A qualitative study of the 2025 mpox epidemic in Sierra Leone as a multidimensional social phenomenon

Abstract

Mpox (formerly known as monkeypox) caused 5442 confirmed cases and 60 deaths in Sierra Leone in 2025. Epidemiological and genomic studies describe its scale and lineage, but not how people governed, interpreted, lived, and survived it. We conducted an interpretive qualitative study in Western Area Urban and Port Loko District. Purposive maximum-variation sampling included survivors, caregivers, clinicians, surveillance and contact-tracing staff, community health workers, community leaders, and policy actors. Fifty-two people completed in-depth interviews. Thirty-eight different people joined six focus group discussions, yielding 90 unique participants. Data collection occurred in Krio, Temne, Mende, and English. We combined the Framework Method with reflexive thematic analysis across six interacting dimensions: structural, institutional, cultural, relational, subjective, and systemic. Material conditions constrained isolation and shifted control costs toward households. Emergency institutions made cases visible, but bed scarcity and frontline discretion shaped facility care. Visible lesions acquired moral meanings linked to sex, dirt, punishment, human immunodeficiency virus (HIV), and Ebola memory. Relationships carried infection, care, disclosure, stigma, and trusted information. Survivors described pain, shame, income loss, altered intimacy, and difficult reintegration. Ebola supplied the dominant bodily analogy, while COVID-19 shaped accounts of restrictions, vaccination, and response fatigue. System limits included workforce pressure, vaccine scarcity, and prolonged needs after clinical recovery. Mpox control required diagnosis, isolation, and vaccination, but technical measures worked through social conditions. Effective response therefore needs livelihood support, safe household care, trusted communication, stigma reduction, survivor follow-up, and transparent resource allocation.