In a recent study posted to the medRxiv* pre-print server, researchers explored the understanding and acceptance of public health messages about the monkeypox virus (MPXV) in the United Kingdom (UK).

Background

During previous viral pandemics triggered by human immunodeficiency virus (HIV) and coronavirus disease 2019 (COVID-19), there was a lack of awareness among the marginalized, which restricted care. Moreover, there was a significant spread of misinformation, which led to delays in diagnosis, treatment, and vaccine uptake, thus, compounding health inequalities. Therefore, public health programs needed to address the needs of the most affected communities during the 2022 human MPXV public health emergency from when authorities documented the first MPXV case in the UK.

The UK government and the National Health Services (NHS) published all the requisite information on their official websites, www.UK.gov and www.NHS.gov. They covered risk factors for MPXV transmission, self-isolation measures, go-to clinics for diagnosis, and vaccine-related information. Further, they specified that sexually active Gay, bisexual and other men-who-have-sex-with-men (GBMSM) were at the highest risk for contracting MPXV.

Experience from previous MPXV outbreaks has shown spreading awareness among the affected communities by leveraging online channels could enhance support and uptake of intervention measures, given the issue of structural barriers is addressed. Evidence of the current MPXV outbreak has only begun to emerge. However, studies investigating the success of public health interventions gathering information on the outlook of the most affected communities about the circulating public health information are urgently warranted.

About the study

In the present study, researchers investigated how well public health messages about MPXV were received and understood by different communities in the UK most affected by the global public health MPXV outbreak.

To this end, they produced a community survey comprising 25 questions related to self-assessment of MPXV risk, awareness, understanding, and acceptance of public health information. Further, this questionnaire explored whether these communities understood the MPXV origins, engaged with care practices, isolation rules, and accepted vaccines; additionally, their views on media messaging regarding MPXV in the UK. The survey was co-produced by the SHARE collaborative at Queen Mary University of London (QMUL), the Love Tank CIC, and the Sophia Forum. The latter are two community-based organizations mainly supporting GBMSM, men from minorities and migrant men plus women living with or at risk of HIV.

The researchers administered this online cross-sectional survey between June 15 and July 27, 2022, with help from the gay dating app Grindr, which also provided a broadcast link of this survey to its UK subscribers in July 2022. They used a General Data Protection Regulation (GDPR)-compliant survey platform – SMART survey.

The survey had information regarding how to obtain support upon MPXV diagnosis. Its opening page detailed the study purpose, custodianship, and use of study data. If a respondent clicked ‘continue’ and commenced the survey, it implied giving consent, although they could stop filling in the questionnaire at any time. The QMUL research team completed data analysis with feedback on results from the remaining authors.

Study findings

The study results revealed that the GBMSM were the most affected community in the 2022 MPXV outbreak. However, the researchers also observed several shortcomings in the public health responses in the early phase of the MPXV UK outbreak, especially among those facing social and structural barriers to care. Subsequently, affected women trusted healthcare professionals (HCPs) more and government websites less. Conversely, White heritage groups trusted government websites more than people of other ethnicities.

Although most study respondents were highly educated and had a good understanding and awareness of MPXV, the authors observed a lack of higher education and unemployment were associated with a poor self-assessed MPXV risk and non-understanding of the public health messages. The study also identified, like a US survey, that around 40% of respondents who did not answer believed in the zoonotic origins of MPXV, which, in turn, suggested confusion, lack of information, and the potential circulation of conspiracy theories about the MPXV causes. Only 49.5% of survey respondents understood or accepted the advice given by the websites of the Department of Health and Social Care, NHS, and UK Health and Security Agency (UKHSA) about which sexual health clinics members of the public could go to if symptomatic with MPXV.

In this study, the respondents from Black heritage groups were less likely to accept vaccines than their White counterparts. Respondents from different heritage groups also hesitated to attend clinics, especially for sexual health-related issues and immunization. People who could not afford basic needs were also less likely to take up vaccines. Despite high vaccine uptake in the majority of the survey respondents, in this case, unfortunately, males, those of White ethnicity, and employed men who have sex with university-educated men neither had a clear understanding of public health information nor accepted advice. Thus, public health authorities should devise innovative ways to reach out to people to alleviate persistent structural barriers, for instance, by organizing vaccination events at places like Black Pride in London.

Though respondents agreed that people should isolate themselves for 21 days if they acquire MPXV, their ability, education, and unemployment negatively affected their intentions around willingness to self-isolate. It could also be the case that isolation-related experiences during the recent COVID-19 pandemic impacted their outlook during the MPXV outbreak. The study also raised significant concerns regarding media coverage not reaching the most affected groups.

Conclusions

There is a need to improve awareness of and inclusive access to appropriate help-seeking during outbreaks of infectious diseases. However, authorities will have to ensure that MPXV-infected people do not go to accident and emergency (A&E) and primary care clinics because that could introduce challenges for the ongoing response, given the infection control issues that attending these clinics would entail.

Amid this new emergency, social factors contributing to health disparities in the UK shall likely become accentuated. In this scenario, it would be crucial to engage disadvantaged members of affected communities for the public health response. Furthermore, future research should increase awareness, risk perception, and vaccine acceptability in more diverse and susceptible populations.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Written by

Neha Mathur

Neha is a digital marketing professional based in Gurugram, India. She has a Master’s degree from the University of Rajasthan with a specialization in Biotechnology in 2008. She has experience in pre-clinical research as part of her research project in The Department of Toxicology at the prestigious Central Drug Research Institute (CDRI), Lucknow, India. She also holds a certification in C++ programming.