From outbreak to opportunity: Sierra Leone’s mpox crisis as a wakeup call for pandemic equity

The 2025 clade IIb mpox outbreak in Sierra Leone, intersecting with a significant HIV burden, is not merely a health crisis but a stark manifestation of deep-seated global health inequities. This commentary argues that the response to this outbreak reveals a familiar and fatal pattern: the neglect of diseases within marginalized populations until they threaten high-income countries. Through analyzing disparities in clinical outcomes, diagnostic and therapeutic access, and containment policies, we critique the reactive, charity-based model of global health. We propose a paradigm shift towards proactive equity, centered on the establishment of a permanent infectious disease Equity Fund to ensure the rapid, equitable distribution of vaccines, therapeutics, and diagnostics for future outbreaks, transforming a moment of crisis into an opportunity for durable change.