Catherine Grant | August 2026 (Guest Blog)

When a new disease outbreak begins, responders naturally look back. What worked last time? Which community leaders can help? Which messages built trust? But previous experience can only take a response so far. A protocol developed for one disease, place or moment may not fit the next.

Sierra Leone faced exactly this challenge when mpox emerged in 2025. The country was not starting from scratch. Ebola and COVID-19 had strengthened surveillance, trained health workers and demonstrated the importance of community trust. But mpox was a different disease, encountered in a different context.

Between September and November 2025, researchers from Njala University, the Institute of Development Studies and Colectiv interviewed 37 health workers involved in Sierra Leone’s mpox response. Their experiences showed that the most valuable legacy of earlier outbreaks was not a fixed playbook, but the ability to adapt it.

Communities were involved earlier

Participants felt that community engagement had started too late during Sierra Leone’s Ebola outbreak, after fear and mistrust had already taken hold. In the 2025 mpox response, teams involved chiefs, religious leaders and community health workers much earlier. These trusted local actors helped share information, report cases and support prevention. As one participant explained:

“We allow the community people to take ownership and lead on implementation.”

Communities were treated as part of the response, rather than simply as audiences for public health messages. Working through people who were known locally helped teams understand concerns, and encourage people to seek care.

Digital surveillance still depended on trust

By the time mpox emerged, Sierra Leone’s surveillance infrastructure had changed substantially since the Ebola outbreak. Community health workers could report suspected cases electronically, while WhatsApp groups and shared reporting systems allowed information to move more quickly between communities, districts and national teams.

But this technology was only part of the system. A national responder arriving in a community might be met with suspicion. A local health worker, chief or religious leader was more likely to understand the context and be trusted. As one participant put it:

“When we use their own children, their own people, they will speak up. They will share their challenges.”

Electronic reporting can show that a case has been reported. It cannot create the relationships that make reporting possible, or explain why people are reporting or not.

Earlier lessons had to be adapted

Participants did not assume that what worked during Ebola or COVID-19 would automatically work for mpox. Ebola had been associated with high mortality and widespread fear. With mpox, people could see patients recovering and returning home. This helped build confidence in treatment and encouraged others to seek care.

The mpox response was also shaped by the relationships built during earlier outbreaks. As one participant said:

“We work hand in glove with the community leaders, religious leaders, and other people in order to combat the situation.”

Medical officer

Yet because mpox was often seen as less severe than Ebola, some people initially underestimated the risk. Previous experience helped, but it also created expectations that did not always fit the new outbreak. Learning meant working out which lessons still applied and which approaches needed to change.

From lessons learned to systems that learn

Outbreak reviews often reach similar conclusions: involve communities earlier, work through trusted local actors and adapt to local realities. The challenge is not identifying these lessons, it is how to make them part of how the response operates. That means finding regular ways to understand whether protocols are working in practice, where frontline workers are struggling, how communities are responding and what local teams are already changing. Some of this knowledge will always travel through meetings, field visits and informal conversations. But when it remains scattered, decision-makers may struggle to see which problems are widespread or urgent.

Digital tools can help bring together perspectives from people working across dispersed locations. But information is only useful if it reaches someone who can act on it, and if teams then learn whether the change worked. Sierra Leone benefited from the systems, relationships and experience built during earlier emergencies. But its mpox response only improved where people could reinterpret what they had learned for a different disease and context.

The next outbreak shouldn’t follow the last playbook. The real test of preparedness is whether a response can learn and adapt to realities on the ground.