Sierra Leone Is Battling an Mpox Outbreak. What Happens Next Affects Us All
A dangerous mpox outbreak is unfolding in Sierra Leone. In just the first week of May, cases rose by 61%, and suspected cases surged by 71%. Roughly half of all confirmed mpox cases in Africa now come from this small West African nation. The virus is moving widely, across geographies, genders, and age groups.
And the virus is changing.
Genomic analysis has revealed a fast-moving new variant of mpox—called G.1—that likely emerged in late November. At first it circulated silently but has since taken hold and quickly began sustained human-to-human transmission. Cases have been doubling every two weeks. Estimates suggest more than 11,000 people in Sierra Leone may already be infected.
This is how outbreaks become epidemics, and mpox, as a pandemic, could be brutal.
Mpox (formerly known as monkeypox) belongs to the same viral family as smallpox. It causes a disease that can be painful, disfiguring, and debilitating, particularly in children. In Sierra Leone, nearly all patients present with severe rashes, and about a quarter have required hospitalization; in some, the disease has progressed to necrotizing lesions. It's no longer rare, no longer contained to the LGBTQ community, and it has already reached more than 100 countries.
Read More: Tedros Adhanom Ghebreyesus: Global-health architect
Sierra Leone has been here before, at the epicenter of a disease outbreak while the world looked away. In 2014, Ebola swept through the West African region. A single mutation supercharged its spread just as it reached Sierra Leone. Tens of thousands died. Health systems collapsed. The global cost soared into the billions. The lesson? Delay is deadly.
As infectious disease researchers, we've lived that lesson. For two decades, we've worked alongside colleagues across Africa and around the world to build faster, smarter ways to detect and respond to outbreaks. We were on the ground during Ebola, Zika, the COVID-19 pandemic, and recently Marburg—plus, many outbreaks that never made the news because they were stopped in time. Together, we've built technologies that track viruses in real time and trained thousands of frontline workers to use them. What once took months, we can now do in days. And now, in Sierra Leone, we are putting that progress to the test.
This time, Sierra Leone isn't waiting for others to step in to do testing and sequencing—it's leading.
Within days of the outbreak's escalation, local public-health teams and scientists under the leadership of Sierra Leone's National Public Health Agency—working with international partners including ourselves—expanded testing, began sequencing the virus, analyzed its evolution, and shared data in real-time. They also launched robust social mobilization and contact tracing that are helping to slow the spread.
To stay ahead of the virus, teams in Sierra Leone are using powerful new tools. One is Lookout, our real-time national platform that fuses genomic, diagnostic, clinical, and epidemiological data into a single cloud-based system. As more data come in, Lookout gives health officials a live, evolving map of the outbreak, showing where it's spreading, how it's changing, and where to act next.
Lookout is just one example of the infrastructure that teams in the U.S. and Africa have co-created through decades of collaboration. It belongs to a broader system called Sentinel, an outbreak detection and response network we co-lead, launched with support from the Audacious Project, a collaborative funding initiative housed at TED. Sentinel is just one part of a larger movement: scientists, engineers, public health leaders, industry partners, and frontline workers working together to build faster, smarter systems to stop outbreaks before they explode.
But even the best systems can't run without support.
Earlier this year, the U.S. canceled all funding to Sierra Leone and halted a $120 million initiative by the U.S. Centers for Disease Control and Prevention (CDC) aimed at strengthening epidemic preparedness in the country. The Africa CDC, U.S. CDC, World Health Organization (WHO) and other organizations continue to offer vital support, but with far fewer resources than before. Philanthropic and industry partners, including the ELMA Relief Foundation, Danaher, and Illumina, have admirably stepped in, but they cannot fill the gap alone.
Today, local teams are doing so much right—with nearly everything stacked against them. The warning signs are flashing. But their resources are running out.
It's tempting to believe this isn't our problem. But thanks to collaborative sequencing efforts, we know the G.1 variant spreading in Sierra Leone has already been detected in at least five patients across multiple U.S. states—Massachusetts, Illinois, and California—and in Europe. It may seem distant—like COVID-19 did at first—but it's not.
Yes, vaccines exist, and they are expected to be effective against this new variant. But supply is limited, distribution is deeply inequitable, and the vaccines themselves present challenges—from limited clinical data and uncertain duration of protection to storage requirements—that make large-scale campaigns far from straightforward. West Africa has received only a fraction of the doses it needs. Without both vaccine access and real-time tracking, we're flying blind. Surveillance isn't a luxury. It's our first and best line of defense.
Sierra Leone is showing the world what preparedness looks like. But it shouldn't have to stand alone. We can wait—again—until the virus spreads further. Or we can act now, support the leaders in Sierra Leone already responding, and get them the resources they need—like diagnostics, clinical support, vaccines, sequencing reagents, and frontline outbreak response—to save lives and cut this outbreak short.
We've seen how the story of viral outbreaks can unfold. This time, with the present mpox epidemic in Sierra Leone, we still have a chance to change the ending.
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