Members of the public require informational shortcuts to understand complex ideas. While the National Library of Medicine may refer to COVID-19 in a communication directed to subject matter experts as “prone to genetic evolution with the development of mutations over time, resulting in mutant variants that may have different characteristics than its ancestral strains,” a communication from the Centers for Disease Control (CDC) tells the general public to “think about a virus like a tree growing and branching out, [where] each branch on the tree is slightly different than the others” when explaining COVID-19 variants.

Here, the CDC employs a common rhetorical strategy by including metaphors in their public health communications. A metaphor is a figure of speech intended to represent or reference a separate phenomenon (Merriam Webster). In political and public health contexts, metaphors are frequently used to convey complicated information to the public. When used responsibly, metaphors pinpoint the most salient and urgent aspects of a situation and place them in the context of a commonly understood frame of reference. Successful metaphors identify a problem and a course of action to resolve said problem. A set of metaphors used to describe one phenomenon can be incorporated into an overarching metaphorical framework, through which a speaker can compare and describe different aspects of a situation by referencing a more commonly understood framework. For example, the last three years have constituted a “War on COVID-19” in America, where masks and vaccinations acted as weapons against the enemy virus.

Despite the benefits of this rhetorical strategy, employing metaphors as informational shortcuts in the context of infectious diseases can cause harm. Overgeneralizing incredibly complex viruses in emergency situations runs the risk of misdirecting and confusing the public. When misused, metaphors can alienate and endanger marginalized populations that disproportionately suffer from the disease, designating infected individuals as the problem rather than the disease itself.

Many studies have correctly noted that it is difficult to establish a causal relationship between the use of certain metaphors and acts of racism or discrimination. Current research suggests that establishing a link between a social group and a disease will “activate” discriminatory sentiments in the public (Reny & Barreto). Several researchers have coined the term “disgust sensitivity” to explain the scientific connection between targeted metaphors and resulting xenophobia. This refers to the behavioral immune system’s practice of scanning an environment for harmful pathogens, using disgust as a tool to keep harmful people or objects away from the body (Reny & Barreto). Disgust sensitivity has since been found to be a strong predictor of xenophobia and discrimination in public health contexts (Reny & Barreto).

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“Features, Evaluation, and Treatment of Coronavirus (COVID-19).” National Institute of Health.

“Metaphor Definition & Meaning.” Merriam-Webster.

Reny, Tyler, and Matt Barreto. “Xenophobia in the Time of Pandemic: Othering, Anti-Asian Attitudes, and Covid-19.”

Variants of the Virus. Centers for Disease Control and Prevention, 2022.

War metaphors are phrases that evoke imagery of battles, fights, or high-stakes competition. Clear-cut winners and losers are created through these metaphors – there are no stalemates in war (Sontag, Susan). Terms like “defeating ‘x’,” “fighting ‘x’,” or “the war on ‘x’” are typical of war metaphors. In the context of a virus, war metaphors should theoretically paint the disease as the enemy of the people. Once the disease is eradicated, the war is won and survivors emerge victorious.

War metaphors populate our daily remarks and conversations, but also constitute larger frameworks that are used to shape perspectives on a particular issue. The War on Drugs, the War on Terror, and the War on Poverty were each declared by political administrations to encompass policies and actions taken to combat societal issues. Diseases are no exception here — the War on COVID-19 is fresh in America’s memory.

The use of war metaphors to describe diseases dates back to the birth of public health discourse. Medical professionals in the early 1900s trying to protect the public from tuberculosis produced illustrated flyers with flies and pests depicted as enemy aircrafts dropping bombs labeled “microbes” and “illness” (Sontag). Other flyers advised the public to fight back against the “enemy” with an arsenal of “weapons,” or illustrated swords labeled as “cleanliness,” “rest,” and “hygiene” (Sontag).

Why do political and public health institutions alike have such a long history of using war metaphors to describe epidemics? Hillmer writes that “since an illness includes innumerable chemical processes inside the body which cannot directly be seen, we use the source domain of war to make those processes easier to understand” (Hillmer). Although individuals might not fully grasp the medical terminology or urgency related to a disease, the concepts of enemies, battlegrounds, weapons, defenses, victories, and defeats are nearly universal (Lakoff and Johnson).

Despite their frequent use in what should be an apolitical issue, war metaphors are inherently political. Wars are not won without casualties. Victimhood in war is purely political – civilian casualties are mourned by whole nations; prisoners of war are captured by the enemy side and succumb to their fate. Susan Sontag writes that “victims suggest innocence - innocence [in turn] … suggests guilt” (Sontag). Implications of innocence and guilt become dangerous in epidemics. To imply that an unassuming person is somehow at fault for falling ill is harmful and perpetuates any existing misconceptions about that person’s identity. Put simply, war metaphors can stigmatize infected individuals, whether or not the speaker intends for this to occur (Sontag). Politicizing epidemics can also mislead the public into believing that diseases are concentrated partisan issues rather than a nondiscriminating medical phenomenon (Power, Jennifer).

