Authors:
Rachel James, Juliet Bedford
Corporate Author:
Social Science in Humanitarian Action Platform
Published:
2025

This note presents a rapid synthesis of evidence related to community protection in countries affected by the mpox clade 1b outbreak.

Synthesising evidence related to community protection for mpox

Medline, Africa Journals Online and Global Index Medicus were searched. IFRC, UNICEF and the World Health Organization (WHO) provided social listening reports, rapid qualitative assessments (RQAs), volunteer perception surveys and quantitative surveys. Briefs and meeting reports by SSHAP were also included, and rapid consultations were held with specialists and programme staff working on the mpox response. A meeting on social and behavioural research for a community-centred public health response to mpox was held in Kinshasa, the Democratic Republic of the Congo (DRC), in November 2024, with the WHO, Africa Centres for Disease Control and Prevention, Global Health EDCTP3 and Elrha. The meeting report was consulted for member state updates, existing knowledge and evidence gaps, and to establish priorities for context-specific social and behavioural research and analytics.1 Aside from these sources, limited primary data are available: there are several research projects underway, but at the time of writing, these projects did not have data available to share.

Countries in which mpox cases were confirmed in 2024, including the DRC, Burundi, Rwanda and Uganda, have been able to deepen understanding of key issues, including community awareness and social and behavioural dimensions of exposure risks. Some countries have data around community perceptions of the mpox response. There is less information on more specific issues, such as the feasibility and acceptability of home-based care, wider social and economic impacts of mpox, and cross-border issues. Previous experiences with outbreaks of Ebola disease, COVID-19 and HIV have been drawn on to develop insights around potential impacts of mpox and to make recommendations for the mpox response, particularly around stigma and vaccine concerns. 2,3 There is recognition, however, that although these other responses provide valuable lessons, the specificities of mpox must be considered due to its close contact transmission. The close contact transmission of mpox is challenging especially in urban informal settlements where prevention is impeded by structural issues around living conditions, limited availability of water, sanitation and hygiene services, and limited economic opportunities.

The reference list includes the sources reviewed for this brief. For further details of specific methodologies and sampling, readers are referred to each individual study. There are a number of limitations with the sources of data reviewed. Social listening enables tracking of digital engagement around mpox by social media users whose concerns may not represent those most at-risk in affected countries and communities. Quantitative data collection, which can be representative, may not provide data for specific populations that may be at higher risk and whose lived experiences are critical to understand. RQAs employing purposive sampling can deepen understanding of key issues and engage with specific populations in specific contexts of interest, but the findings are not generalisable. Triangulating socio-behavioural data from different sources and with epidemiological data can provide timely operational insights to inform responses.

Community awareness and risk perception

Most of the reports reviewed were based on data gathered at the community level on knowledge of mpox symptoms, transmission and prevention, and perceptions of severity and risk. Overall, higher levels of knowledge and lower levels of risk perception were noted over the course of national mpox outbreaks in populations in general. Social listening reports documented mpox-related questions, concerns and misinformation found online, and the reports suggested higher levels of engagement and interest in critical information when cases were initially confirmed in a country.4–8 This has also been the case in countries such as Togo, Sierra Leone and Ghana where initial cases have only recently been confirmed, and there is increased engagement around symptoms and prevention.9 Social listening reports regularly produced by UNICEF and WHO have enabled misinformation on mpox (e.g., on alternative or traditional treatments and conspiracy theories on vaccination) to be tracked and addressed by response partners.

Quantitative data collection has been undertaken to rapidly identify key issues and monitor trends over the course of the mpox outbreak and even across countries. UNICEF conducted a series of quantitative surveys using U-Report, mostly at the start of national outbreaks.10 In December 2024, UNICEF also implemented quantitative community rapid assessments in Burundi, the Central African Republic, the DRC, Kenya, Rwanda and Uganda, and plans to repeat these in 2025.11 IFRC collected volunteer perceptions across 30 African national societies, including in Burundi and the DRC, in August and September 2024.12–14

