Narrative discordance between headlines and images – and why it matters in this mpox outbreak

There have been multiple mpox outbreaks in recent memory, including the global mpox Clade II outbreak in 2022 that primarily impacted MSM. The current outbreak affecting several countries in Africa is Clade I, which is considered more virulent and deadly. There is a particular strain, Clade Ib, associated with sexual transmission. This variant is what is causing major regional and global concern.

Although these are two different outbreaks that affect different populations in different geographies, the recent WHO PHEIC does not distinguish between these Clades as both are outbreaks that need effective responses. However, in media and social media, there is discordance in accurately talking about the current outbreak when choosing appropriate images and examples to educate the public.

Below are three examples of headlines that don’t match the accompanying image. This is a problem because people associate pictures with the disease and may draw incorrect conclusions about risk to their own health.

Using images from the past and out of context

For example, in this first article, although it is laudable to avoid using pictures of those affected by mpox in stigmatizing ways, this article used a picture of men standing in line in the US from the 2022 outbreak. This is not an accurate representation of the current outbreak in Africa.

Using non-informative images

In this second example, the article describes how the Kenyan government is encouraging people not to share pictures of suspected cases of mpox on social media. This is for several reasons, including protecting patient privacy, avoiding stigmatization of people, and mitigating the spread of mis/disinformation where mpox cases from other outbreaks or other countries are labeled as from Kenya, causing panic and fear.

However, the illustration accompanying this article is a WHO public service announcement that portrays two white men touching each other. This is not an accurate reflection of the situation in Kenya and how and where primarily mpox is spread there.

Additionally, this image doesn’t actually help the reader understand how to protect themselves from mpox – it just makes a statement, leaving the recipient with more questions and feelings than before seeing it.

Uncritically using AI-generated images

Generally, I predict more images like in the article below are going to be featured more often. Beyond the fact that the headline is talking about mpox vaccines and the picture is implying to show mpox sample kits – this picture is just not accurate.

We can expect to see more fake or AI-generated images by editors who are trying to come up with a quick photo illustration related to mpox for their new article.

Things to look out for are obviously photoshopped mpox sample kits or vaccine vials or scary needles that are the wrong type or diameter for vaccinations, and images that are being used to illustrate articles about mpox and mpox vaccines. You also might see pictures of scared patients and menacing nurses holding large needles and accompanying articles on vaccine hesitancy.

We saw a lot of this during COVID and these inaccurate pictures can further confuse people.

The bottom line

Lazy editorial choices are being made in news articles about mpox and images accompanying them. Similarly, on social media, some people might also grab the first image they find to underscore their point, which may be inaccurate or stigmatizing or noninformative.

It’s important to find the balance between portraying a situation accurately and in context and dehumanizing people suffering from a disease who didn’t plan on having their faces or their child’s faces and body parts splashed across newspapers and the internet.

The repeated use of specific images can reinforce narratives that are unhelpful, such as “mpox only infects white men,” “mpox only affects Africans,” or “mpox is a sexually transmitted disease” or “you can only get mpox from eating dead monkeys”.

All of these contain partial truths, but stripped of context, they can stigmatize and leave out important information, such as the fact that mpox can be spread through non-sexual contact.

Articles and social media content circulating in Europe about mpox will potentially describe risks and affected population groups differently than, for example, what might be described in a news article in DRC. However, even if this content is accurate, social media knows no borders and images and headlines out of context can quickly spread to other places where the risk of mpox infection and whom it affects looks different.

This is a clear example of how a one-stop shop image and content repositories for communicating about outbreaks can be misused by unwitting communicators or media people.

Whoever is communicating about this mpox global emergency should take extra care in their own work and advise others how to illustrate or portray the outbreak, who is at risk, and what someone suffering from mpox looks and feels like.

I learned a lot about this visual narrative propagation during COVID, and one tool that I keep referring health communicators to is the CDC’s health equity style guide. It has a section on use of inclusive images that you might also find useful.