America is no stranger to declaring unsuccessful wars on grand, overarching problems. “If a virus is an enemy, it’s an enemy without generals, a foe with no military training academy, an adversary with no master plan for world domination,” writes author and journalist Moustafa Bayoumi. “The lack of structure within the war metaphor allows far too much room for misinterpretation of who the enemy is, who the victorious side might be, and who should be blamed for any lasting conflict after ‘victory’ is declared” (Bayoumi, Moustafa). The respective Wars on Poverty, Drugs, and Terror have all failed at achieving their objectives. Yet, they each succeeded in misdirecting public vitriol towards impoverished communities and people of color (Bayoumi). War is senseless and leaves violence, trauma, and death in its wake. With no room for marginalized communities to obtain equal footing in battle, America’s wars cause innocent casualties rather than alleviating root problems.

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Bayoumi, Moustafa. “The Coronavirus and the Failures of War Metaphors.” Moustafa Bayoumi, 12 Apr. 2020.

Hillmer, I. (2007). The way we think about diseases: “The immune defense” - comparing illness to war. NAWA J. Lang. Commun. 1, 22–30.

Lakoff, George, and Mark Johnson. Metaphors We Live By. University of Chicago Press, 1981

Sontag, Susan. AIDS and Its Metaphors. Penguin, 1988.

“The ‘Homosexual Cancer’: AIDS = Gay.” Movement, Knowledge, Emotion: Gay Activism and HIV/AIDS in Australia, by Jennifer Power, ANU Press, 2011, pp. 31–58.

Disease metaphors are phrases that evoke imagery of serious illnesses. Disease metaphors frequently employ the words “cancer” or “plague” to refer to their subject matter (Sontag). The term “plague” is one of the most prolific disease metaphors used to describe large-scale epidemics throughout history, whether or not they actually resemble plague-like proportions. The term “plague” consistently evokes the highest levels of chaos, evil, and destruction in the public consciousness as compared to other disease metaphors (Sontag).

Kathleen Hines uses a disease metaphor of her own to share that “plague’s slippery meaning in language is a symptom of its contagion” (Hines, Kathleen). The biblical origins of plague terminology specify that plagues are not caught by just anyone – they are a judgment on society from God himself, inflicted as punishment for deviance (Sontag). Similar to war metaphors, disease metaphors imply that infected individuals are deserving of illness and death as a result of their lifestyle and background.

The magnifying glass that is placed on at-risk populations through disease metaphors is further sharpened through “the need to make a dreaded disease foreign” (Sontag). Diseases are frequently described as foreign plagues and deadly illnesses hailing from faraway lands. This type of rhetoric has the potential to evoke xenophobia and all sorts of hateful and discriminatory sentiments in an audience. The natural progression of the plague metaphor is to place the blame on “foreigners” for the illness (Sontag). Sontag writes that the plague metaphor “brings summary judgments about social crisis and impacts political response” in a given setting (Sontag). In the same way that war metaphors position audiences into an “us vs. them” mindset, disease metaphors fashion the population into two segments: innocent survivors and infected individuals that ultimately deserve their fate.

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Hines, Kathleen. “Contagious Metaphors: Liturgies of Early Modern Plague.” The Comparatist, vol. 42, University of North Carolina Press, 2018, pp. 318–30.

Sontag, Susan. AIDS and Its Metaphors. Penguin, 1988.

Susan Sontag is credited with developing one of the first comprehensive frameworks that examines the effects of metaphors used to discuss infectious diseases. Sontag famously analyzed the metaphors disseminated during the AIDS epidemic, criticizing the news media and the Reagan administration’s harmful use of war and disease metaphors throughout the crisis. She argues that due to the intrinsically political nature of war and disease metaphors, the public discourse about AIDS encouraged homophobia and discrimination against the LGBTQ+ community rather than illuminating any preventative measures or the pursuit of a cure (Sontag).

Throughout the 1980s, AIDS was largely perceived as a disease that only impacted gay men, an already stigmatized population. The use of popular war metaphors like “the AIDS invasion,” “the war on AIDS,” and “battling AIDS” only further stigmatized gay men (Sontag). AIDS was frequently described by a multitude of political actors and media outlets as a type of “enemy invasion.” In such an invasion, the body’s cells “mobilized” to attack the immune system of infected individuals. AIDS was depicted as not only invading the body of infected individuals, but invading society at large. Sontag suggests that gay men in America were perceived as being the sole carriers of AIDS, thus acting as deviant “invaders” of an otherwise pure society – much as the disease invaded immune systems (Sontag). We can conclude that the association between homosexuality and deviance was further strengthened by the dissemination of war metaphors throughout the 1980s, which led to increased stigmatization and criminalization of gay men.

