Ontario's homeless community is falling behind in vaccine coverage as province drops pandemic restrictions

A homeless man sleeps on the street, in Toronto, on Friday, March 11, 2022. THE CANADIAN PRESS/Chris Young

A new Ontario-based study illuminates a reality health equity experts have been echoing throughout the pandemic – access to vaccines is not equitable.

The study found just under 62 per cent of Ontario’s homeless population received their first dose of a COVID-19 vaccine. Meanwhile, more than 86 per cent of the general adult population received their first dose.

This research – the first of its kind in Canada, published in The Lancet Public Health this month – tracked the vaccination rate of more than 23,000 adults who recently experienced homelessness in the province between Dec. 14, 2020 and Sept. 30, 2021. 

These findings come as the province enters a new stage of the pandemic – one that ushers in the lifting of mask mandates and acceleration of third doses, while this historically marginalized population lags behind in first dose coverage.

“There are often assumptions that everyone has access to the same level of health care, and while that may technically be true, we know that health care is not being accessed equitably,” Dr. Naheed Dosani, health equity lead at Toronto’s Kensington Health and an author on the Lancet study, said.

A new study published in The Lancet Public Health followed 23,247 adults with a recent experience of homelessness from December 14, 2020 to September 30, 2021 and examined vaccination rates, which they compared to Ontario’s adult population. (IC/ES) Dr. Salimah Shariff, another member of the research team and a scientist at ICES, said one of the striking findings in their study was that the homeless population was prioritized early on in the province’s vaccination effort. Yet, vaccination rates still fell behind.

“What we were able to glean from our data was that people who were more likely to engage with the health care system,” Shariff said. “These individuals were more likely to be vaccinated.” For example, Shariff  pointed to a family physician practicing in the community or a holistic health centre targeting marginalized populations.

She said their findings point to the essentiality of a targeted and tailored approach to vaccine delivery. “That really just brings to the forefront the necessity for trust and relationship building and leveraging those relationships,” Shariff said. 

Part of that approach includes acknowledging that this patient population has in many cases experienced significant trauma, which at times has taken place “at the hands of health care,” Dosani said, emphasizing the need for prioritizing trauma-informed approaches to vaccination strategies.

“Ultimately, a society that is equity-oriented would ensure that everyone has adequate access to safe high-quality housing. But until that point actually happens, the least we can do is invest in equitable approaches to health care, in the midst of a health crisis, like a pandemic.”