COVID-19 vaccination rates among adults experiencing homelessness substantially lower than rates among adults living in Ontario

A new study published in The Lancet Public Health found that by the end of September 2021, uptake of COVID-19 vaccines among adults with a recent experience of homelessness was 25 percentage points lower than the adult population of Ontario for a first dose and 34 percentage points lower for a second dose.

This study is the first in Canada to examine vaccination rates among persons experiencing homelessness.

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Using provincial data from ICES, the researchers followed 23,247 adults with a recent experience of homelessness from December 14, 2020 to September 30, 2021 and examined vaccination rates for a first and second dose of a COVID-19 vaccine, which they compared to the adult population of Ontario.

“What is particularly striking about our study findings is that despite being prioritized for early vaccination receipt and the considerable efforts by shelters, public health organizations, healthcare institutions, and various community organizations to make vaccines available to people experiencing homelessness in Ontario, vaccination rates for a first dose have substantially lagged behind the rest of Ontario,” says Dr. Salimah Shariff, associate scientist at Lawson, adjunct research professor at Western and scientist at ICES Western.

The study identified the following vaccination rates by the end of September 2021:

• First dose: 61.4 per cent in adults with a recent experience of homelessness vs. 86.6 per cent in the total adult population of Ontario
• Second dose: 47.7 per cent in adults with a recent experience of homelessness vs. 81.6 per cent in the total adult population of Ontario

To assist with tailored public health communication and vaccine delivery efforts, researchers also examined factors that may have influenced vaccine uptake of a first dose of a COVID-19 vaccine among persons with a recent experience of homelessness. Findings revealed that individuals who had more contact with the healthcare system, particularly with primary care, had higher rates of vaccine uptake.

Factors also found to be associated with higher uptake include:

• being older (≥50 years)
• having a chronic health condition
• receiving a COVID-19 PCR test
• receiving a flu shot
• living in a large urban setting

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“These findings suggest that connection and access to primary healthcare is a vital factor in facilitating the uptake of COVID-19 vaccination among persons experiencing homelessness. From the very beginning, vaccination approaches in this population have outlined that trust and relationship building would be central to a successful vaccination strategy,” explains Dr. Richard Booth, associate scientist at Lawson, associate professor at Western and scientist at ICES Western. “Concerted and informed efforts to enhance vaccination rates, such as integration of family medical practices and Community Health Centres in vaccination efforts, may help in increasing vaccination rates in this population,” continues Dr. Booth.

People experiencing homelessness have been disproportionately impacted by the COVID-19 pandemic. Previous research by this team revealed that during the first wave of the COVID-19 pandemic in Ontario, people experiencing homelessness were more likely to test positive, be hospitalized, receive intensive care for, and die of COVID-19 compared to the general population.

“With emerging COVID-19 variants and strains, public health guidance now recommends that everyone who is eligible should receive a third dose of a COVID-19 vaccine for added protection; however, our research brings to light that many people experiencing homelessness have yet to receive a first dose of the vaccine. There is therefore an urgent need to increase vaccination efforts in this historically marginalized population,” adds Dr. Shariff.

The researchers add that their findings reinforce recommendations from experts on leveraging existing health and service organizations that are accessed and trusted by people who experience homelessness for targeted and tailored vaccine delivery.

“COVID-19 vaccine coverage and factors associated with vaccine uptake among 23 247 adults with a recent history of homelessness in Ontario, Canada: a population-based cohort study,” was published on March 9, 2022 in The Lancet Public Health.

Author block: Salimah Z Shariff, Lucie Richard, Stephen W Hwang, Jeffrey C Kwong, Cheryl Forchuk, Naheed Dosani, Richard Booth

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Niveen Saleh
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ICES
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Downloadable Media

Dr. Salimah Shariff, Associate Scientist at Lawson,
Adjunct Professor at Western and Scientist at ICES Western
(click image for full size)

Dr. Richard Booth, Associate Scientist at Lawson,
Associate Professor at Western and Scientist at ICES Western
(click image for full size)

Vaccination rates of a first and second dose of a COVID-10 vaccine from December 14, 2020 to September 30, 2021 (click image for full size)

ABOUT LAWSON HEALTH RESEARCH INSTITUTE – @lawsonresearch
Lawson Health Research Institute is one of Canada’s top hospital-based research institutes, tackling the most pressing challenges in healthcare. As the research institute of London Health Sciences Centre and St. Joseph’s Healthcare London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world.

ABOUT WESTERN – @WesternU
Western delivers an academic experience second to none. Since 1878, The Western Experience has combined academic excellence with life-long opportunities for intellectual, social and cultural growth in order to better serve our communities. Our research excellence expands knowledge and drives discovery with real-world application. Western attracts individuals with a broad worldview, seeking to study, influence and lead in the international community.

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