For the second time in three years, the WHO has declared an mpox outbreak a public health emergency of international concern.
Since news of the epidemic, the media has circulated images of patients infected with mpox. Some of these photographs show mpox on patients’ arms, legs, and hands, but others are headshots that resemble mugshots of African people with mpox covering their faces. The photos include an African patient somberly looking into a camera, a doctor’s hand pointing at vesicles on an African child’s face, and a disturbing image of a child who has his hands raised, as if being held up by the police, revealing pustules on his face, hands, and chest. I am purposely not linking to them, because these images tend to pathologize, even criminalize, the patients.
Distributing images of mpox to medical professionals is necessary so they don’t misdiagnose it as syphilis or herpes as they did when mpox first erupted in the U.S. in 2022. Ordinary Americans must be made aware of the outbreak and how it presents on the arms, hands, and other parts of the body. But the circulation of these mpox mugshots may reinforce stigma and do more harm than good.
Historical context is vital to understand mpox and to guide our response. The mpox outbreak in Africa has already triggered stereotypes about racial inferiority and endemic tropical disease. Because mpox looks like a deadly plague from the Middle Ages, far removed from our modern world, the growing media representations of Africans covered with unfamiliar pustules further stigmatizes the virus. Mpox looks like its cousin smallpox, but because smallpox was literally wiped off the planet in 1980, very few, if any, Americans have come in direct contact with a person’s body covered in vesicles. Mpox, in other words, not only looks foreign but appears ancient — which reinforces its stigma.
Certainly, Americans have seen some version of blisters forming on the body — from chickenpox to herpes — but these viruses don’t present the same dramatic symptoms that plague the entire body like mpox or smallpox.
While mpox originated in Africa, we need to resist the implication it can only thrive there, which was how people in the past often explained the origin of epidemics.
Before people understood that invisible agents known as microbes spread infectious disease, they created fictional narratives to explain them. They pointed to concrete markers like the climate, landscape, and people in Africa and Asia as the cause of epidemics. When cholera infected waterways from Asia to Europe to the United States in 1832 and again in 1849, people couldn’t see it traveling in the water, so instead they pointed to gray clouds that hung in the air or piles of trash to explain how it spread. They then blamed the epidemic on the poor and other dispossessed populations for creating such conditions.
When yellow fever threatened to invade London in 1845 from British ships arriving from Africa, medical and government authorities did not know that mosquitos were the culprit that caused this vector borne disease. Instead, they theorized that yellow fever originated among Africans and was spread by human contact and carried onto ships that sailed to London. In fact, Scottish doctor James Ormiston McWilliam, who conducted a massive epidemiological study of the yellow fever epidemic, took copious notes of the African people’s racial features, reinforcing the notion that that disease carriers needed to be visualized to be understood.
By distributing mpox mugshots, the media is unwittingly following in that pattern. Though they hope to educate the public, they are framing African people, often children, as the cause of the epidemic. Since Americans are not used to seeing visible manifestations of an epidemic, they risk stigmatizing it.
Even though we just went through a pandemic, that does not mean we know one when we see it. Covid has limited lessons for mpox. Covid’s major symptoms — coughing, lack of breath, fatigue — are not only invisible to the naked eye but resemble other respiratory infections. Perhaps the most recent outbreak that resembles mpox came during the early days of the HIV epidemic, when media stories were often illustrated with images of Kaposi sarcomas among some patients with full-blown AIDS. Then, too, alarming images of a marginalized group contributed to stigma.
Mpox’s visual manifestations can be helpful, since they propel people into action, but they also can seem like something out of a zombie movie or a science fiction novel. A perfectly healthy person begins to present mysterious symptoms of infection and then within few days some pustules begin to break through their skin. Within a week, their entire body has been invaded by the virus.
When mpox broke out in 2022, public health authorities sent images of the virus to clinics and hospitals to avoid it from being misdiagnosed as either herpes or syphilis. These clinical images did not include facial shots unlike the current representations of African people. Meanwhile, gay men began recognizing that it was spreading primarily in their community. They took photos of the pustules on their bodies and posted them on social media to show how it was transmitted because of sexual contact.
The images were not mpox mugshots but carefully curated photos of how the virus presented on various parts of the body accompanied with captions that provided clinical insight. Seeing these posts propelled tens of thousands of gay men to immediately sign up at city centers and to wait in long lines to get vaccinated, creating one of the most energized vaccination campaigns of the last century. Unlike polio or diphtheria vaccination efforts in the 20th century, which required public health authorities to go door to door to ensure all children were vaccinated, the mere appearance of mpox on gay men’s social media timelines propelled them to take immediate action.
We need a similar campaign in the U.S. to inform 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 parts of the body but we don’t need to see them presented on the face. If it is necessary to show the face, the media should block out images of the eyes or any other recognizable features. That will help readers train their eyes to see 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 is the Gilder Lehrman-NEH professor of history at Gettysburg College.
