Improving vaccination is essential for several diseases with available vaccines. In addition to creating safe and effective vaccines, it is necessary to solve logistical challenges, ensure equitable distribution, and promote acceptance in the population to guarantee the demand for vaccines (45).
Monkeypox is gradually becoming a globally relevant public health issue. There are still uncertainties regarding the exact routes of transmission of this disease (8, 46). Therefore, it is essential to propose sound preventive approaches, such as the implementation of targeted vaccination programs against the Mpox virus, to address this issue efficiently (45).
The present systematic review and meta-analysis determined the prevalence of intention to receive the Mpox vaccine. The combined prevalence of intention to be vaccinated against Mpox was 61%. According to investigations, the prevalence of intention to be vaccinated against Mpox ranged from 8.8–93.6% (30, 44). Riad A, et al. showed that 51% of participants were willing to receive the Mpox vaccine if it was offered free, safe, and effective (47). Another study proposed by Alarifi AM, et al. reported that 52.7% of the participants expressed a willingness to receive the Mpox vaccine. The results indicated that the main reasons for this willingness were trust in the Saudi Arabian Ministry of Health (57.7%) and perception of the vaccine as a social responsibility (44.6%) (48). A systematic review and meta-analysis study proposed by Ulloque-Badaracco JR, et al. reported a pooled prevalence of acceptance of the Mpox vaccination of 56% (45).
Globally, vaccination represents a fundamental strategy to mitigate both the spread and severity of contagious viral infections, especially for immunocompromised individuals (49). Smallpox vaccination provides cross-protection for both smallpox and Mpox, preventing approximately 85% of Mpox virus infection. Two vaccines are available: modified vaccinia Ankara (Jynneos/Imamune/Imvanex, Bavarian Nordic, Hørsholm, Denmark) and ACAM2000 (Emergent BioSolutions, Gaithersburg, MD, USA) (50, 51).
In the subgroup analysis by continents on the intention to be vaccinated against Mpox, the following prevalences were found: Asia (64%), Europe (62%), America (63%), and Africa (43%). Ulloque-Badaracco JR, et al. reported that the prevalence of Mpox vaccine uptake was 50% in Asian countries and 70% in European countries (45). In addition, in China and Indonesia, they reported the highest prevalence of intention to vaccinate against Mpox, around 90.2% and 93.6%, respectively (34, 44). This variation could be due to how different countries respond to the severity of a disease and take precautions, which is related to socioeconomic and cultural factors, access to information, and distrust in the health system and government policies.
In the subgroup analysis on the intention to be vaccinated against Mpox, focused on the target population of the studies, the following prevalences were found: general population (54%), health care workers (57%), and LGBTI community (76%). The study conducted by Alarifi AM, et al. revealed that physicians and pharmacists demonstrated a higher willingness to receive the Mpox vaccine, with percentages of 57.5% and 56.1%, respectively, compared to nurses, whose willingness was 46.7% (48). Ulloque-Badaracco JR, et al. reported that the prevalence of vaccine acceptance was 43.0% in the general population, 63.0% in health care workers, and 84.0% in the LGBTI community (45). In addition, the results may indicate an increased awareness among study subjects of the importance of prevention in different groups that have faced barriers to medical care. The current Mpox outbreak continues to impact primarily men who have sex with men and who have reported having recent sexual encounters with one or more male partners (52). Therefore, it is crucial to monitor people who have been in contact with the reported cases in order to prevent the spread of this disease.
Another important secondary outcome found by the study was that the pooled prevalence of Mpox vaccination refusal was 22%. Finally, it is worth mentioning that both the Americas and healthcare workers exhibited the highest rates of refusal towards Mpox vaccination, with 29% and 23% refusal, respectively. Riad A, et al. showed that 30.6% and 18.1% of participants were unsure and refused the Mpox vaccination (47). Another study proposed by Alarifi AM, et al. reported that 47.3% of participants refused the Mpox vaccination (48). Ulloque-Badaracco JR, et al. in their systematic review and meta-analysis, reported a refusal of Mpox vaccination of 24% (45). One investigation identified insufficient information about the vaccine, fear of unknown adverse reactions, and doubts about the effectiveness and safety of the vaccine as the most reported reasons for unwillingness to receive the Mpox vaccine (48).
This study highlights the importance of recognizing regional and subgroup disparities in willingness to vaccinate and refusal of Mpox vaccination. The findings emphasize the need to implement communication and education strategies tailored to particular contexts in order to enhance vaccination uptake. Additionally, identifying populations with higher refusal rates can guide specific efforts to address concerns and strengthen vaccine confidence within these groups. Ultimately, understanding these factors is essential to achieving optimal levels of vaccination coverage and safeguarding global public health.
4.1. Limitations and strengths
The present study has some limitations. First, information about Mpox is constantly evolving. Second, it is crucial to recognize the possibility of bias in the incorporated studies. Third, it is important to keep in mind that the studies addressed in the meta-analysis may cover diverse populations, interventions, and outcomes, thus making it difficult to extrapolate the findings to other populations. Regarding its strengths, this current study has a rigorous methodological approach, as it was conducted following the guidelines proposed by the PRISMA guidelines. Furthermore, it constitutes the first systematic review and meta-analysis analyzing the prevalence of the intention to receive the Mpox vaccine. In addition, all the procedures used to select the studies were performed independently by two or more authors.