U-Report surveys undertaken at the start of mpox outbreaks generally found lower levels of knowledge and higher levels of confusion around transmission, symptoms and preventive behaviours. For example, after confirmation of the country’s first mpox cases, UNICEF Malawi launched a U-Report poll at the end of April 2025. Of the 11,735 respondents, only half had heard of mpox, 61% correctly identified close contact with an infected person as the main mode of transmission, 45% knew that rashes and lesions were a symptom, and 85% believed mpox to be a very serious disease.15 UNICEF’s U-Report Chatbot, which was rolled out across 21 African countries between August and November 2024, in the early stages of the clade 1b outbreak, found similar results. Of the 240,334 users, 55% were aware of mpox, with women having lower awareness generally; 23% identified rash, fever and swollen glands as symptoms; 40% identified close contact as the main transmission route; and 78% believed mpox to be a serious threat.10 Similar results were found in IFRC’s volunteer perception surveys that were conducted in September 2024.13,14 UNICEF’s community rapid assessments from December 2024 found generally higher levels of knowledge across the different countries, but there were lower levels of prevention intentions, including discussing and planning how to protect themselves, aside from seeking healthcare if they had symptoms.11

Similar findings about mpox knowledge were also highlighted in more nuanced qualitative data gathered, for example, through RQAs using semi-structured interviews, focus group discussions and observations. In Rwanda, the community rapid assessment conducted in December 2024 found that of the 1,200 respondents, 95% of respondents had heard of mpox, but only 44% of respondents had discussed with their household how they would protect themselves (although 76% respondents reported handwashing more frequently).11 An RQA, also from December 2024, found high levels of knowledge across stakeholder groups and also amongst higher risk groups (sex workers, truck drivers and taxi drivers) who felt powerless to avoid infection without vaccination.16

In Burundi, RQAs conducted in mpox hotspot areas in September 2024,17 December 202418 and March 202519,20 showed increasing knowledge of mpox over time alongside declining risk perception in the general population due to changing beliefs around the severity of mpox. Each round of the RQAs included sex workers as participants. The sex workers showed high levels of knowledge, risk perception and fear related to the economic consequences of mpox infection, and they reported limited ability to prevent transmission. In the DRC, an RQA conducted by Breakthrough Action in February 2025 in South Kivu, Kinshasa and Equateur provinces also found high levels of knowledge about mpox transmission and prevention.21 The RQA also found high levels of vaccine acceptance in South Kivu and Equateur provinces where respondents were likely to know someone who had been vaccinated, compared to lower levels of knowledge and vaccine willingness from earlier quantitative data collection.

Social and behavioural dimensions of exposure risks

RQAs conducted in Burundi, Rwanda and Uganda provided further details about community perceptions and experiences of mpox. Community participants reported challenges in preventing mpox transmission, including the lack of supportive infrastructure, especially in informal urban settlements subject to overcrowding; mobile populations; limited availability of water and soap for washing hands, clothes and bedding; and limited income generation options that did not require close contact. In turn, limited income reduced access to healthcare due to transport costs, lack of insurance, limited childcare options and limited sick leave.

With multiple rounds of qualitative data collection in Burundi, changing stigma profiles were noted. Few reports of stigma were seen in the initial data collection (September 2024), but in the later rounds (December 2024, March 2025) stigma towards sex workers and people from the DRC appeared to increase.17,18,20 Perceived and experienced stigma were also increasingly reported in the later rounds by survivors.

Only the RQA from Rwanda (December 2024) included men who have sex with men, and the assessment found this participant group had lower levels of prevention knowledge than other risk groups.16 A recently published SSHAP brief (May 2025) focuses on supporting the mpox response for people with diverse sexual orientation, gender identity and/or gender expression in contexts where their rights are restricted. The brief emphasises that the need for targeted risk communication for gay, bisexual and other men who have sex with men, and people with other diverse sexual orientations, gender identities and/or gender expressions must be balanced with the risk of reinforcing harmful stereotypes and contributing to the politicisation of sexual diversity.22

Community perceptions of response and response measures

Limited data on community perceptions of the response and response measures are available. A Geopoll survey in the DRC (October 2024) noted low confidence in the government’s ability to handle the mpox outbreak.23 An RQA in Uganda (December 2024) found that communities were comparing the less strict mpox response recommendations to those imposed under previous COVID-19 and Ebola disease outbreaks and deducing that mpox was not as serious.24 The RQAs in Burundi demonstrated more general satisfaction with response measures and case management in isolation centres (despite concerns around economic and childcare issues related to isolation). A very high willingness to take a vaccine if offered was found across almost all data sources, although these data were mostly collected at the start of national outbreaks and before vaccines were available. RQAs also provided participants with an opportunity to provide feedback and recommendations for increasing the effectiveness of the response. These recommendations (and the RQA findings) were shared with the national Ministry of Health and response partners to inform operations.

