Mpox and the Ethics of Outbreak Management: Lessons for Future Public Health Crises.

Abstract

Mpox, first identified in captive monkeys in 1958 and recognized in humans by 1970 in the Democratic Republic of Congo, was historically confined to sporadic zoonotic outbreaks in Central and West Africa. These outbreaks, often driven by rodent-to-human transmission in resource-limited settings, reflect persistent systemic health disparities. In recent years, mpox has also been reported in high-income countries (including the United States, United Kingdom and Europe), underscoring its global health implications beyond traditionally endemic regions. This article examines the mpox outbreak through the lens of public health ethics, evaluating how core ethical frameworks-justice (encompassing equitable vaccine distribution and addressing health inequities), solidarity and respect for rights (including intellectual property considerations)-shape outbreak management strategies. These strategies are ensuring equitable access to vaccines and therapeutics amid intellectual property barriers, combating stigma and misinformation through transparent risk communication and fostering international solidarity in coordinating responses. The analysis highlights how neglect of these principles exacerbates existing disparities and undermines the effectiveness of interventions. Integrating ethical principles into outbreak responses is critical for building public trust, accountability and community resilience. By distilling lessons from the mpox response, this article contributes to ongoing debates in public health ethics and outbreak preparedness, arguing that ethically grounded approaches are essential for fair and effective management of future public health crises.