The Evolution of Monkeypox Vaccination Acceptance in Romania: A Comparative Analysis (2022-2025), Psychosocial Perceptions, and the Impact of Anti-Vaccination Rhetoric on Societal Security.

This study examines the evolution of willingness to accept the monkeypox (Mpox) vaccine in Romania between 2022 and 2025. It explores key sociodemographic and behavioral predictors of vaccine acceptance and investigates how public perceptions-particularly concerning disease severity and conspiracy beliefs-have shifted across two independent cross-sectional samples. Two nationally distributed surveys were conducted in July 2022 (n = 820) and January-February 2025 (n = 1029), targeting Romanian residents aged 18 and above. Data were analyzed using descriptive statistics, Chi-square tests, Kolmogorov-Smirnov tests, and a Random Forest classification model to assess the relative importance of predictors of vaccine acceptance. Between 2022 and 2025, vaccine acceptance increased modestly, particularly among individuals aged 36-65 and those with prior experience of voluntary or COVID-19 vaccination. Random Forest analysis identified behavioral factors as the strongest predictors of acceptance in both years, while the influence of education and gender varied over time. Belief in conspiracy theories slightly declined and lost predictive relevance by 2025. Perceptions of pandemic potential and fear of infection also decreased, suggesting reduced risk salience and possible pandemic fatigue. Despite a slight upward trend, overall Mpox vaccine acceptance in Romania remains among the lowest in Europe. These findings highlight the need for targeted public health communication, particularly toward skeptical or demographically vulnerable groups. Prior vaccination behavior emerged as a key driver of acceptance, indicating that trust-building strategies should capitalize on existing pro-vaccination habits. Future research should adopt qualitative and longitudinal approaches to better capture the evolving psychosocial dynamics of vaccine hesitancy.