In response to the 2022 multi-country Mpox outbreak, a six-month ESRC-funded rapid research collaboration between IDS and the University of Ibadan focused on Nigeria: the country with the highest number of recorded Mpox cases in Africa.
Our research explored the structural drivers and key routes of Mpox transmission in Nigeria, as well as preparedness capacities and the social, bureaucratic and political contexts that shape these capacities at national, state and local levels.
A rise in Mpox cases detected in West Africa from 2017 provided warning signs of the potential for outbreaks elsewhere. Human-to-human transmission had been documented for some time and provided cause for concern. Yet it was not until this wider multi-country outbreak in 2022 that the disease received significant global attention.
Our research has raised important questions for a wider discussion of Mpox as a Public Health Emergency of International Concern (PHEIC) and the implications for epidemic preparedness:
- How can global preparedness and response efforts adapt better to regional diversity in the experience of outbreaks and related vulnerabilities?
- How can global efforts interconnect more effectively with national and regional preparedness and take account of varying priorities and perspectives?
- What can be done to strengthen community-level efforts for outbreak detection and care provision and how might approaches be adapted to different contexts, with different health systems and legal environments?
Our key findings include:
A heterogeneous picture
In contrast to the pattern established elsewhere in the multi-country outbreak (where Mpox has remained concentrated in younger men, and those who identify as MSM), the situation in Nigeria appears to be much more heterogeneous in terms of transmission patterns and range of people affected.
Challenges to detection and diagnosis
Low levels of knowledge of the disease amongst healthcare workers affected detection in primary care and was compounded by low levels of presentation at clinics.
Interruptions in the continuity of resources and supplies and infrastructure challenges hampered operations and compromised sampling and processing. This is exacerbated by chronic underfunding of state primary care and a lack of Universal Health Coverage (UHC).
Clear uncertainties obscure epidemiological and social knowledge of Mpox in Nigeria, including the extent of undetected cases in people who would be reluctant to come forward with Mpox, such as those whose sexual orientation is subject to legal sanction or whose livelihoods make them subject to discrimination, such as commercial sex workers.
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