Stigma & Discrimination related to Covid-19: Hurt twice over

Stigma related to Covid-19 has been a profound issue since the very onset of the pandemic in early 2020. As the virus started spreading around the world, so did reports of people experiencing stigma and discrimination. This included people who were, or had been, unwell with Covid-19 but also people suspected of being unwell, people who came into contact with Covid-19 through their work (for example health or care workers), and those with perceived links to geographical regions associated with Covid-19, whether through place of residence, or country or ethnicity of origin.

In essence, people affected by Covid-19 can be harmed twice over: first by the direct effects of the virus, and second by being shunned, or worse, by those around them.

Since the first detection of the Covid-19 in Wuhan, China, in particular people of Chinese and Asian descent have frequently been targeted by stigmatising attitudes, anti-Chinese sentiments, xenophobia, hostility and attacks. Such stigmatisation and racist attitudes linked to Covid-19 have continued throughout the pandemic, and is evident for example in the recent investigations into the racism and discrimination faced by Jeremy Lin, the Asian-American NBA player who was called ‘coronavirus’ during a match.

Stigmatising language

Such stigma and discrimination has been partly fuelled and emboldened by language that placed undue emphasis on a connection between Covid-19 and China, such as the use of terms like ‘China Virus’ and ‘Wuhan Virus’, rather than speaking of Covid-19. This serves to further link the virus to a given geographic region, which can lead to attributions of responsibility and assigning blame to people associated with that part of the world, and stigmatising people from the region, or perceived to be associated with it. 

To avoid stigma of this nature, the World Health Organisation has issued explicit guidance on naming human infectious diseases. These principles of best practice precede Covid-19, but are fully applicable to guide terminology in relation to the current pandemic. For example, WHO emphasised that naming of a new disease should minimise negative impacts, with explicit instructions to not include geographic locations or references to cultures or populations in disease names.

Naming options and conventions can be problematic, and inclusion of stigmatising geographical terms should be avoided. The impacts of stigma and discrimination experienced by people of Asian descent in relation to Covid-19 are poignant reminders of why this is so important.

Unfortunately, emerging variants of the Covid-19 virus are commonly described in terms of the location where they were first detected, e.g. the Kent (or UK) variant, the Brazil variant, and the South African variant. The likely risk of stigma and discrimination related to such naming is concerning, in addition to the fact that these variants have since spread far beyond these original places of detection, rendering location-based distinctions meaningless.

The Importance of addressing stigma

Addressing stigma in a public health crisis such as Covid-19 is crucial, as if left unaddressed stigma drive people to deny or hide the illness to avoid discrimination, to prevent or delay timely health care seeking, and can discourage people from adopting healthy behaviours and following guidance for management of the illness due to unwillingness to be associated with the condition. Such barriers could contribute to more severe health problems, and greater difficulties in controlling the viral disease outbreak. Stigma and discrimination often also affect the mental health of stigmatised people, which may worsen these negative outcomes.

A recent paper by our research group with international colleagues reflects on these adverse consequences of stigma and discrimination related to Covid-19, and critically how these negative impacts can be anticipated and mitigated.

Our team set out to review evidence at the onset of the pandemic to develop recommendations for strategies and interventions to reduce stigma and discrimination related to Covid-19. We concluded with the following recommendations: 

1. A careful focus is needed on language and words used to refer to Covid-19 and people affected by it. For example, not attaching locations or ethnicity to the disease, not referring to people with Covid-19 as “victims” or “suspects”; not using exaggerated language or metaphors, such as “plague” or “apocalypse”; and not using words that could imply intentional transmission or blame.
2. The role of media and journalists needs to be recognised in shaping public perceptions around disease, ensuring media platforms take responsibility to use accurate sources of information, challenge inaccurate beliefs, and reduce prejudice against people affected by Covid-19.
3. Public stigma-reducing interventions are needed for the general population, e.g. campaigns to correct myths, rumours and stereotypes, and to challenge bias. These should go further than merely providing factual knowledge, but also include efforts to strategically challenge and change public perceptions about who is responsible for the outbreak, while also correcting specific public misconceptions.
4. Targeted anti-stigma programmes are needed for people directly affected by Covid-19, their family members, healthcare and frontline workers, and vulnerable populations who are at high risk of exposure to stigma and at high risk of contracting Covid-19.
5. Local communities and key stakeholders need to be involved in contextualising messages of anti-stigma initiatives using local knowledge, using the voices and images of the community and involving people affected by Covid-19. Interventions should be designed and delivered in consultation with local organisations and community leaders to build trust, foster community resilience and bring legitimacy to activities designed to reduce stigma.

Our work provides the first evidence-based guidance on stigma and discrimination reduction in relation to Covid-19. Reducing stigma in relation to COVID-19 will not only reduce distress and negative experiences in the short term, but ultimately reducing stigma helps addressing structural inequalities that drive marginalisation and exacerbate both health risks and the impact of stigma.

Reducing stigma and discrimination associated with COVID-19: early stage pandemic rapid review and practical recommendations (P. C. Gronholm, M. Nosé, W. H. van Brakel, J. Eaton, B. Ebenso, K. Fiekert, M. Milenova, C. Sunkel, C. Barbui, and G. Thornicroft) was published in Epidemiology and Psychiatric Sciences

For further information, please contact Patrick O’Brien (Senior Media Officer)