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, 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).