Mpox vaccine acceptance and uptake in Africa: a systematic review and meta-analysis

BACKGROUND: Mpox remains a significant public health threat in Africa, with recent outbreaks driven by newly emergent clades I and II. Vaccination is a critical intervention for outbreak control, yet detailed evidence on vaccine acceptance and uptake across the continent has not been comprehensively synthesized. This study aimed to determine the pooled prevalence and determinants of mpox vaccine acceptance and uptake in Africa during and after the global mpox outbreak. METHODS: We searched PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ScienceDirect, and African Journals Online. Studies conducted between 2022 and 2024 were included. Articles available in French and English were considered. A random-effects model was used to pool the estimates. Subgroup analyses explored heterogeneity. Key determinants of vaccine acceptance and uptake were systematically identified from the included report findings. RESULTS: The pooled mpox vaccine acceptance rate in Africa was 54.97% (95% confidence interval (CI): 49.22-60.59; 15,613 participants; 22 records, 10 countries) with high heterogeneity (I² = 97.8%; p < 0.001). The pooled willingness to vaccinate differ significantly by participant type (p < 0.001). It was higher among the general population (62.02%; 95% CI: 52.86-70.39; n = 9 records; I² = 98.8%) than among healthcare workers (47.97%; 95% CI: 37.35-58.78; n = 6 records; I² = 97.1%). In contrast, pooled vaccine uptake was low at 3.40% (95% CI: 0.56-17.96; 5,740 participants; 8 records, 10 countries), indicating high heterogeneity (I² = 99.7%; p < 0.001). A significant difference (p < 0.001) was observed between studies conducted in the Central Africa region (2.24%: 95% CI: 0.46-10.14; n = 4 records; I² = 81.6%) and the Western zone (38.13%; 95% CI: 27.21-50.39; n = 2 records; I² = 97.5%). Key factors positively influencing acceptance included higher education, greater mpox knowledge, higher risk perception, and trust in health authorities and vaccine safety. CONCLUSIONS: There is a substantial gap between mpox vaccine acceptance and actual uptake in Africa. Strategies to enhance vaccination must address both demand and supply challenges as well as equitable distribution. These findings underscore the need for context-specific, multi-level interventions to translate reported willingness into actual vaccine uptake. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251126033.