Attitudes toward Monkeypox vaccination among healthcare workers in France and Belgium: a part of complacency?

On the 13th of September 2022, the Europe WHO region had reported 23,837 cases of Monkeypox (MPX), with at least 91 infections occurred in healthcare workers (HCWs) [1]. Although occupational exposure is not the primary source of infection in HCWs, cases of contamination at work were reported [2,3]. World Health Organization (WHO) recommends immunization against MPX for HCWs at-risk for occupational exposure [4]. Vaccine hesitancy affects HCWs and have an impact on their personal vaccination status [5]. After two years of the COVID-19 pandemic and vaccination, attitudes toward vaccination in HCWs against another emerging infection have not been analysed, particularly in France, where mandates were required to achieve high vaccine coverage in HCWs (Table 1 ).

Table 1

Factors associated with intention to get vaccinated against Monkeypox in healthcare workers obtained with multivariable binary regression model adjusted on gender, profession, COVID-19 vaccine eagerness; 7C- vaccination readiness, confidence, and concerns about Monkeypox epidemics. aOR adjusted odds ratio aa higher score indicates low responder complacency, ba 30-point confidence score was obtained adding the following 6 items: confidence in HCWs, confidence in government, confidence in pharmaceutical companies, confidence in Public Health agencies, confidence in medias, and confidence in colleagues. COVID-19 eagerness was transformed in a binary variable: individuals vaccinated as soon as they were eligible or before being eligible were defined as eager.

Characteristics	aOR (95 % CI)	p-value
GenderFemaleMale	Ref1.4 (0.9-2.4)	0.15
7C Vaccination readinessConfidenceComplacencyaConstraintsCalculationCollective responsibilityComplianceConspiracy	1.2 (0.9-1.6)1.3 (0.98-1.52)1.2 (0.94-1.5)0.8 (0.7-1)1.2 (0.8-1.7)1 (0.8-1.3)0.9 (0.7-1.3)	0.280.070.140.060.30.580.64
Confidenceb	1 (0.9-1.1)	0.83
COVID-19 Vaccine eagerness	2.5 (1.03-6.1)	0.04
ProfessionPhysicians/pharmacistNurses and Assistant NursesOthers	Ref0.8 (0.4-1.4)0.7 (0.5-0.9)	0.40.02
Had concerns about the emergence of Monkeypox	2.6 (1.3-5.3)	0.009

We carried out an anonymous on-line survey from the 15th of June 2022 to the 8th of August 2022, by snowball sampling in France and Belgium, aiming to evaluate attitudes toward MPX vaccination and to study factors associated with intentions to get the vaccine (gender, profession, vaccination readiness evaluated with the 7C-scale –Confidence in vaccines, Complacency, Constraints, Calculation, Collective Responsibility, Compliance, Conspiracy [6]; as well as Confidence/trust in HCWs, colleagues, government, Public Health agencies, media, and pharmaceutical companies). Among the 690 responders, 397 were HCWs (mean age 43.3 ± 12 years, 260/397 women). Acceptance of the MKP vaccination in HCWs was low, particularly in the case of a specific recommendation for professional exposure. In the case of a specific vaccination recommendation for HCWs, 99 (30.5 %) of the 397 respondents would get the vaccine as soon as possible, 121 (24.9 %) would probably get vaccinated, 88 (22.2 %) were undecided, 49 (12.3%) would probably not get the vaccine, and 40 (10.1%) would certainly not get the vaccine. Overall, only two hundred and twenty (55.4 %) would accept vaccination. In case of spread within the general population, 314 (79.1 %) of the responders would accept the vaccination. This observation suggested that there is little acceptable for MPX vaccine recommendations within HCWs. In the context of a specific recommendation, the proportion of HCWs with intention to get vaccinated was significantly greater in physicians and pharmacists (65.3 % versus 46.6 % nurses and assistant nurses or 43 % in other professions such as midwives, physiotherapists). The same observation was made if the recommendation was extended to the general population with the following acceptance rates: 84.7 % in physicians and pharmacists, 70.7 % in nurses and assistant nurses, 77.2 % in other HCWs. After adjustment for gender, and vaccination readiness, nurses and assistant-nurses were less inclined to get the vaccine than physicians and pharmacists. This observation suggests that vaccination readiness is probably lower in nurses and assistant-nurses than in physicians and pharmacists. Highly prevalent vaccine hesitancy in nurses and assistant-nurses is particularly challenging in the context of infectious emerging diseases as their close contacts with infected patients are frequent [7]. Of note, HCWs who reported multiple sexual partners were not more prone to get a vaccine against MPX than HCWs who did not.

Complacency may in part explain the low acceptance rate if vaccine was specifically recommended to HCWs. At the beginning of the COVID-19 pandemic, self-perceived risk for infection was one of the most important drivers of intentions to get the COVID-19 vaccine among HCW [8]. Although MPX is also an emerging infectious diseases, only forty-four (11 %) responders felt at-risk of MPX infection, and 87 (21.9 %) expressed concerns about the current MPX epidemics. Communication relating to mild infections, mainly affecting men having sex with men, may have generated feelings of complacency in HCWs. COVID-19 vaccine eagerness (defined by vaccination before eligibility or as soon as HCWs became eligible) was associated with intention to get vaccinated against MPX in HCWs. In addition, confidence in government, HCWs, public health agencies, media, colleagues, and pharmaceutical companies (assessed by a 30-point score) was also associated with intentions to get vaccinated against MPX, if vaccination was specifically recommended in HCWs. In addition, HCWs might suffer from pandemic fatigue specifically about vaccine recommendations, notably in France, where COVID-19 vaccine mandates for HCWs were implemented.

Our observation suggests that better communicating on potential professional exposure to MPX in HCWs might be required to increase MKP vaccine acceptance. The main limitations of our work are the lack of representativeness of our sample of the HCWs in France and Belgium and the relatively small sample size. Physicians and pharmacists were overrepresented, and due to more favorable attitudes toward vaccines in physicians and pharmacists in general, intentions of getting vaccinated against MPX in HCWs were probably overestimated.