Name-calling is Not Helpful for Pandemic Risk Reduction

Written by Peter R. Jutro, PhD

The recent name-calling regarding COVID-19 (Wuhan virus, Chinese virus, or Kung Flu) is hardly without precedent, but certainly not helpful for preventing the next pandemic.

History provides us with many examples of nations attempting to shift blame for disease problems. Although the 14th Century Black Death, or Black Plague’s Yersinia Pestis bacterium most likely moved westward from Asia to Europe along the Silk Road, it never acquired a geographic name.  Perhaps the earliest disease to become the cause of international blame-shifting, took place in the 15th and 16th centuries, when many countries tried to assign responsibility for one particular disease to other countries. 

Syphilis is widely believed to have been brought to Europe through the return of Columbus’s ships to Spain from the New World, but whatever its origin, it was probably first spread throughout much of Europe in 1494 and 1495 by the army of King Charles VIII of France. Girolamo Fracastoro, a Veronese scientist and poet who named the disease ‘Syphilis’, and was one of the first to suggest that  individual diseases had specific causes, called it the ‘Morbus Gallicus’. The Germans and British also called it the French disease, the Russians called it the Polish Disease, the Danes called it the Spanish Disease, the Turks called it the Christian Disease, and in India, the Moslems blamed the Hindus and the Hindus blamed the Moslems.  

These assignments of ethnic blame were not confined to the disease itself, but even extended to treatments. At the time, the wood of the lignum vitae tree, known as “Holy Wood”, was widely, albeit inaccurately, believed to be a cure for syphilis, and was imported into Europe from the New World.  By 1600, an extensive traffic also appears to have developed in “pseudo” or fake lignum vitae, mostly imported from Africa. In 1602, Demetrio Canevari wrote a lengthy polemic, in which he attempted to prove that “pseudo legno pernicioso,” or dangerous fake wood, was on the Italian market, “brought to Rome from the north, where evils always come from”.

Similarly, the 1918 Influenza pandemic became known as the Spanish Flu. Why Spanish? The disease began during World War I, when in neutral Spain, a free press reported on cases that arose in the country. Because of the war, other counties censored reporting, thus allowing the impression that they were unaffected. Not only is there no evidence that the disease originated in Spain, but the first recorded case appears to have been identified in Kansas.  The Spanish, however, called it the French flu, not the American Flu.

At one level, one might assume that there is nothing intrinsically wrong with identifying a disease with a geographic reference if one is certain of the location of origin. At another, however one must recognize that over history such naming often has been used in order to engender resentment and antagonism, or to abjure responsibility for consequences. The Asian flu of 1957 was first identified in east Asia, Hantavirus, a rodent borne disease, was named after the Hantan river in S. Korea after a mid-1970s outbreak there. Russian flu was so named after a case was described in 1889 in Bukhara in the then Russian Empire. Zika virus, a mosquito borne virus, was named after the Zika Forest in Uganda following a 1947 outbreak. MERS or Middle East Respiratory Syndrome, a bat and camel borne virus, was first reported in Saudi Arabia in 2012. Lassa virus was first described from a 1969 case in Lassa, Nigeria. Lyme Disease, a tick borne bacterial disease was first diagnosed in 1975 in Old Lyme, CT, and 1994’s outbreak of Hendra virus, a flying fox and horse borne disease, was named after a 1994 outbreak in Hendra, a suburb of Brisbane, Australia. 

As time passed, however, some scientists became sensitive to the potential hazard of identifying a specific place as the site of origin of a disease. West Nile virus, a bird and mosquito borne virus first observed as a hemorrhagic fever in 1937 in Uganda, was later named after the less specific sub-Saharan branch of the Nile River. The MERS appellation was said to have adversely affected the economies of several Middle Eastern countries.  For fear of dangerously stigmatizing the residents of Yambuku, Zaire, one of two places where an emergent viral disease was first identified, in 1976 researchers named it after the less location-specific Ebola River. Such nomenclature hazards are not hypothetical.

