Willingness of Chinese medical students to work on the frontline during a potential mpox outbreak: a nationwide cross-sectional study

Background: The global mpox epidemic has been designated a public health emergency of international concern, placing substantial strain on public health systems worldwide. As a critical reserve workforce for outbreak response, medical students' willingness to serve on monkeypox (mpox) frontlines remains understudied, and evidence on their mpox-related knowledge, attitudes, and practices and their association with frontline work willingness is still limited. Methods: We conducted an online nationwide cross-sectional survey among Chinese medical students from November 2023 to March 2024 using snowball sampling. We used multinomial logistic regression to identify independent influencing factors. Results: We included a total of 4,098 participants. Overall, 77.06% were willing to perform frontline mpox work, 18.57% were hesitant, and 4.37% refused. Among participant characteristics, studying medicine at others' suggestion was associated with both higher hesitancy (odds ratio (OR) = 1.425; 95% confidence interval (CI) = 1.142-1.776) and refusal (OR = 1.635; 95% CI = 1.110-2.407). Greater mpox knowledge (OR = 0.973; 95% CI = 0.966-0.981) and higher vaccination-related behaviour scores (OR = 0.894; 95% CI = 0.882-0.907) were associated with lower hesitancy to work on the mpox frontline. Higher vaccination-related behaviour scores were also associated with lower refusal (OR = 0.883; 95% CI = 0.862-0.904). Conclusions: Most Chinese medical students demonstrated favourable willingness to support frontline mpox response. Medical education should strengthen training in mpox prevention and professional ethics. Public health policies should use risk-stratified deployment, provide adequate protection and psychological support, and establish targeted mobilisation mechanisms to improve the emergency response capacity of the medical student reserve workforce.