COVID-19 VACCINATION AND HOMELESSNESS: THE NEED FOR A PERSON-CENTERED INTEGRATED APPROACH

Abstract

Introduction: As homeless people in general suffer from poor health and are at elevated risk for COVID-19 infections they have an indication for receiving COVID-19 vaccination. However, several barriers in accessing vaccination can be identified. There is no information on the willingness of homeless people to receive the COVID-19 vaccination, nor on the experiences with the vaccination process of homeless people and professionals involved. Therefore, this qualitative study aims to provide insight into vaccination willingness among homeless people in the Netherlands, in the barriers and facilitators in accessing vaccination, and in the experiences of professionals involved in the vaccination process. Methods: We performed semi-structured interviews with 53 homeless persons, 16 professionals involved in health care or shelter for homeless people as well as 7 public health professionals who were involved in the vaccination process for homeless people. Interviews were thematically analyzed. Results: Homeless people experienced a lack of understandable and consistent information, which resulted in distrust and vaccination hesitancy. Mistrust in the government was common. However, approximately half of them were vaccinated at the end of the first vaccination campaign, sometimes because not being vaccinated would restrict their possibilities to access public places. Barriers to access vaccination included the complicated process and forms and difficulties accessing the vaccination venue. Especially difficult turned out to be the bureaucratic process of acquiring the Corona virus entry pass. Identified key-elements for a successful vaccination campaign for homeless people: a strong collaboration between all stakeholders, easy to understand information by trusted professionals, the possibility of vaccination at out-reach sites like homeless shelters. Conclusion: Although the vaccination rate among homeless people in the Netherlands is estimated to be lower than among the general public, successful vaccination campaigns are possible if trusted people provide easy to understand information, all stakeholders work together and vaccination takes place at easy to reach locations.