 The 1900 bubonic plague outbreak in San Francisco was widely blamed on Chinese immigrants, as the first case was diagnosed in the city’s Chinatown. This led to extensive discrimination against Chinese residents, a quarantine of Chinatown, and suppression of disease information by the California State government which tried to prove that the disease was peculiar to Chinese people. The Governor of California, Henry Gage, when told of the plague diagnosis, rejected the conclusions of local and federal scientists who determined the disease to be bubonic plague, out of fear that this information would be a political liability and interfere with the state’s economy. Even the Surgeon General of the United States, Walter Wyman, described it as an “oriental disease”. Similarly, widespread incidents of racial harassment against people with Asian features have been reported around the world in response to the current COVID-19 pandemic.

As a result, it seems clear that demonizing the countries or blaming or shaming their governments or their inhabitants can only frustrate any efforts at achieving what is absolutely necessary international cooperation.  We have already seen a worrisome reciprocal effort on the part of some Chinese officials to shift blame for the COVID-19 pandemic to the United States. The extent of near-term American dependence on trade with China should not be minimized; the country is a critical element of the US supply chain for drugs, diagnostic components, and personal protective equipment. Following political philosophies based on unilateralism, isolationism, and xenophobia can only serve to alienate other governments, reduce their willingness to cooperate, and thus increase the risk of a future emergent disease.

In 2015, having seen the consequences of geographic naming of diseases, and recognizing that social media could spread misleading information quickly and broadly, the World Health Organization (WHO) issued an advisory stating that whoever first reports on a newly identified human disease should use a name that is “scientifically sound and socially acceptable”, and specifically notes that geographic names (as well as people’s, occupational, or animal names) were not to be used. WHO recommended that the naming first used for identification of a new disease should include the causative organism and information about the symptom expression of the disease. WHO made clear that this was a best-practice recommendation for the first public reference to an emergent disease, but that a formal name would be assigned using the International Statistical Classification of Diseases and Related Health Problems, a process managed by WHO. Accordingly, the causative organism for the disease COVID-19 was labeled SARS-CoV-2.

Addressing future risk reduction is more than a matter of not trying to shift responsibility and blame. We need to work to ensure that a mechanism is put in place to foster necessary international cooperation. We already know that such pandemic diseases tend to emerge as a result of practices such as deforestation, land fragmentation, trade in wild and endangered species, and the bushmeat trade, that allow viruses or bacteria to more easily transfer from animals to humans. Efforts to achieve cooperation have existed in the past, particularly through United Nations organizations including the World Health Organization (WHO) and its Global Outbreak Alert and Response Network, the Food and Agriculture Organization (FAO), and the United Nations Environment Program (UNEP), but for the most part, as a result of those agencies’ specific mandates, their approaches have been understandably stove-piped.  We must also remain aware of the critical fact that that these international organizations are absolutely dependent on the transparency and cooperation of member nations’ governments, and we must be prepared to decide how to deal with these potential obstacles.

Attempting to plan for an uncertain, event – a pandemic – that might take place at an undetermined future time is extremely difficult, both intellectually and structurally. Not only will we need the involvement and cooperation of a possible country of origin, but we must realize that long term strategic thinking is not easy; it is also difficult to come up with an organizational structure that would allow people to undertake preparation for an event that may not occur for decades. Traditional organizations are evaluated and supported based on their ability to produce near-term results. That will not work here. One example of a attempt to address long-term issues might be the US Department of Defense’s Office of Net Assessment, whose charge, since 1973, has been to look 20 to 30 years into the future of the military. There are, no doubt, several others.

As sensible as existing mechanisms may be, the extent to which we were unprepared for a pandemic of the magnitude of COVID-19 does make clear that effective, stable mechanisms to achieve these public health risk reduction ends have not yet been indestructibly institutionalized. This is not a time to antagonize those with whom we will have to cooperate. Rather, now is the time to begin to design a cooperative review and planning process that holds the promise of success.

Dr. Peter Jutro is a retired scientist who worked for a total of four decades in the legislative and executive branches of the US government.