Abstract:

The 2024 Public Health Emergency of International Concern (PHEIC) declaration for mpox exposed a critical demand-side gap in Africa’s vaccination response. Despite the Africa CDC and WHO-led Access and Allocation Mechanism (AAM) delivering over 1.9 million doses to African nations, uptake in several high-burden settings remained well below target coverage levels. A systematic review and meta-analysis following PRISMA 2020 guidelines pooled data from 18 studies (120-source evidence base, 2016–2026) using the DerSimonian–Laird random-effects model with Freeman–Tukey double arcsine transformation. Databases searched included PubMed/MEDLINE, Embase, Scopus, and grey literature from WHO, Africa CDC, and UNICEF. Subgroup analyses were conducted by subregion and outbreak phase; meta-regression examined determinants including trust in health authorities, prior vaccination history, education level, and misinformation exposure. Study findings showed pooled vaccine acceptance across 14 studies was 0.58 (95% CI: 0.52–0.64; I² = 89%). Pooled hesitancy was 0.32 (95% CI: 0.27–0.38; I² = 89%). East Africa had the highest subregional acceptance (64%; 95% CI: 57–71%) and Central Africa the lowest (49%; 95% CI: 41–57%). Trust in health authorities (OR 2.1), prior vaccination history (OR 1.8), higher education (OR 1.5), and misinformation exposure (OR 0.6) were the strongest determinants. Peak outbreak phase was associated with higher uptake (67%; 95% CI: 59–74%) versus early phase (49%; 95% CI: 42–56%). Conclusion: Vaccine acceptance in Africa averages below 60%, with one-third of populations expressing hesitancy. Demand generation must operate alongside supply-side scale-up through trust-based communication, community engagement, and targeted misinformation responses.

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