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)

Introduction In 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. Results Of 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. Conclusion In 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Investigator initiated ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Medical Ethical Committee of Maastricht University waived ethical approval because the data were coded and were analyzed anonymously (METC 2022-3324). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The anonymous data for this study can be requested for research by sending an email to helen.sijstermans{at}ggdzl.nl.