Inside the Red Zone: Sierra Leone’s terrifying mpox outbreak
August 11, 2025
Sierra Leone’s worst mpox outbreak has infected over 5,000 people and killed at least 47 since late 2024, overwhelming its fragile health system. Initially encouraging home isolation, the government reversed course, mandating treatment in designated centers, combining this with vaccination and outreach to curb stigma. Cases have since dropped sharply, though facilities still see steady admissions. Challenges persist: delayed care due to fear, mistrust, traditional healer use, and limited resources. The outbreak shows Clade IIb’s potential for widespread, nonsexual transmission in high-density, low-resource settings. Sustained surveillance, vaccination, and community engagement are essential to prevent resurgence and contain future high-consequence pathogen threats.
Sierra Leone’s mpox crisis, the worst in its history, has laid bare both the vulnerability and resilience of health systems in low-resource settings. Since the first confirmed case in December 2024, over 5,000 infections and 47 deaths have been recorded, with Clade IIb mpox spreading rapidly through crowded communities. Initially, authorities advised home isolation, a strategy that failed to curb transmission. By mid-2025, the government pivoted to mandatory treatment center care, rapidly activating 1,000 beds nationwide. This shift, paired with targeted vaccination and stigma-reduction campaigns, has driven a sharp fall in daily cases.
Despite progress, the outbreak’s human toll remains stark. Patients like Ibrahim Turay, immunocompromised and unable to clear the virus, illustrate the severe complications faced by those with underlying conditions. Others delayed seeking care due to misdiagnosis, stigma, or fear rooted in traumatic memories of Ebola. These delays increased both transmission and disease severity. Mistrust of hospitals, corruption in parts of the health system, and reliance on traditional healers continue to undermine public health messaging and risk driving cases underground.
Clade IIb’s spread in Sierra Leone has defied assumptions, affecting all demographics and transmitting through both sexual and nonsexual contact. Overcrowding, weak surveillance, and limited access to early testing accelerated its expansion. While case declines are encouraging, Guinea, Liberia, and Gambia have already reported new Clade IIb cases, underscoring the regional risk.
This outbreak highlights the urgency of early, decisive intervention: rapid case identification, immediate facility-based isolation, robust vaccination strategies, and sustained community engagement. Without these, resurgence remains a real threat. For global health security, Sierra Leone’s experience is a warning: high-consequence pathogens can exploit gaps in preparedness anywhere, but the stakes are highest where infrastructure is weakest. Long-term investment in surveillance, public trust, and vaccination is critical to prevent future crises.