key: cord-0737637-etkq1zlg
authors: Paudyal, Vibhu; Racine, Melanie; Hwang, Stephen W.
title: COVID-19 vaccination amongst persons experiencing homelessness: practices and learnings from UK, Canada and the US
date: 2021-09-01
journal: Public Health
DOI: 10.1016/j.puhe.2021.08.015
sha: 4458290243902310ae6909810a45cc6f70b98014
doc_id: 737637
cord_uid: etkq1zlg

nan

As previously described 1 , persons experiencing homelessness (PEH) have faced intersecting crises during the COVID-19 pandemic. A study in the province of Ontario, Canada found that individuals with a recent history of homelessness were 20 times more likely to be hospitalized for COVID-19 and five times more likely to die after testing positive for COVID-19 than individuals in the general population. 2 During the pandemic, many Western countries have managed to offer shelters to rough sleepers at a pace unseen before, albeit these have tended to be temporary alternative care sites and hotels as opposed to supportive housing.

Vaccinating PEH is an effective strategy for infection outbreak mitigation in such shelters which often reflect congregate living and social environments. Here we aim to describe current practices and learnings from vaccination efforts in the UK, Canada and the US, where a combined population of approximately 2 million experience homelessness every year.

In the UK, after lobbying from local city authority housing leaders and a recommendation by the Joint Vaccination and Immunisation (JCVI), the UK Government in March 2021 included PEH amongst 'priority six' group alongside 'adults 16-65 with health problems' to be vaccinated at a national level. 3 While the initial strategy was aimed at getting as many PEH to register with a general practice, which in turn would offer them the vaccines, there was fear that important timelines would be missed in such a lengthy route to vaccine access by PEH. organizations. In particular, the presence of community-based frontline workers who have previously established relationships of trust with PEH has been critical to these efforts. The proportion of PEH that has received a first dose of vaccine continues to lag behind that of the general population, and future efforts will likely require a substantial intensification of dedicated time, energy and resources. 5 In the US, prioritization schema for COVID-19 vaccinations are determined state by state.

Only about two-thirds of states have explicitly prioritized homeless individuals in congregate settings, 6 despite the known COVID-19 infection risk posed by these environments. 7 The development of partnerships among public health departments, hospitals, and health and homeless service agencies has defined vaccine rollout to homeless individuals in the US.

Given the material limitations imposed by homelessness, scheduling appointments through public vaccination websites and arranging transportation to centralized clinics produces barriers to vaccination. On-demand vaccinations-including pop-up and mobile clinics, and those sited directly at congregate shelters, have been critical to reaching this population.

Given histories of racism in the health care system, 8 

COVID-19 and homelessness: when crises intersect. The Lancet Public Health

Testing, infection and complication rates of COVID-19 among people with a recent history of homelessness in Ontario, Canada: a retrospective cohort study

JVCIJCVI advises prioritising homeless people and rough sleepers for COVID-19 vaccine

Oldham COVID-19 vaccine hub set up for homeless people in first scheme of its kind

Toronto faces obstacles in vaccinating homeless populations while COVID-19 outbreaks erupt in shelters. The Globe and Mail

National Academy for State Health Policy -States Plan for Vaccinating their Populations against COVID-19

Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters -Four

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

County-Level COVID-19 Vaccination Coverage and Social Vulnerability -United States