The role of fighting Mpox stigma – Why It Matters, and What We Can Do about It

Sierra Leone reported its first confirmed case of Mpox on January 10, 2025, with the Minister of Health declaring a Public Health Emergency shortly thereafter. In just a few months, the country has recorded 4,440 confirmed cases as of today, making it one of the most affected nation in West Africa according to the National Public Health Agency (NPHA), 52.4% of these cases are male and 47.6% female.

While the scale and speed of the outbreak in Sierra Leone have raised international alarm, this crisis did not begin here. Just across the region, the Democratic Republic of the Congo (DRC) has long been recognized as the epicenter of Clade I Mpox. In 2024, DRC reported 12,967 confirmed cases, a stark reminder of the virus’s persistence in limited resources settings. By mid-2025, DRC continues to lead the continent with over 7,800 additional suspected infections, pointing to ongoing transmission fueled by gaps in surveillance, limited access to vaccines, and structural inequities.

The 2022 outbreak, mostly affected gay, bisexual and other men who have sex with men (MSM) Despite these global narratives linking Mpox primarily to MSM, the data from Sierra Leone tells a broader story, one that includes dense population networks in the highest-incidence areas, where contact tracing has proven especially challenging. The MSM framing has fueled harmful misconceptions and stigma, discouraging people from seeking care and fragmenting the public health response. In a context where LGBTQ+ identities are already marginalized, the cost of such stigma is even higher. Hidden Accelerants: Infrastructure, Sanitation & the Rainy Season

At the same time, living conditions, such as overcrowding, inadequate sanitation, and limited infrastructure, may be accelerating the spread of the virus. While there is currently no confirmed case of Mpox transmission through contaminated wastewater, and replication-competent virus has not been detected in such environments, the virus can be shed into grey water during routine activities like bathing or using the toilet. These environmental vulnerabilities matter, especially with the rainy season approaching in Sierra Leone, when flooding can further compromise already strained sanitation systems. The combination of limited clinical capacity and systemic barriers makes one thing clear: we need a robust surveillance system that not only tracks outbreaks, but also enables early detection, knowledge-sharing, and community-driven partnerships.

The Genomic Story: Fast Spread, Global Reach

Genomic sequencing reveals that the current outbreak is linked to a newly identified lineage, G.1, belonging to clade Ib. This lineage likely emerged around mid-November 2024, but wasn’t detected until early 2025, by which point it had already begun spreading rapidly across Sierra Leone. One of the most alarming findings is its short doubling time: just 2.2 weeks. This rapid pace mirrors the spike in cases and highlights the urgency of real-time data systems and early detection tools. By March 2025, variants of this lineage had already been detected in Germany and the United States, emphasizing the outbreak’s cross-border implications and the urgent need for international coordination.

Emergency Response and Vaccine Distribution: Building Trust in Crisis

In response to the surge, Sierra Leone has deployed both national resources and regional support: On June 13, 2025, the government deployed 36 responders from the AVoHC-SURGE team, a specialized emergency workforce coordinated by Africa CDC, WHO, and WAHO, to outbreak hotspots. ECOWAS also sent a regional field team to assist with contact tracing, treatment, and logistics in the most affected areas. On June 11, 2025, a high-level stakeholder meeting was held in Freetown to align partners and assess critical gaps, including slow lab turnaround times, low vaccine uptake, and insufficient community engagement.

Despite these efforts, the outbreak continues to outpace the response capacity. To strengthen its national response, Sierra Leone has received over 153,000 doses of the Mpox vaccine. In April 2025, 61,300 doses arrived with support from the UAE and Gavi. On June 18, 2025, an additional 75,000 doses were donated by the Democratic Republic of Congo, facilitated by the WHO. The Expanded Program on Immunization (EPI) is leading the rollout, with a focus on protecting vulnerable populations and frontline workers. While these doses offer critical protection, they must be paired with trust-building and effective community outreach to achieve real impact in the highest risk areas. Reflections from the Field

Throughout our time on the ground supporting outbreak preparedness and public health efforts in Sierra Leone, one truth has become clear: science becomes more effective when public health systems earn the trust of the communities they serve. Trust building doesn’t happen in isolation, it requires overcoming real, structural barriers. In many rural areas, poor road conditions and unreliable internet access limit not only logistics and reporting cases, but also the flow of timely, accurate information. Many communities still lack basic knowledge of Mpox symptoms, and without clear, culturally relevant messaging, stigma flourishes. Effective communication must be grounded in local language and tailored to the specific resource constraints of each setting. When community leaders understand the risks and trust the proposed solutions, they help bring their communities along. But when fear, stigma, or misinformation dominate, even the most technically approach and interventions can fall short.

A Final Word: Learning and Breaking Stigma

Fighting Mpox in Sierra Leone is about vaccination, a robust surveillance system with fast-paced strategic action, but it’s also about listening to each district’s unique challenges, and empowering people to protect themselves and their communities. Sierra Leone is fighting not just a virus, and this isn’t just a public health emergency. It’s a battle against deep-rooted social and systemic vulnerabilities, especially in a country shaped by a long history of outbreaks. When we choose to learn and to challenge the narratives that exclude or blame, we create space for meaningful change. Standing with public health workers and community leaders is essential, not only to reach the most affected, but to truly understand how we build trust, respond to resource-constrained settings, and break stigma wherever it exists.