As for disease metaphors, terms like “the gay plague,” “the homosexual cancer,” or “the homosexual plague” flourished at the height of the epidemic (Sontag). As disease metaphors continued to dominate political discourse and news headlines around the nation, attitudes of homophobia steadily increased (Ruel and Campbell). Cruel jokes were frequently made by members of the Reagan administration at the expense of gay men. At a packed briefing, White House press secretary Larry Speakes publicly subjected a journalist to comments about his sexual orientation - on the record - when he questioned how the president was addressing the AIDS epidemic, eliciting a round of laughter from the room (Ruel and Campbell). By inextricably linking AIDS to themes of homosexuality, deviance, and sin through the use of disease metaphors, political actors and media outlets discouraged meaningful medical action against the disease.

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Ruel, Erin, and Richard T. Campbell. “Homophobia and HIV/AIDS: Attitude Change in the Face of an Epidemic.” Social Forces, vol. 84, no. 4, 2006, pp. 2167–2178. JSTOR.

Sontag, Susan. AIDS and Its Metaphors. Penguin, 1988.

The use of anti-Asian disease metaphors stretches back many centuries. When Chinese laborers first arrived in America in the early 1800s, the term “Yellow Peril” catapulted into the public consciousness, describing an intense period of irrational fear of Asians (Rubin, Daniel). Chinese immigrants have long since been stereotyped as carriers of disease, with Americans in the late 1800s concluding that Chinese people, “bred and disseminated disease, thereby endangering the welfare of the state and the nation” (Reny and Barreto).

The same framing patterns observed during the Yellow Peril and at the peak of the AIDS epidemic have resurfaced during the COVID-19 pandemic. Contemporary anti-Asian disease metaphors have invoked Yellow Peril imagery and endangered the safety of Asian Americans as a result. Traditional news media outlets fell prey to this practice at the start of the COVID-19 pandemic – a New York Times reporter writing about the disease described it as “a deadly Chinese coronavirus” in January of 2020, closely followed by a Wall Street Journal article referring to China as “the real sick man of Asia” during that time period (Rubin).

During the earliest months of the pandemic, President Trump and other members of his administration frequently used disease metaphors like the “China virus,” “Wuhan virus,” and “Kung Flu” to describe COVID-19 (Dhanani and Franz). This type of rhetoric had a direct impact on the safety of people of East Asian descent in the Western world (Dhanani and Franz). One study found that respondents with less accurate knowledge about COVID-19, coupled with increased trust in President Trump, were more likely to report negative attitudes and likelihood to engage in discriminatory behavior towards Asian Americans (Dhanani and Franz). One third of Asian Americans surveyed reported that they had been targeted with racist slurs, jokes, and acts of violence following the start of the pandemic. Researchers concluded that trust in President Trump increased the likelihood of being exposed to anti-Asian disease metaphors, in turn increasing the likelihood of acts of racism and discrimination occurring against Asian Americans (Dhanani and Franz).

The beginning of the pandemic was largely dominated by the aforementioned disease metaphors, with war rhetoric failing to enter the picture until April of 2020. That month, President Trump “declared war” on COVID-19, saying, “I view it—in a sense as a wartime president” (Sered, Susan). “We’re at war with the virus,” proclaimed Joe Biden during his presidential run (Sered). “This is a war,” Andrew Cuomo concurred (Sered). These declarations prompted a wide range of responses from communications scholars, with many pointing out the negative ramifications of this metaphor. “Like any war, COVID-19 will disproportionately hurt those who are already vulnerable,” wrote author and sociology professor Susan Sered. “Metaphorical wars on disease easily turn into wars on those who are believed to embody the disease, as was the case in the early decades of the HIV/AIDS epidemic” (Sered).

Despite having slowed over the last year, the COVID-19 pandemic is ongoing. With new scientific developments coming to light, the manner in which the pandemic is discussed by political actors, the media, and the public will continue to shift. However, it is telling that two presidents on different sides of the aisle relied on variations of disease and war metaphors to guide public thought and actions relating to the pandemic, as did the Reagan administration at the height of the AIDS crisis.

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Dhanani, L.Y., Franz, B. “Unexpected public health consequences of the COVID-19 pandemic: a national survey examining anti-Asian attitudes in the USA.” Int J Public Health 65, 747–754 (2020).

Reny, Tyler, and Matt Barreto. “Xenophobia in the Time of Pandemic: Othering, Anti-Asian Attitudes, and Covid-19.” Taylor & Francis, Apr. 2020.

Rubin, Daniel. A Time of Covidiocy: Media, Politics, and Social Upheaval. Brill, 2021.

Sered, Susan. “Why 'Waging War' on Coronavirus Is a Dangerous Metaphor.”

