Introductionlittle has been documented about public perceptions and acceptance of the mpox vaccine in endemic countries, such as Nigeria. We assessed public awareness, risk perception, and correlates of vaccine acceptability in urban Kano, Nigeria.Methodsemploying a mixed methods design, structured questionnaires were administered to 415 adults in metropolitan Kano. The data were analyzed using binary logistic regression and the framework approach.Resultsnearly all respondents (99.0%, n=411) have heard about mpox, but only one-half (49.9%, n=207) of the respondents were willing to take the mpox vaccine. Female respondents were 33% less likely to accept mpox vaccination (adjusted odds ratio, aOR=0.67, 95% confidence interval CI: 0.42-0.92). Respondents who perceived mpox as a severe disease (aOR = 1.37, 95% CI, 1.12-2.20), those who self-assessed as high risk (aOR=2.10, 95% CI, 1.10-7.46) or who perceived vaccines as protective (aOR=8.99, 95% CI,1.79-45.30) were more likely to accept the vaccine. There were three-fold increased odds of accepting the mpox vaccine among participants who received vaccinations during adulthood (aOR=3.58, 95% CI, 2.20-5.82), and those who were vaccinated against COVID-19 (aOR=2.86, 95% CI, 1.45-5.64). Reasons for vaccine hesitancy include vaccine safety concerns, low-risk perception, mistrust of authorities and pharmaceutical companies, the newness of the vaccine, hurried introduction, fear of side effects, and perceived misplaced government priorities.ConclusionMpox awareness was near-universal in our study population, but mpox vaccine acceptance was sub-optimal. mpox vaccine acceptance was influenced by sociodemographic (gender, ethnicity, religion), vulnerability (perceived risk, perceived effectiveness of vaccines), and health behavior-related (COVID-19 vaccination status) factors. Risk communication, community engagement, and socio-behavioral interventions could help build public confidence and boost vaccine acceptance in similar settings
