Knowledge, attitudes, perceptions and factors associated with mpox vaccine hesitancy among university students in Sierra Leone: a cross-sectional study
This cross-sectional study of 422 university students in Sierra Leone reveals that while two-thirds expressed willingness to receive an mpox vaccine, 32% reported hesitancy, which was significantly associated with lower knowledge, negative perceptions, and specific academic colleges and year levels, highlighting the need for targeted risk communication and accessible vaccination strategies.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the crowded corridors of university life, where students share meals, study in packed lecture halls, and live in close quarters, the spread of infectious diseases is a constant possibility. One such disease, mpox, is caused by a virus that moves from person to person through direct contact or by touching contaminated objects. While the virus has long been known in parts of Africa, recent global attention has highlighted the need for communities to understand how it spreads and how to protect themselves. A key tool in this protection is vaccination, but a vaccine is only effective if people are willing to receive it. This willingness is not always guaranteed; sometimes, even when a vaccine is available, people hesitate. This hesitation is not always about refusing medicine outright. Often, it stems from a lack of clear information, a feeling that the disease cannot affect them personally, or a distrust of the systems offering the shot. Understanding why young adults, who are often at the center of social networks, might hesitate is crucial for public health officials trying to keep communities safe.
Researchers at the University of Sierra Leone set out to explore these feelings among their student body. They wanted to know what students knew about mpox, how they felt about the disease, and whether they would take a vaccine if one were offered to them. The team surveyed 422 students from three different colleges within the university: one focused on arts and sciences, another on public administration and business, and a third dedicated to training doctors, nurses, and pharmacists. By including students from both health-related and non-health-related fields, the researchers could see if medical training made a difference in how people viewed the virus and the vaccine. They asked the students a series of questions to gauge their knowledge of the virus, their attitudes toward getting vaccinated, and their perceptions of the risk mpox posed to them and their country.
The results revealed a complex picture of readiness. Nearly two out of every three students said they would take an mpox vaccine if it were available, suggesting a strong underlying willingness to protect themselves. However, a significant minority, about one in three, indicated they would not. The researchers found that this hesitation was not random; it was closely tied to what the students knew and how they perceived their own safety. Students who had a solid understanding of how mpox spreads and what symptoms it causes were much less likely to hesitate. Similarly, those who believed the disease was a real threat to their own lives were more willing to get vaccinated. Interestingly, simply having a generally positive attitude toward vaccines in the abstract did not predict whether a student would accept an mpox shot once the specific details were considered.
The study also uncovered how the educational environment shapes these views. Students training to become health professionals were far less hesitant than their peers studying other subjects. This difference persisted even after accounting for how much they knew about the virus, suggesting that the culture and daily exposure to health information within medical schools play a powerful role. Furthermore, students in their earlier years of study were more willing to vaccinate than those in their final years, a finding that surprised the researchers and suggests that the length of time spent at university does not automatically increase confidence in vaccines. The data also highlighted practical barriers; while many students believed the vaccine was safe and effective, a majority said that cost would stop them from taking it, and most agreed they would be more likely to get vaccinated if a doctor recommended it or if the shot were easily available on campus.
Ultimately, the study suggests that the hesitation among these students is not a deep-seated refusal of medicine, but rather a gap in understanding and a lack of personal connection to the risk. Many students recognized that mpox was dangerous for Sierra Leone as a whole but did not feel that it was dangerous for them individually. The researchers concluded that to increase vaccination rates, public health efforts need to go beyond simply telling people the disease exists. Instead, communication must focus on making the risk feel real and personal, explaining exactly how the virus moves through shared spaces like dormitories and classrooms, and ensuring that vaccines are free, accessible, and recommended by trusted health professionals. The findings serve as a reminder that preparing for a potential outbreak requires building trust and clarity long before the vaccine arrives, ensuring that when it does, the students are ready to accept it.
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