Vaccination coverage and attitudes toward vaccines among people experiencing homelessness: Pilot study findings from Warsaw, Poland

Background
People experiencing homelessness (PEH) have elevated rates of vaccine-preventable diseases, such as influenza, hepatitis A/B, tuberculosis, invasive pneumococcal disease, or COVID-19, compared to people in secure living, as well as poorer associated health outcomes. PEH, unlike the general population, have lower rates of vaccination. Delivering vaccinations to this vulnerable and marginalized group poses a complex challenge, as little is known about vaccine acceptance in this population, and the current understanding of best practices in this context is still limited.

Objectives
This study aimed to explore socio-demographic situation, vaccination rates and vaccine hesitancy among PEH in Warsaw.

Material and methods
This questionnaire-based cross-sectional survey was conducted as a pilot study among adult people currently experiencing homelessness in Warsaw, Poland (April–June 2023). We collected data on socio-demographic characteristics, vaccination status, and vaccine hesitancy among PEH using the validated Polish version of the Adult Vaccine Hesitancy Scale (PL-aVHS).

Results
A total of 21 individuals participated in the survey (12 males and 9 females). The mean age was 51.95 years (SD = 12.47), ranging from 20 to 75 years. Most (11; 55%) belonged to the ‘Roofless’ ETHOS category, followed by ‘Houseless’ (8; 40%). Participants who had received COVID-19, influenza, or hepatitis B vaccination accounted for 76.2%, 42.9%, and 23.8% of the total group, respectively. 9 respondents (42.9%) were categorized as vaccine-hesitant based on their PL-aVHS score. PEH displayed considerable hesitancy towards accepting influenza (52.4% respondents), hepatitis B (52.4%), and COVID-19 (42.9%) vaccines.

Conclusions
The study highlights the persistent vaccine hesitancy among PEH. Co-designing intervention strategies reaching out to these at-risk and hard-to-reach populations are crucial to maximize vaccine uptake.