Social and behavioural science

Embedding community engagement in mpox-related R&D

Successful development and deployment of mpox medical countermeasures will be dependent on a sound understanding of community knowledge, attitudes and practices.

Strong community engagement will help to ensure the suitability and acceptability of mpox medical countermeasures. In addition, mpox is associated with significant stigma and discrimination, an important consideration in the design of public health interventions and care pathways.

Social and behavioual science knowledge gaps

Primary knowledge gaps identified in the Mpox R&D Roadmap 2026:

Community trust

What are the best ways to build sustainable trust and leverage community-led mobilisation to improve the uptake of medical countermeasures and behavioural changes across diverse populations?

Stigma, discrimination and inclusive language

How do stigma, discrimination and communication practices shape access to care, participation in research, and uptake of medical countermeasures during mpox outbreaks, and what strategies can mitigate these barriers across contexts?

Care seeking and service pathways

How do social, structural and economic factors influence the journey from symptom onset to recovery, and how can pathways be optimised to ensure equitable access to care?

Vaccination confidence, behaviour and delivery

What behavioural, social and structural factors influence uptake of mpox vaccines, and how can vaccination strategies be optimised to improve uptake across diverse contexts?

Implementation research for systems integration

How can health systems and surveillance infrastructures be optimised and integrated to ensure the equitable, timely and scalable delivery and evaluation of mpox medical countermeasures across diverse and resource-constrained environments?

Engagement with R&D

How can social, behavioural and participatory research/co-production be integrated throughout the R&D lifecycle to build community trust, ensure ethical trial conduct, and maximise the social acceptability of mpox interventions?

More detailed research questions can be found in the Mpox R&D Roadmap 2026.

Social and behavioural science workplan

A CORC workplan for the social and behavioural science theme is in development.

Social and behavioural science background

Mpox outbreaks are biosocial events. They are shaped by wider political and economic factors and do not affect populations equally. Effective control and optimal deployment of medical countermeasures is therefore dependent on an understanding of contextual factors shaping the dynamics of mpox outbreaks, as well as pre-existing vulnerabilities.

Mpox social and behavioural science (SBS) research has grown since the 2022 global outbreak; however, critical gaps remain. This is especially evident in sub-Saharan Africa. A 2025 review identified 50 SBS studies conducted in African settings; most were cross-sectional, small-scale or embedded in larger clinical trials[1]. The majority of SBS studies (70–80%) are rapid assessments designed to inform immediate responses, while only a minority, around 20–30%, are more in-depth or based on methodologically rigorous or theoretically informed research.

Specifically, there is limited evidence on how communities in Africa, particularly groups such as gay and bisexual men who have sex with men and other key populations, understand and respond to mpox countermeasures, particularly vaccines. This includes perceptions of vaccine safety, concerns regarding side effects, and public understanding of regulatory processes, such as emergency or conditional approvals.

Understanding attitudes and behaviours

Understanding social and behavioural dimensions is essential for the effective development and implementation of mpox medical countermeasures (MCMs) and for implementing public health measures in ways that avoid harm to communities. Factors such as risk perception, trust in institutions, stigma, misinformation and structural barriers to accessing care strongly influence whether individuals seek testing, engage with treatment, or accept vaccination[2]. Engagement and communication approaches that clearly explain evolving evidence, safety monitoring and eligibility criteria are critical to sustaining public trust during countermeasure rollout.

Furthermore, a similar range of issues affect willingness to participate in research, including during outbreaks. Mechanisms to evaluate medical countermeasures will struggle to deliver evidence if communities are unwilling to participate. Furthermore, research raises issues such as randomisation and placebo controls that require careful engagement with target populations.

In summary, there is a need for sustainable investment in SBS research before, during and after public health emergencies to create a robust body of evidence on outbreak preparedness and response[3]. This section builds on the extensive sociobehavioural science evidence base as well as experience from implementation of social, behavioural and biomedical interventions for other infectious diseases such as HIV, Ebola and TB from the African context. Mpox-specific evidence has been generated through use of umbrella qualitative protocols, including one developed for rapid deployment during mpox outbreaks in African settings[4].

[1] Duclos D, Schmidt-Sane M, Macgregor H. A review of the social and behavioural science research landscape for mpox in African settings. 2026. Social Science in Humanitarian Action Platform (SSHAP). www.doi.org/10.19088/SSHAP.2026.002

[2] WHO. 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. 2025. Geneva: WHO

[3] WHO. Interim guidance on social and behavioural research for the mpox public health response. 2025. Geneva: WHO

[4] https://www.protocols.io/view/an-umbrella-protocol-for-qualitative-research-in-i-36wgqpee3vk5/v1