Mpox vaccination hesitancy, previous immunisation coverage, and vaccination readiness in the African region: a multinational survey.

Background: Vaccination hesitancy poses a serious threat to mpox vaccination programs. Historically, vaccine uptake in the African region has been low, and this trend may impact future vaccination efforts. Our aim was to investigate the relationships between mpox vaccination hesitancy, immunisation coverage for other vaccines, and vaccination readiness among African adults.

Methods: A multinational commercial web panel survey was conducted among 1832 African adults across six countries (Uganda, Nigeria, Morocco, Egypt, Kenya, and South Africa) from October 1 to October 10, 2024. Mpox vaccination hesitancy for themselves and children was defined as the reluctance to receive vaccines against mpox (if vaccines were available) for themselves and for children (if they had children). Vaccination readiness was assessed via the 7Cs model, which includes confidence, complacency, constraints, calculation, collective responsibility, compliance, and conspiracy. Weighted logistic regression models with the set of calibration sampling weights were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs). The analysis explored the effects of immunisation coverage for other vaccines and vaccination readiness on hesitancy toward mpox vaccination, including mediation and joint relationships. DerSimonian-Laird random-effects meta-analyses were utilised to pool the results from six countries.

Findings: The pooled weighted rate of mpox vaccination hesitancy among participants was 32.7% (95% CI: 25.4-40.0,  = 91.5%, p < 0.0001) for themselves and 38.9% (95% CI 30.2-47.6,  = 93.7%, p < 0.0001) for children. After adjusting for covariates, the absence of immunisation coverage for other vaccines independently increased the risk of mpox vaccination hesitancy for themselves and for children, with a pooled OR of 2.66 (95% CI 1.67-4.26,  = 25.8%, p = 0.241) and a pooled OR of 2.16 (95% CI 1.42-3.30,  = 0%, p = 0.471), respectively. The pooled mediation proportions of vaccination readiness for the relationship between immunisation coverage for other vaccines and mpox vaccination hesitancy were 15.85% (95% CI 0.64-31.06,  = 60.9%, p = 0.703) and 52.53% (95% CI 20.93-84.14,  = 0%, p = 0.988) for themselves and for children, respectively. The pooled weighted rate of mpox vaccination hesitancy was highest among individuals with low vaccination readiness and no history of other vaccinations, with a pooled weighted rate of 62.7% (95% CI 44.7-80.7,  = 82.8%, p < 0.0001) for themselves and 76.3% (95% CI 66.9-85.7,  = 40.6%, p = 0.135) for children. Compared with the reference group (high vaccination readiness and a history of other vaccinations), populations that reported low vaccination readiness and no history of other vaccinations exhibited the highest risk of mpox vaccination hesitancy for themselves (pooled OR 7.83, 95% CI 3.28-18.70,  = 63.2%, p = 0.018) and for children (pooled OR 12.55, 95% CI 7.38-21.33,  = 0%, p = 0.585), followed by populations that reported low vaccination readiness and a history of other vaccinations (pooled OR for themselves 2.69, 95% CI 1.70-4.26,  = 66.7%, p = 0.01; pooled OR for children 4.97, 95% CI 3.66-6.74,  = 19.6%, p = 0.286). However, populations that reported high vaccination readiness and no history of other vaccinations demonstrated a higher risk of mpox vaccination hesitancy for themselves (pooled OR 2.28 95% CI 1.05-4.94,  = 0%, p = 0.608), but not for children.

Interpretation: Our findings indicate a significant level of hesitancy toward mpox vaccination in the African region. Individuals who have not previously received other vaccines are at a higher risk of refusing to vaccinate against mpox for themselves and for children. However, high vaccination readiness can help mitigate this risk. The study recommends that regions in Africa with low immunisation coverage should continue to enhance vaccination education and improve vaccination readiness to reduce hesitancy and promote the mpox vaccination program.

Funding: This work was partly supported by the National Natural Science Foundation of China (grant numbers 72122001, 72474005).