Monkeypox vaccination willingness, determinants, and communication needs in gay, bisexual, and other men who have sex with men, in the context of limited vaccine availability in the Netherlands (Dutch MPX-survey)

IntroductionIn the global monkeypox outbreak primary preventive vaccination is offered to people at higher risk for infection. We study vaccine acceptance and its determinants, to target and tailor public health (communication-)strategies in the context of limited vaccine supply in the Netherlands. Methods. Online survey in a convenience sample of gay, bisexual and other men who have sex with men, including transgender persons (22/07-05/09/2022, the Netherlands). We assessed determinants (sociodemographic, social environment, medical, and behavioral factors, and beliefs) for being (un)willing to accept vaccination. We used multivariable multinominal regression and logistic regression analyses, calculating adjusted odds ratios (aOR) and 95 percent confidence-intervals. An open question asked for campaigning and procedural recommendations. ResultsOf respondents, 81.5% (n=1,512/1,856) were willing to accept vaccination; this was 85.2% (799/938) in vaccination-eligible people (HIV-PrEP use, living with HIV, STI, or >3 partners) and 77.7% (713/918) in those non-eligible. Determinants for non-acceptance included: urbanization (rural: aOR:2.2;1.2-3.7; low-urban: aOR:2.4;1.4-3.9; versus high-urban), not knowing monkeypox-vaccinated persons (aOR:2.4;1.6-3.4), and lack of connection to gay/queer-community (aOR:2.0;1.5-2.7). Beliefs associated with acceptance were perception of higher risk/severity of monkeypox, higher protection motivation, positive outcome expectations post vaccination (effectiveness and side-effects), and perceived positive social norms regarding vaccination of their social network. Respondents recommended more accessible communication, delivered regularly, stigma-free, sex positive and with facts on monkeypox, vaccination benefits and procedures, and explain (other) preventive options. For vaccination, it was recommended to add self-registration, provision also at non-clinic settings, discrete/anonymous options, and more inclusive strategies to reach people (e.g., those not in existing patient-registries) at high risk for monkeypox. ConclusionIn the public health response to the monkeypox outbreak, key is a broad and equitable access to information, and low-threshold vaccination options for those at highest risk. Communication should be transparent and tailored to beliefs, such as perceived risks of monkeypox, benefits of vaccination, and social norms, and should include other preventive options. Public health efforts may be strengthened in less urbanized areas and reach out to those who lack relevant social network influences.