Home-based care

Few studies have collected data on the feasibility and acceptability of home-based care for mpox. SSHAP briefs on home-based care,25 mpox in urban and informal settlements,26 and mpox in rural and cross-border areas27 consider the challenges of home-based care in contexts where there are considerable structural constraints that impact the ability to prevent transmission. Caregivers and people living in high-density, high-mobility or low-resource settings with limited access to water, sanitation and hygiene services are particularly affected by these challenges. The RQAs in Burundi suggested that although the community considered the quality of care in isolation centres to be acceptable, there continued to be many challenges experienced by those admitted to isolation centres, including around childcare, stigma upon discharge and the economic costs of hospitalisation (transport, communications, lost income).17,18,20

Wider social and economic impacts of mpox

Data to quantify the wider social and economic impacts of mpox are limited. Findings from the various RQAs noted the impact of stigma on survivors and sex workers in terms of job loss, evictions and loss of income. Recent funding cuts will impact response efforts, especially for people living with HIV who may experience poorer outcomes from mpox when they are not taking antiretroviral medications.

Cross-border issues

There has been limited documentation of cross-border issues about community protection related to mpox, aside from a SSHAP brief focusing on the Kenya-Uganda border. This brief, which has relevance to other borderlands, suggested that focusing on ‘higher risk’ groups at border crossings, such as truck drivers and sex workers, fails to recognise that transmission is taking place more generally at the community level in border areas.

Data on the impact of conflict on mpox transmission and the response, including across the DRC-Burundi border, remain very limited.

Conclusion

Data collection around mpox in countries with outbreaks caused by clade 1b has focused on tracking community perceptions, misinformation and intended preventive behaviours through online social listening and quantitative surveys in multiple countries, especially at the outset of their outbreaks. Qualitative data collection to better understand social and behavioural dimensions has taken place in some countries through RQAs, including with high-risk groups. There are research projects underway or being planned that should provide further evidence, but ongoing efforts are required to more fully understand the dimensions of community protection related to mpox.

References

  1. World Health Organization. (2025). Advancing social and behavioural research for a community-centred public health response to mpox: Meeting report, Kinshasa, Democratic Republic of the Congo, 27-28 November 2024. https://iris.who.int/handle/10665/380847
  2. Umar, T. P., Jain, N., Sayad, R., Tandarto, K., Jain, S., & Reinis, A. (2024). Overcoming stigma: The human side of monkeypox virus. In N. Rezaei (Ed.), Poxviruses (Vol. 1451, pp. 383–397). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-57165-7_25
  3. Adebisi, Y. A., Ezema, S. M., Bolarinwa, O., Bassey, A. E., & Ogunkola, I. O. (2024). Sex workers and the mpox response in Africa. The Journal of Infectious Diseases, 230(4), 786–788. https://doi.org/10.1093/infdis/jiae435
  4. UNICEF. (2024). Public narratives on mpox. A social and community listening (SCL) analysis. Vol. 2. 21 August to 03 September 2024.
  5. UNICEF. (2024). Media narratives on mpox: A social and community listening (SCL) analysis. Vol. 4. 10 September to 09 October 2024.
  6. UNICEF. (2024). Mpox and mental health: A social and community listening (SCL) analysis. Vol. 5. October 2024.
  7. UNICEF. (2024). Mpox: Media and social media narratives: A social and community listening (SCL) analysis. Vol. 6. December 2024.
  8. UNICEF. (2025). Mpox misinformation: What ‘not’ to believe and what to do about it. Harmful beliefs, narratives, and counter strategies for effective health interventions. A social and community listening (SCL) analysis. February 2025.
  9. Africa Infodemic Response Alliance. (2025). AIRA Infodemic Trends Report: 18-23 May 2025. Weekly brief #162. https://www.afro.who.int/countries/togo/publication/aira-infodemic-trends-report-18-23-may-2025
  10. UNICEF Youth Engagement Team – Division of Global Communication and Advocacy (DGCA). (2024, November 13). 2024 Mpox chatbot deployment [PowerPoint slides].
  11. UNICEF – Social and Behaviour Change Monitoring and Evidence Team. (2024, December 16). Mobile phone-based community rapid assessment (CRA) on mpox: Findings for all countries 1st round. December 16, 2024 [PowerPoint slides].
  12. IFRC. (2024). Community perceptions as perceived by volunteers.
  13. IFRC. (2024, September). Volunteer perception survey: Findings mid-September 2024. DRC. 25 September 2024 [PowerPoint slides].
  14. IFRC. (2024, September). Volunteer perception survey: Findings mid-September 2024. Burundi. 25 September 2024 [PowerPoint slides].
  15. UNICEF. (2025). U-report poll findings on Mpox awareness and perception. 28 April 2025.
  16. UNICEF, Rwanda NGOs Forum on HIV/AIDS and Health Promotion, IFRC, & Rwanda Red Cross. (2024). Rwanda mpox and Marburg community insights. 3rd – 7th December [PowerPoint slides].
  17. Collective Service. (2024, September 18). Rapid qualitative assessment on mpox in Bujumbura Hotspots [PowerPoint slides].
  18. UNICEF, & Anthrologica. (2024). Infographic of key findings: Rapid qualitative assessment (RQA) of mpox in Bujumbura Nord, Burundi. December 2024.
  19. Anthrologica. (2025). Rapid qualitative assessment: Mpox, Burundi. Summary report. April 2025.
  20. UNICEF, & Anthrologica. (2025). Infographic of key findings: Rapid qualitative assessment (RQA) of mpox in Bujumbura Nord, Bujumbura Centre and Gitega, Burundi. March 2025.
  21. Breakthrough Action. (2025, February 12). Rapid qualitative study on mpox in the DRC: Perceptions of disease risk and vaccine acceptability (Sud Kivu, Equateur, Kinshasa) [PowerPoint slides].
  22. Müller, A. (2025). Supporting the mpox response for people with diverse sexual orientation, gender identity and/or gender expression in contexts where their rights are restricted. Social Science in Humanitarian Action Platform (SSHAP). https://doi.org/10.19088/SSHAP.2025.023
  23. Lau, C. (2024). DRC mpox outbreak survey. GeoPoll.
  24. Craig, C., & UNICEF SBC Surge Support Mpox. (2024, December 11). Rapid qualitative assessments for mpox—Kampala [PowerPoint slides]. RCCE meeting.
  25. Duclos, D., Okello, B., Muzalia, G., & Parker, M. (2025). Key considerations: Home-based care for mpox in Central and East Africa. Social Science in Humanitarian Action Platform (SSHAP). https://doi.org/10.19088/SSHAP.2025.026
  26. Schmidt-Sane, M., & Wilkinson, A. (2025). Key considerations: Mpox response in urban informal settlements. Social Science in Humanitarian Action Platform (SSHAP). https://doi.org/10.19088/SSHAP.2025.025
  27. Lamarque, H., & Brown, H. (2025). Key considerations: Mpox in the Busia-Malaba border region linking Uganda and Kenya. Social Science in Humanitarian Action Platform (SSHAP). https://doi.org/10.19088/SSHAP.2025.022

