For the second time in three years, the WHO has declared an Mpox outbreak an international health emergency.
Since the epidemic became known, images of patients infected with Mpox have been circulating in the media. Some of these photos show Mpox on the patients’ arms, legs and hands, but others are portraits that resemble mugshots of Africans with their faces covered in Mpox. The photos show an African patient looking somberly at a camera, a doctor’s hand pointing to blisters on an African child’s face, and a disturbing image of a child with his hands raised as if being restrained by police, showing pustules on his face, hands and chest. I am intentionally not linking to these images because these images tend to pathologize or even criminalize the patients.
Distributing pictures of Mpox to healthcare professionals is necessary so that they do not misdiagnose the disease as syphilis or herpes, as happened during the first outbreak of Mpox in the US in 2022. Ordinary Americans need to be informed about the outbreak and its manifestations on the arms, hands, and other parts of the body. But distributing these Mpox mugshots may reinforce the stigma and do more harm than good.
Historical context is critical to understanding Mpox and guiding our response to it. The outbreak of Mpox in Africa has already triggered stereotypes about racial inferiority and endemic tropical diseases. Because Mpox looks like a deadly plague from the Middle Ages, far removed from our modern world, the virus is further stigmatized by increasing media portrayal of Africans covered in unfamiliar pustules. Mpox looks like its cousin, smallpox, but since smallpox was literally eradicated from the planet in 1980, very few, if any, Americans have come into direct contact with the body of a person covered in blisters. In other words, Mpox not only looks alien, but also appears ancient—reinforcing its stigma.
Of course, Americans have also seen one form or another of blistering on the body – from chickenpox to herpes – but these viruses do not cause the same dramatic, body-wide symptoms as smallpox or smallpox.
Although Mpox originated in Africa, we must not assume that the disease can only thrive there. In the past, this was often used as an explanation for the origin of epidemics.
Before people understood that invisible agents called microbes spread infectious diseases, they invented fictional stories to explain them. They pointed to concrete factors such as the climate, landscape, and people of Africa and Asia as the cause of epidemics. When cholera infected waterways from Asia through Europe to the United States in 1832 and again in 1849, people could not see the disease in the water. Instead, they pointed to gray clouds in the air or piles of garbage to explain how it spread. They then blamed the poor and other dispossessed populations for the epidemic because they had created such conditions.
When British ships from Africa arrived in London carrying yellow fever in 1845, medical and government authorities were unaware that mosquitoes were the cause of this vector-borne disease. Instead, they suspected that yellow fever originated in Africa and was spread through human contact and transmitted to ships bound for London. In fact, Scottish physician James Ormiston McWilliam, who conducted an extensive epidemiological study of the yellow fever epidemic, took detailed notes on the racial characteristics of Africans, reinforcing the idea that disease vectors needed to be visualized to understand them.
By distributing police photographs of Africans, the media unwittingly follows this pattern. Although they want to educate the public, they portray Africans, often children, as the cause of the epidemic. Since Americans are not used to seeing visible signs of an epidemic, they run the risk of stigmatizing them.
Even though we’ve just been through a pandemic, that doesn’t mean we know it when we see it. There are few lessons to be learned from Covid for Mpox. The main symptoms of Covid – cough, shortness of breath, fatigue – are not only invisible to the naked eye, but also resemble other respiratory infections. The most recent outbreak, which resembles Mpox, may have occurred in the early days of the HIV epidemic, when media reports were often illustrated with pictures of Kaposi’s sarcoma in patients with full-blown AIDS. Even then, alarming images of a marginalized group contributed to stigma.
The visual manifestations of Mpox can be helpful because they prompt people to take action, but they can also seem like something out of a zombie movie or a science fiction novel. A perfectly healthy person will show mysterious symptoms of infection and within a few days, some pustules will start to break through their skin. Within a week, their entire body will be infected by the virus.
When Mpox broke out in 2022, health authorities sent pictures of the virus to clinics and hospitals to prevent it from being misdiagnosed as herpes or syphilis. These clinical images did not include facial images, contrary to current portrayals of African people. Meanwhile, gay men realized that the virus was spreading primarily in their community. They took photos of the pustules on their bodies and posted them on social media to show how the virus was transmitted through sexual contact.
The images were not mpox mugshots, but carefully selected photos showing how the virus presented itself on different parts of the body, accompanied by captions that provided clinical insight. When these posts appeared, tens of thousands of gay men immediately signed up in inner cities and waited in long lines to be vaccinated. This sparked one of the most energetic vaccination campaigns of the last century. Unlike the polio or diphtheria vaccination campaigns of the 20th century, where health authorities had to go door to door to ensure that all children were vaccinated, the mere appearance of mpox on gay men’s social media timelines prompted them to act immediately.
We need a similar campaign in the US to educate Americans about Mpox. We don’t need to circulate Mpox mugshots of African children or even adults. We can continue to see images of Mpox on arms, hands and other body parts, but we don’t need to see it on the face. If it is necessary to show the face, the media should omit images of the eyes or other recognizable features. This will help readers train their eyes to recognize Mpox without stigmatizing it as a foreign, even ancient disease.
Jim Downs is the author of Maladies of Empire: How Colonialism, Slavery, and War Transformed Medicine (Harvard University Press, 2021) and the Gilder Lehrman NEH Professor of History at Gettysburg College.
