise, when a hantavirus with 50% mortality was described in rodents in the Four Corners region of the U.S., politicians reportedly voiced opposition to a name that would associate their state with the virus. As a compromise, the scientists termed the virus "sin nombre," translated to “no name.”

Suggestions for Future Nomenclature

Loeffelholz thinks there is little, if any, benefit to naming diseases after places, especially in today’s interconnected world where microbes defy borders. "Global travel has exploded in ease and amount; for many of these diseases the place of origination is in fact irrelevant," he said. Changing climate conditions are also altering and expanding the range of ticks, mosquitoes and other vectors, bringing tropical diseases to areas they have not historically been found. "We really need to focus away [from] using geographic origins in the nomenclature and choose names for viruses that are more relevant to their physical structure or the disease they cause," he said.
Perlman agrees from a social, as well as a scientific perspective, citing confusion between the scientific community and media over emerging COVID-19 variants. WHO now identifies variants by names and numbers reflecting technical aspects of each strain. However, the public or media may find these designations arbitrary or confusing and opt for the simple, albeit misleading, geographic terms instead. "For example, the U.K. strain is B.1.1.7 while the South African strain is B.1.351. There are already several versions of the U.K. strain, so calling it the U.K. strain is both a problem for the reasons discussed and for specificity," Perlman said. Organizations like the Association Press (AP) have attempted to provide terminology for media outlets, though the challenge to remain both accurate and easy-to-understand has resulted in frequent changes.

Editor's Note: In May 2021, WHO announced a new naming system for COVID-19 variants based on the Greek alphabet and their order of detection. According to The Guardian and other media outlets, this decision was made after months of discussion among WHO experts on best ways to reduce stigma and misinformation.

Map of COVID-19 Variants
Phylogeny map showing evolutionary relationships of SARS-CoV-2 viruses from initial emergence in Wuhan followed by sustained human-to-human transmission at a global level.
Source: Nextstrain.org

Scientific societies like ASM have the expertise and responsibility to serve as trusted, accurate nonjudgmental resources for the public and for press. The way scientists speak about their topics of study has far-reaching consequences, and it is important to address misconceptions and gaps in knowledge. Since the coronavirus pandemic began, ASM has strived to provide useful and evolving information on our COVID-19 resources page and will continue to provide updates as they arise.

Author: Ashley Mayrianne Robbins, MELP

Ashley Mayrianne Robbins, MELP
A. Mayrianne Champagne is a Communications Manager at the National Geographic Society.