A Qualitative Exploration of Vaccine Uptake and Hesitancy Among People Experiencing Homelessness in Toronto

Homelessness is a public health crisis in Canada, exacerbated by the COVID-19 pandemic. People experiencing homelessness face disproportionate physical, mental, and social burdens, risk factors for poor outcomes if infected with COVID-19. Those living in shelters are at higher risk for contracting COVID-19 because of shared living spaces, crowding, difficulty physical distancing, and high population turnover. Once infected with COVID-19, people experiencing homelessness have a higher likelihood of hospitalization, intensive care unit admission, or death than the general population. Given increased risk for exposure and serious infection, homeless individuals who live in congregate settings are a priority population for the vaccine rollout in Canada. However, vaccination rates among people experiencing homelessness are historically lower than the general population, linked in part to vaccine misinformation and mistrust of healthcare systems and providers. No Canadian studies have yet investigated COVID-19 vaccine uptake and hesitancy among this population. This qualitative study will explore reasons for COVID-19 vaccine uptake and hesitancy among people experiencing homelessness. Over 3 months, we will interview a diverse group of up to 40 homeless individuals living in physical distancing hotels and emergency shelters in Toronto, to better understand opinions, beliefs, and attitudes towards the COVID-19 vaccine. This study will be conducted at MAP Centre for Urban Health Solutions and leverages existing partnerships with City of Toronto and Canadian Alliance to End Homelessness. Findings will be rapidly communicated to our public health partners to develop more targeted interventions and strategies to improve vaccination rates among homeless individuals. COVID-19 has disproportionately impacted people who are homeless and this study will create evidence to address this health inequity.