Mpox vaccine uptake in the most endemic focus in Africa: a systematic review and meta-analysis (1970–2024)
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
The Democratic Republic of Congo (DRC) represents the global epicenter of human Mpox. Vaccination remains the cornerstone of outbreak prevention as the disease continues to evolve from zoonotic spillover to sustained human-to-human transmission. However, comprehensive assessments of vaccination coverage trends across this vast, conflict-affected nation remain strikingly absent from the literature. This systematic review and meta-analysis provide the first pooled estimate of Mpox vaccine uptake and acceptance in the DRC spanning 54 years (1970-2024), capturing critical transitions including the post-smallpox eradication era and recent global outbreaks. Our study addresses temporal trends, geographic disparities, and the gap between vaccine acceptance and actual uptake in this high-risk setting.
Methods
We conducted this review following PRISMA guidelines, systematically searching PubMed, ScienceDirect, and Google Scholar through February 2025. Using random-effects models, we calculated pooled estimates for vaccine uptake and acceptance rates, with prespecified subgroup analyses examining variations by: (1) period (1970-2000, 2000-2020, 2020-2024), (2) geographic region (Northwest endemic zone, Central/South zone, conflict-affected East), and (3) study design (surveillance vs. cross-sectional). We quantified heterogeneity using I 2 statistics and conducted meta-regression to identify predictors of vaccination coverage. Sensitivity analyses assessed the robustness of our findings.
Results
Our analysis revealed a pooled Mpox vaccine uptake of just 30.26% (95% CI:14.11-46.41) with extreme heterogeneity ( I 2 = 99.9%, p<0.001), indicating substantial variability across studies. Vaccine acceptance was higher at 54.55% (95% CI: 16.64-92.46) demonstrating a concerning 24.29% intention-action gap. Temporal analysis showed catastrophic declines, from 35.31% coverage during 1970-2000 to just 1.79% in 2020-2024 - a 95% reduction post-global smallpox eradication. Geographic disparities were profound: Northwest endemic zones achieved 45.95% coverage compared to 9.78% in Central/South zones ( p <0.001). Meta-regression identified no significant predictors of coverage (all p>0.05), suggesting complex, unmeasured determinants beyond conventional variables.
Conclusion
Despite moderate acceptance rates, actual Mpox vaccination uptake in the DRC remains critically low, with worsening coverage in recent years and substantial regional inequities. These findings underscore the urgent need for context-specific interventions to bridge the intention-action gap in this high-risk setting.
