Study: International healthcare workers’ experiences and perceptions of the 2022 multi-country mpox outbreak. Image Credit: Corona Borealis Studio / Shutterstock

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

A survey was recently conducted to understand the experiences and perceptions of multi-national healthcare workers during the recent mpox outbreaks worldwide.

The study is currently available on the medRxiv preprint* server.

Background

Healthcare workers play a significant role in health system preparedness and resilience during public health emergencies. The coronavirus disease 2019 (COVID-19) has taught the world how severely a pandemic can impact the health and wellbeing of healthcare workers.

During a pandemic like COVID-19, frontline healthcare workers face major challenges in providing necessary service to people affected by a disease with a largely unknown clinical course and prognostic factors. They also have to cope with uncertainty, anxiety, stress, fear of disease contraction, a lack of personal protective equipment, and extended working hours.

Real-world studies have reported wide-ranging experiences of adversity, moral distress, and resilience among healthcare workers during the COVID-19 pandemic. International knowledge exchange and transfer programs have been found to partially ameliorate the difficulties experienced by healthcare workers during the pandemic.

The 2022-2023 global monkeypox (mpox) disease outbreaks have significantly impacted healthcare workers, especially those residing in non-endemic countries like Europe and the USA. The emergence of mpox outside historically affected regions posed new challenges, particularly in the context of ongoing global health crises like COVID-19. Most of the challenges healthcare workers face are associated with a lack of knowledge and experience about the disease.

In this study, an international team of scientists has examined multi-national healthcare workers’ personal and clinical experiences during mpox outbreaks.

Study design

This survey was conducted between August and October 2022 on healthcare workers involved in the clinical management of mpox outbreaks. A total of 725 multi-national healthcare workers from 41 non-endemic countries were enrolled for the survey.

Self-reported data on clinical workload, safety, preparedness, workplace training and support, mental wellbeing, and vaccination was collected through online questionnaires. The emergence of mpox outside historically affected regions posed new challenges, particularly in the context of ongoing global health crises like COVID-19.

Important observations

Healthcare workers in the United Kingdom, the European Union, the Caribbean, Central America, South America, the United States, and Canada participated in this survey.

About 91% of participants were physicians specialized in sexual health or infectious diseases, and 34% were involved in mpox policy.

About 41% of participants reported longer working hours during the mpox outbreak, and 87% reported dealing with this extra load along with their regular clinical responsibilities. This additional workload, without the removal of existing responsibilities, exacerbated the pressure on healthcare systems already strained by the ongoing pandemic.

About 30% of participants reported not having any knowledge about mpox before the outbreak, with only 1% reporting having experience treating a mpox case before the outbreak. This highlights the significant knowledge gap among healthcare workers about re-emerging diseases, a critical concern given the increasing frequency of such outbreaks.

More than 25% of participants reported misdiagnosing someone with a mpox-related rash with another condition initially. The most commonly reported misdiagnoses were chickenpox, syphilis, and herpes.

Over half of the study population agreed that their institutions provided clear, timely, and authoritative information about the disease and that they had received the required education, training, or instruction. However, there were notable regional disparities, with healthcare workers in the Caribbean, Central America, and South America reporting significantly less institutional support compared to their counterparts in Europe and North America.

About 60% and 72% of participants reported following local service guidelines and national guidelines, respectively. About 40% of participants expressed their dissatisfaction with the support received from national public health agencies. This dissatisfaction was particularly pronounced in regions with historically limited access to public health resources, underscoring the need for more equitable support structures.

More than half of the study population reported feeling moral distress due to their work experiences in managing suspected or confirmed clinical cases of mpox. About 37% of participants reported impaired psychological wellbeing due to moral distress.

The study’s findings emphasize the significant psychological toll on healthcare workers, which could have long-term consequences for the sustainability of the workforce.

Vaccination to prevent mpox

Less than 50% of participants reported receiving smallpox vaccination before the mpox outbreak. In the USA, Europe, and Canada, around one in three participants received the vaccine, whereas the vaccination rate was one in ten in the Caribbean, Central America, and South America.

Overall, the vaccine uptake was high across all studied regions. More than 90% of participants in each region reported that vaccination should be offered to people at high risk of mpox infection prior to exposure.

Despite this high acceptance, the survey revealed significant inequities in vaccine access, particularly in low-resourced regions, which mirrored the challenges faced during the COVID-19 pandemic.

Study significance

This multi-national survey finds a profound gap in knowledge about mpox among healthcare workers, even though this neglected disease has been circulating among humans since 1970.

Such a deficit in knowledge highlights the urgent need for increasing global pandemic preparedness initiatives for frontline healthcare workers.

The findings suggest that health systems must prioritize educating and training healthcare workers on emerging infectious diseases to ensure rapid and effective responses in future outbreaks.

The survey finds a high vaccine acceptance and uptake level among healthcare workers involved in managing suspected or confirmed mpox cases. However, vaccine inequity and access have been significant in the Caribbean, Central America, and South America. This inequity hampers the effectiveness of outbreak responses in these regions and raises concerns about global health interventions’ overall fairness and efficiency.

Such inequity highlights the need to prioritize healthcare workers for mpox vaccination, particularly in regions with scarce infection prevention resources. The study calls for a coordinated global effort to address these disparities and ensure that healthcare workers, especially in low-resourced settings, are adequately protected. The scientists mentioned that similar surveys should be conducted on African clinicians to understand how unavailability or inaccessibility to essential resources like vaccines impacts their psychological well-being and perception of support.

Overall, the survey findings highlight a critical need for strengthening the resilience of global health systems and multidisciplinary approaches against future outbreaks. This resilience-building must include addressing the systemic issues leading to healthcare worker burnout and moral distress, ensuring that the global healthcare workforce is prepared and supported in future public health emergencies.

*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.