The monkeypox virus – hereafter referred to as “mpox” – is a “viral zoonosis, [or] a virus transmitted to humans from animals” with symptoms resembling those of smallpox (World Health Organization). With the first recorded human case occurring in the Democratic Republic of Congo in 1970, mpox is most common in areas close to tropical rainforests in central & west Africa, although the virus has recently cropped up in urban areas across the world (World Health Organization).

The most visible and common symptom of mpox is a rash that may develop on an individual’s hands, feet, face, chest, mouth, or genitals (Centers for Disease Control and Prevention). Mpox rashes can be itchy, painful, and initially appear as pimples or blisters before scabbing over a period of several days or weeks. Infected people may also experience flu-like symptoms like fever, chills, fatigue, or respiratory symptoms (Centers for Disease Control and Prevention).

Human transmission of mpox occurs through close skin-to-skin contact, including direct contact with mpox rashes (Centers for Disease Control and Prevention). Mpox can be spread through both sexual and non-sexual contact, through birth, and from contact with infected animals. Scientific research to determine if the virus spreads through respiratory secretions and genital fluids, and how the virus spreads when symptoms are not yet present, is ongoing (Centers for Disease Control and Prevention).

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“How It Spreads.” Centers for Disease Control and Prevention, 2 Feb. 2023.

“Monkeypox.” World Health Organization, 2022.

“Signs and Symptoms.” Centers for Disease Control and Prevention, 2 Feb. 2023.

The non-endemic mpox outbreak of 2022 began on May 7, 2022 in the United Kingdom, where a patient was treated for mpox after returning from a trip to Nigeria. The following week, under 100 confirmed and suspected cases combined were reported in Canada, Italy, Portugal, and the United Kingdom (Think Global Health).

With mpox continuing to spread throughout non-endemic nations, LGBTQ+ activists called for more attention and resources to be devoted to the prevention of mpox, and for acts of homophobia against gay men to be condemned. In late July 2022, WHO reversed its previous decision and officially labeled mpox as an international public health emergency, “a designation used to describe only two other diseases, COVID-19 and Polio…[opening] the door for a coordinated international response to fight the virus” (Think Global Health).

In early August 2022, WHO began soliciting suggestions from the public to rename the “monkeypox” virus. In November 2022, after most affected nations had successfully accessed and implemented vaccination and treatment programs, WHO recommended a new name for the virus: “mpox” (Think Global Health). As mpox management officials transitioned out of the White House into the CDC, the Department of Health and Human Services issued a 60-day expiry notice for the public health emergency declaration issued in August, with the Biden administration not planning to renew the declaration in 2023 (Nirappil, Fenit). As of February 15, 2023, there have been 30,193 recorded cases of mpox in the United States from the 2022 outbreak. In 2022, there were 32 confirmed U.S. deaths from mpox. Globally, there have been 85,922 mpox cases recorded during the 2022 outbreak (Centers for Disease Control and Prevention).

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“2022 Outbreak Cases and Data.” Centers for Disease Control and Prevention, 31 Jan. 2023.

“Monkeypox Timeline.” Think Global Health, Council on Foreign Relations, Jan. 2023.

Nirappil, Fenit. “Biden Administration Poised to Lift Monkeypox Emergency Declaration.” The Washington Post, WP Company, 2 Dec. 2022.

Monkeypox was given its original name in 1970 when it was discovered in captive monkeys – although the virus itself did not originate in monkeys (Gumbrecht, Jamie). Following the spread of the virus to non-endemic countries in 2022, scientists and rhetoric experts raised concerns about the negative impact that the name of the virus could have on the willingness of the general public to get tested or vaccinated. Additional levels of stigmatization were added with gay men of color being the primary population at risk for catching the virus (Gumbrecht, Jamie). In a letter to WHO, New York City Health Commissioner Dr. Ashwin Vasan wrote that there was “growing concern for the potentially devastating and stigmatizing effects that the messaging around the ‘monkeypox’ virus can have on these already vulnerable communities” (Gumbrecht, Jamie).

Under the stipulations laid out by the International Classification of Diseases (ICD), WHO has the authority and responsibility to assign names to new diseases. In very rare cases, WHO may rename existing diseases if certain conditions are present (World Health Organization). On November 28, 2022, WHO issued a news release discussing their decision to implement the term “mpox” rather than “monkeypox” to describe the virus outbreak. The official release explained that following the mpox outbreak in May 2022, a number of instances of “racist and stigmatizing language online, in other settings and in some communities was observed and reported to WHO” (World Health Organization).

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Gumbrecht, Jamie. “Who Renames Monkeypox as 'Mpox'.” CNN, Cable News Network, 28 Nov. 2022.

“International Classification of Diseases (ICD).” World Health Organization.

“WHO Recommends New Name for Monkeypox Disease.” World Health Organization, 2022.