Abstract

The January 2025 Mpox outbreak in Sierra Leone has exposed critical weaknesses in the country’s epidemic preparedness, raising urgent questions about whether this represents systemic policy failure, lack of preparedness, or negligence in implementing lessons from Ebola and COVID-19. This study employs a mixed-methods approach, combining quantitative analysis of surveillance data with qualitative insights from health workers and policymakers, to assess Sierra Leone’s response through the lenses of structural violence, institutional panic-neglect cycles, and dependency theory. Key findings reveal alarming gaps: (1) a 9-day median detection delay for Mpox cases, worse than during Ebola; (2) only 15% of districts equipped with diagnostic capacity; (3) vaccine coverage of just 0.01%, reflecting persistent global health inequities; and (4) 38% testing refusal rates among high-risk groups due to stigma. Comparative analysis with Nigeria (2017) and DRC (2024) outbreaks demonstrates how Sierra Leone’s post-Ebola reforms, including the Epidemic Ready Primary Healthcare program, were systematically dismantled due to funding cuts and lack of institutionalization. The study makes three key contributions: first, it provides empirical evidence of backsliding in Sierra Leone’s health security architecture; second, it identifies stigma and vaccine nationalism as underappreciated drivers of outbreak amplification; and third, it proposes a five-point reform agenda including decentralized testing, African vaccine production partnerships, and One Health surveillance integration. These findings have immediate policy relevance for Sierra Leone’s National Public Health Agency and regional bodies like Africa CDC, while also advancing theoretical debates about structural determinants of outbreak recurrence in post-crisis settings. The research underscores how cycles of “panic and neglect” continue to undermine global health security, with Sierra Leone serving as a critical case study in the consequences of unlearned epidemic lessons.