In this blog post, we share our findings from surveying people experiencing predominantly unsheltered homelessness in Las Vegas, NV, and Orlando, FL, about motivators, barriers, and receipt of COVID-19 vaccination during 2021.

People experiencing homelessness in the US often face difficulty protecting themselves from infectious diseases, including COVID-19. During the COVID-19 pandemic, many public bathrooms closed, creating additional barriers to handwashing access. To address this need, Clean the World Foundation, the CDC Foundation and CDC partnered to establish handwashing stations and portable toilets for people experiencing homelessness in Nevada, Florida, and Puerto Rico from September 2020 to June 2021. During the project period, the stations served an estimated 8,000 unique individuals during a time when many services and shelter facilities were shuttered due to COVID-19.

In 2021, vaccines offered the promise of greater protection from COVID-19 for people experiencing homelessness. However, while there have been significant efforts to understand vaccine acceptability and hesitancy for other pathogens and infections (such as Hepatitis A and Influenza), it wasn’t clear how well this research would translate to COVID-19 vaccination. As the vaccines began to roll out, little was known about whether COVID-19 vaccine would be acceptable to people experiencing homelessness.

So our team of collaborators from the Centers for Disease Control and Prevention (CDC), CDC Foundation, and Clean the World Foundation implemented a vaccination acceptability survey of people who were accessing the handwashing stations in Nevada and Florida beginning in March 2021.

We found that just over half of surveyed participants (53%) were “vaccine accepting,” while the rest (47%) were “vaccine hesitant.” Top motivators for vaccine acceptance included protecting the health of oneself or their family and friends and resuming social activities or travel. Top concerns about COVID-19 vaccinations included concerns over the newness of the vaccines, skepticism of their effectiveness, concerns about side effects, and a general desire for more information. Participants also described some logistical barriers to being vaccinated for COVID-19, including distance to vaccination sites, lack of transportation, and long wait times associated with receiving a COVID-19 vaccine.

This information, complemented by estimates indicating lower COVID-19 vaccine uptake among people experiencing homelessness than the general population, is important to improve public health efforts in collaborative ways with existing community-based organizations and social service providers. Despite having similar motivations and concerns about COVID-19 vaccination, PEH may not be getting vaccinated to the same extent as the general population. Considering the increased risk for COVID-19 in congregate shelters, like emergency homeless shelters, understanding what might encourage people to be vaccinated and facilitate access to vaccination is critical for COVID-19 prevention.

Taken together, the study offers unique considerations for COVID-19 messaging and vaccination strategies tailored for the PEH population to increase vaccine uptake and decrease the prevalence of COVID-19 among PEH. Strategies can focus both at the individual decision-making level, like tailoring messaging that emphasizes the protective aspects of the COVID-19 vaccine or ensuring that service providers are able to respond to questions about side effects, efficacy and safety, or the systems level, like ensuring vaccines are physically meeting the individuals where they are to decrease logistical barriers. Public health departments and organizations can consider ways to collaborate with other community service organizations to support PEH in their communities in the most effective ways.

The findings and conclusions of this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

To learn more, read our article “COVID-19 Vaccine Acceptability Among People Experiencing Homelessness in Central Florida and Southern Nevada, March-June 2021” in the Journal of Public Health Management and Practice.

Helpful links:

• https://endhomelessness.org/blog/what-are-the-latest-insights-on-vaccination-for-people-experiencing-homelessness/
• https://pubmed.ncbi.nlm.nih.gov/34693782/
• https://link.springer.com/article/10.1007/s11606-021-07161-1
• https://www.usich.gov/resources/uploads/asset_library/Homelessness-in-America-Focus-on-chronic.pdf
• Vaccinate with Confidence | CDC