Authors: Rachel James (Anthrologica) and Juliet Bedford (Anthrologica).

Acknowledgements: Thanks are extended to colleagues who shared source materials including Sophie Everest (UKHSA, UK-PHRST), Nadine Beckmann (LSHTM, UK-PHRST), Anastasiia Atif (UNICEF), Elizabeth Ganter (IFRC) and Eva Niederberger (WHO).  Nina Gobat (WHO) and Hayley MacGregor (IDS) reviewed the note. Editorial support was provided by Harriet MacLehose. This brief is the responsibility of SSHAP.

Suggested citation: James, R. and J. Bedford. (2025). Rapid evidence synthesis: Mpox community protection. Social Science in Humanitarian Action Platform (SSHAP). www.doi.org/10.19088/SSHAP.2025.030

Published by the Institute of Development Studies: June 2025.

Copyright: © Institute of Development Studies 2025. This is an Open Access paper distributed under the terms of the Creative Commons Attribution 4.0 International licence (CC BY 4.0). Except where otherwise stated, this permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited and any modifications or adaptations are indicated.

Contact: If you have a direct request concerning the brief, tools, additional technical expertise or remote analysis, or should you like to be considered for the network of advisers, please contact the Social Science in Humanitarian Action Platform by emailing Annie Lowden ([email protected]) or Juliet Bedford ([email protected]).

About SSHAP: The Social Science in Humanitarian Action (SSHAP) is a partnership between the Institute of Development Studies, Anthrologica , CRCF Senegal, Gulu University, Le Groupe d’Etudes sur les Conflits et la Sécurité Humaine (GEC-SH), the London School of Hygiene and Tropical Medicine, the Sierra Leone Urban Research Centre, University of Ibadan, and the University of Juba. This work was supported by the UK Foreign, Commonwealth & Development Office (FCDO) and Wellcome 225449/Z/22/Z. The views expressed are those of the authors and do not necessarily reflect those of the funders, or the views or policies of the project partners.

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