WHO's Strategy for Effective Mpox Response: The Role of Social and Behavioral Research in Crisis

The WHO's interim guidance on social and behavioral research for the mpox response emphasizes the integration of ethical, community-centered research to inform public health interventions and address the social drivers of disease transmission. It aims to enhance the effectiveness and equity of outbreak responses through collaborative, culturally sensitive research practices.

The World Health Organization (WHO) has recently published interim guidance on social and behavioral research aimed at enhancing the global response to mpox (formerly known as monkeypox), a viral disease that has emerged as a public health emergency worldwide. This document was developed in collaboration with a range of global research institutes, including the United Nations Children's Fund (UNICEF), the Africa Centres for Disease Control and Prevention (Africa CDC), and Johns Hopkins University. The guidance underscores the need for a community-centered approach that integrates social and behavioral science into public health strategies to control the spread of mpox, especially in vulnerable populations across Africa, Asia, and Europe.

The outbreak was officially declared a Public Health Emergency of International Concern (PHEIC) by the WHO in August 2024 after a sustained rise in cases and the emergence of new virus strains. As the disease spreads across the globe, affecting regions like Burundi, the Democratic Republic of the Congo, and Uganda, the importance of understanding human behavior, community engagement, and social dynamics has never been clearer. The WHO's guidance highlights that health interventions must be rooted in a deep understanding of these social factors, alongside biomedical solutions, to be truly effective.

The Role of Social and Behavioral Research

Social and behavioral research is increasingly recognized as a critical component of public health emergency responses. In the case of mpox, the guidance emphasizes that understanding community attitudes and behavioral patterns is just as important as controlling the disease biologically. Mpox is primarily transmitted through human contact, including sexual contact, and research on social behaviors such as sexual practices, health-seeking behavior, and caregiving can directly inform targeted interventions. Without this understanding, public health measures like vaccination campaigns and contact tracing may fail to reach or be accepted by the populations that need them most.

Beyond direct transmission, the social impacts of mpox, such as stigma and discrimination, have the potential to exacerbate the crisis. In communities where being associated with a disease like mpox is stigmatized, individuals may avoid seeking care or sharing vital information about their exposure. For example, populations in conflict zones, marginalized groups, or those with limited access to healthcare may face greater barriers in adhering to health measures, further contributing to the spread. Social and behavioral research is essential in understanding these dynamics to ensure that interventions do not inadvertently deepen inequities or reinforce harmful stereotypes. The guidance emphasizes that researchers must explore local contexts and the social vulnerabilities of affected populations to design inclusive and culturally sensitive responses.

Ethical Considerations in Crisis Situations

A cornerstone of the WHO's guidance is ethical research practices, which are vital in ensuring that the rights and safety of research participants are upheld in the rush to respond to an epidemic. Rapid research methods, while essential for gathering real-time data to inform public health actions, must still adhere to the highest ethical standards. The document stresses the importance of informed consent, where participants are fully aware of the purpose and potential risks of the study. It is especially important to protect sensitive information, particularly regarding sexual health, behavioral risks, or vulnerabilities that might expose individuals to social exclusion or legal consequences.

In emergency contexts like the mpox outbreak, ethics review processes must be adapted to ensure timely approval of research protocols without compromising ethical integrity. The guidance recommends the use of expedited ethics reviews and outlines specific safeguards for protecting privacy and minimizing harm. Special attention is required when working with high-risk populations, such as those involved in sex work or those in LGBTQ+ communities, where the disclosure of sensitive data may place participants at risk. Therefore, researchers are urged to implement robust data protection measures and use neutral, non-judgmental language throughout the study process to avoid reinforcing stigma.

Stakeholder Engagement for Effective Research

The success of social and behavioral research in the mpox response hinges on collaborative efforts between researchers, affected communities, and public health authorities. The WHO guidance emphasizes the importance of stakeholder engagement, which ensures that research is relevant, contextually appropriate, and responsive to the needs of the affected populations. Stakeholder engagement can be particularly challenging in emergency situations, where health systems may be overwhelmed, and community mistrust of authorities is high.

One of the key recommendations is to co-develop research questions and protocols with local communities to ensure that they are meaningful and locally grounded. This community-centered approach helps identify key knowledge gaps, such as understanding local transmission dynamics, community-level risks, or barriers to accessing healthcare. The involvement of community representatives also improves the acceptability of research findings and ensures that interventions are trustworthy and effective. Furthermore, it aids in tackling issues like discrimination and marginalization, which may otherwise complicate efforts to implement successful interventions. Local health workers, faith-based organizations, and civil society groups should be actively engaged in the process, ensuring that the research aligns with community priorities and concerns.

Data Protection and the Future of Research

The guidance also underscores the need for strong data protection policies. As with any health-related research, confidentiality is critical to safeguarding the privacy of participants, particularly when sensitive social or behavioral data is being collected. Researchers are encouraged to anonymize data, use encrypted platforms for data storage, and restrict access to sensitive information to authorized personnel. Special protocols are necessary to ensure the safe handling of ethnographic data, which often involves deep personal insights that can identify individuals even when names are removed.

Moreover, the guidance calls for data sharing to be handled responsibly. While sharing research data is essential to advancing knowledge, the protection of participant privacy remains paramount. Researchers are urged to ensure that data-sharing agreements are in place, clearly stating how data will be used, stored, and protected. The document concludes with an emphasis on building research capacity in low-resource settings. By strengthening local research infrastructure and training community-based researchers, future outbreaks can be addressed more effectively and with greater resilience.

Strengthening Global Health Response

The WHO's interim guidance on social and behavioral research for mpox represents a significant step forward in recognizing the importance of human-centered research in managing public health crises. By integrating ethical research practices, community engagement, and data protection, the guidance aims to create a research environment that is responsive, equitable, and effective. This research will not only enhance the current response to mpox but also serve as a model for addressing future health emergencies, ensuring that both the biomedical and social aspects of public health crises are understood and addressed.