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macOS Safari users press Control + Option (Alt) + Accesskey.
⌃ = Control, ⌥ = Option
In Safari, Press "Control + Option + 7" Now to show the accesskeys. (Modifier Keys for Firefox, Chrome, IE).
Accesskey values as a letter may conflict with other apps or screen readers so using numbers 1 2 3 4 5 6 7 8 9 0 ensures the least amount of conflicts. e.g. Alt + D in Chrome Windows sets focus to the browser address bar rather than activating the accesskey. When testing this demo page I found no conflicts with VoiceOver/Safari or NVDA/JAWS/Firefox, only conflict was with NVDA/Chrome Alt + D key. Accesskey values may also conflict with user-installed apps like Magnet for macOS which uses Control + Option + D and Control + Option + C and prevents the accesskey from working in macOS.
When VoiceOver is running you must hit the Control key only rather than hitting Control + Option keys together.
You will have to perform the VoiceOver PassThrough command first which is Control Option Tab before you can activate the accesskey.
Tell VoiceOver to ignore the next key combination you press with VO-Tab