Monkeypox and the Dangers of "Stigma Power"

by Alexandra Brewis and Amber Wutich

Tired as all we are of pandemic life, the science and history of infectious diseases show that new ones will continue to emerge, and old ones can easily resurge. In 2022, monkeypox is on the rise, identified as a global outbreak with cases in multiple countries (with the U.S. currently leading).

Most of these laboratory-confirmed cases are in persons identifying as male and gay or bisexual, with the primary mode of transmission (probably around 95 percent of cases) presumed to be sexual. On this basis, most of the current anti-monkeypox response of nations and agencies like the World Health Organization has focused on delivering public health advice to those who identify as gay and bisexual and men who have sex with men. This also means 5 percent of cases are outside this group, including children—but recognizing widening risk is not the focus of current efforts.

In a commentary published this week in The Lancet–Europe, bioethicists have also raised concerns about how this dangerously ignores the international sociopolitical realities faced by LGBTQ+ persons. In many countries, there is political hostility, criminalization, and denial of human rights. As the initial reactions to HIV/AIDS in the 1980s show—especially clearly in retrospect—public and political stigma toward those most at risk means delays and even avoidance of timely intervention in prevention and treatment efforts, with many unnecessary deaths in the interim.

Multiple medical conditions are stigmatized, not just emerging diseases. People living with diseases as diverse as diabetes, acne, bipolar disorder, and chronic back pain report the suffering that comes from being devalued and rejected by others simply because they happen to contract a disease that others are scared by or believe is somehow “their own fault.”

One of the most crucial aspects of public stigma, however, is that it not only blocks individual people’s access to medical treatment or denies them needed social or economic support (although both can be devastating). It also can be leveraged by those with power, like politicians, as a means to advance their own agenda. This year there have been efforts to deploy public fear of monkeypox to legislate against Pride events in Latvia, ban LBGTQI+ identities in Iraq, and curtail children's exposure to these identities in the U.S.

The Lancet–Europe commentary provides recommendations for how to respond better to the disease. “Better” means using a toolkit for preventing further spread and limiting stigma around the disease. This includes formally renaming the disease (to something less scary), clarifying that monkeypox is not contracted just by men who have sex with men, increasing government investment in outbreak response measures, passing anti-discrimination legislation, compulsory education on sexual health for policymakers, and efforts by those in power at more open and supporting communication with LGBTI+ communities.

The recommendations make great practical sense from the perspective of actually preventing suffering and death. But such measures are also extremely difficult to implement when they are not politically advantageous to those in a position to make the necessary changes. Social scientists have referred to this intimate connection between maintaining political advantage and unwillingness to act as “stigma power.”

The reality is that new emerging and resurgent diseases are hazards we face and will continue to do so for many lifetimes. But it takes politics to turn a disease hazard into a disaster. If monkeypox spreads further, a key factor will be that people in power will grasp the advantages of letting the disease and the fear around it proliferate.