The Mpox virus (formerly known as monkeypox) continues to make an unsettling return across several communities in West and Central African countries, with Sierra Leone becoming the latest hotspot.
Sierra Leone has faced the previous emergence of mpox cases, but none that escalated into an outbreak of the scale we are witnessing today. The surge of mpox cases in the Democratic Republic of the Congo (DRC) in 2024 led to the outbreak being declared both a Public Health Emergency of International Concern (PHEIC) and a Public Health Emergency of Continental Concern (PHECS) for the second time in two years, under the International Health Regulations (2005). Since then, a few countries have experienced outbreaks where the virus has found the right conditions to spread. The recent outbreak in Sierra Leone has drawn global attention ,as it is putting the hard-earned lessons from Ebola and COVID-19 to the test.
Sierra Leone has been open in reporting mpox cases, data. As of 16th June 2025, the National Public Health Agency’s website reported 4,085 confirmed cases and 25 deaths. This places Sierra Leone as the country with the third highest number of mpox cases in Africa this year, after the Democratic Republic of Congo and Uganda.
Experience from other outbreaks shows that mpox is a difficult to control quickly. It spreads through close or intimate contact with an infected person, and once it gains a foothold in communities, it tends to persist, until high-risk behaviours are significantly reduced or population immunity is boosted with the use of vaccines.
The Ministry of Health and the new National Public Health Agency in Sierra Leone, has initiated a robust response to the outbreak, with the Minister of Health, Dr Austin Demby often leading from the front. The current outbreak has prompted the activation of a Level 2 emergency response and the setup of several treatment facilities, including the newly opened Médecins San Frontieres/Doctors Without Borders (MSF) supported 50-bed centre at Calaba Town. However, authorities say they are still struggling to overcome low compliance with admission into newly established treatment centres and insufficient funding to fully execute the Mpox Incident Action Plan.
The World Health Organization (WHO), Africa CDC, WAHO and other partners are supporting Sierra Leone efforts to control the outbreak, including the recent deployment of 36 responders to the country’s hotspot districts. The responders, drawn from multiple sectors, represent a powerful show of solidarity at a times when speed, coordination and precision are critical.
During the first global mpox outbreak in 2022, many shortcomings in epidemic preparedness, particularly in diagnostic capacity, surveillance systems, and access to critical health interventions, especially in endemic regions, were highlighted. There have been many efforts to invest in these systems, since then, including opportunities through the Pandemic Fund but these are often long term investments.
Critically, the main tool available for countries to respond to mpox outbreaks are vaccines and Sierra Leone has struggled to find sufficient vaccine supplies to respond. A total of 61,300 vaccine doses initially delivered to Sierra Leone from the emergency stockpile managed by GAVI was used to vaccinate at-risk populations, including healthcare workers and hotspot communities. The supplies have since been exhausted and the country has struggled to find more. With a dose of the vaccine costing over $100 per person, a vaccination strategy alone is probably out of the reach of most countries, and probably out of the reach of the global organisations supporting access.
Are current responses enough?
Sierra Leonen Health authorities and partners have made significant strides in managing this outbreak and appear to be pushing hard to do more. Their nascent national public health agency has taken the lead in the response with surveillance teams also actively tracing over 5,900 contacts and nearly 4,200 have completed monitoring. Messages on the risks of mpox and how to prevent it are being shared on radio discussions, school orientations, and mosque-based awareness campaigns. Infection prevention efforts are being intensified in health care settings, as well as the training for health workers on this new disease.
This outbreak resurgence highlights deeper challenges in Sierra Leone’s capacities for outbreak management and many opportunities for improvement. Investments are needed not only to strengthen primary healthcare but in all aspects of public health, from the promotion of safe practices to basic infection prevention and control, to the ability of health workers to recognise symptoms early and refer cases appropriately. In addition, it needs a much better laboratory infrastructure as well as trained healthcare workers to deliver on the timely diagnosis and treatment of cases.
Role of WAHO and regional institutions
The mpox outbreak extends beyond Sierra Leone, with a few other countries in the region reporting cases. On May 17, 2025, Togo reported its first Mpox case, and the number has since risen to eight as of June 12. Ghana has also seen a steady increase, with 79 cumulative cases reported by June 10. Meanwhile, Liberia recorded 66 cases as of June 9, indicating a concerning trend of regional spread. With the increasing number of cases in West Africa, coordination across the region will increasingly be critical. This is the type of scenario that led ECOWAS to set up the Regional Centre for Surveillance and Disease Control (RCSDC) based in Abuja, Nigeria and under the supervision of the West African Health Organisation (WAHO).
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Viruses do not respect borders, and without a unified strategy, gains in one country can easily be undermined by gaps in another. The current situation of the outbreak presents a critical opportunity for regional bodies such as RCSDC and WAHO to step into a leadership role and drive a region-wide response. While RCSDC can support the operational aspects of the response, WAHO is uniquely positioned to coordinate joint procurement of Mpox vaccines, medical counter measures and essential supplies, ensuring equitable access across all member states.
Beyond logistics, WAHO can spearhead high-level advocacy with ECOWAS, the African Union, and international partners to secure funding, technical assistance, and global attention. In addition, WAHO can convened emergency regional fora, bringing together health ministers, national public health institutes, and development partners to support Sierra Leone in its response. This outbreak should not be seen in isolation but used as a catalyst to drive long-term epidemic preparedness and health security planning across West and Africa.