COVID-19 vaccine access and attitudes among people experiencing homelessness from pilot mobile phone survey in Los Angeles, CA

Abstract

People experiencing homelessness (PEH) are at high risk for COVID-19 complications and fatality, and have been prioritized for vaccination in many areas. Yet little is known about vaccine acceptance in this population. The objective of this study was to determine the level of vaccine hesitancy among PEH in Los Angeles, CA and to understand the covariates of hesitancy in relation to COVID-19 risk, threat perception, self-protection and information sources. A novel mobile survey platform was deployed to recruit PEH from a federally qualified health center (FQHC) in Los Angeles to participate in a monthly rapid response study of COVID-19 attitudes, behaviors, and risks. Of 90 PEH surveyed, 43 (48%) expressed some level of vaccine hesitancy based either on actual vaccine offers (17/90 = 19%) or a hypothetical offer (73/90 = 81%). In bivariate analysis, those with high COVID-19 threat perception were less likely to be vaccine hesitant (OR = 0.34, P = 0.03), while those who frequently practiced COVID-19 protective behaviors were more likely to be vaccine hesitant (OR = 2.21, P = 0.08). In a multivariate model, those with high threat perception (AOR = 0.25, P = 0.02) were less likely to be hesitant, while those engaging in COVID-19 protective behaviors were more hesitant (AOR = 3.63, P = 0.02). Those who trusted official sources were less hesitant (AOR = 0.37, P = 0.08) while those who trusted friends and family for COVID-19 information (AOR = 2.70, P = 0.07) were more likely to be hesitant. Findings suggest that targeted educational and social influence interventions are needed to address high levels of vaccine hesitancy among PEH.

Fig 1. COVID-19 vaccine hesitancy by prior vaccine access.

Respondents who were offered a vaccine (n = 17) were asked whether or not they received the vaccine; those who received the vaccine (n = 10) were classified as not vaccine hesitant and those who did not receive the vaccine were classified as vaccine hesitant (n = 7). Respondents who had not been offered the vaccine (n = 73) were asked if they would take the vaccine. Those who said they would take the vaccine (n = 37) were classified as not hesitant and those who said they wouldn’t (n = 23) or declined to answer (n = 13) were classified as hesitant.

Fig 2. Reasons for vaccine hesitancy among those who refused offer of COVID-19 vaccine.

Respondents who refused an actual or hypothetical offer of the COVID-19 vaccine were asked their reason(s) for refusal (n = 30). Other possible reasons for vaccine hesitancy that were not selected by any participants included “I am not at risk for COVID-19” and “I could not afford the vaccine”.