COVID-19 vaccine hesitancy is frequent and can constitute a barrier to the dissemination of vaccines once they are available. Unequal access to vaccines may also contribute to socioeconomic inequalities with regard to COVID-19. We studied vaccine hesitancy among persons living in homeless shelters in France between May and June 2020 (n=235). Overall, 40.9% of study participants reported vaccine hesitancy, which is comparable to general population trends in France. In multivariate regression models, factors associated with vaccine hesitancy are: being a woman (OR=2.55; 95% CI 1.40-4.74), living with a partner (OR=2.48, 95% CI 1.17-5.41), no legal residence in France (OR=0.51, 95% CI 0.27-0.92), and health literacy (OR=0.38, 95% CI 0.21, 0.68). Our results suggest that trends in vaccine hesitancy and associated factors are similar among homeless persons as in the general population. Dissemination of information on vaccine risks and benefits needs to be adapted to persons who experience severe disadvantage.

Background Accumulating evidence suggests that the COVID-19 pandemic has negatively affected global mental health and well-being. However, the impact amongst homeless persons has not been fully evaluated. The ECHO study reports factors associated with depression amongst the homeless population living in shelters in France during the Spring of 2020. Methods Interview data were collected from 527 participants living in temporary and/or emergency accommodation following France's first lockdown (02/05/20 – 07/06/20), in the metropolitan regions of Paris (74%), Lyon (19%) and Strasbourg (7%). Interviews were conducted in French, English, or with interpreters (33% of participants, ∼20 languages). Presence of depression was ascertained using the Patient Health Questionnaire (PHQ-9). Results Amongst ECHO study participants, 30% had symptoms of moderate to severe depression (PHQ-9≥ 10). Multivariate analysis revealed depression to be associated with being female (aOR: 2.15; CI: 1.26-3.69), single (aOR: 1.60; CI: 1.01-2.52), chronically ill (aOR: 2.32; CI: 1.43: 3.78), facing food insecurity (aOR: 2.12; CI: 1.40-3.22) and participants’ region of origin. Persons born African and Eastern Mediterranean regions showed higher levels of depression (30-33% of participants) than those migrating from other European countries (14%). Reduced rates of depression were observed amongst participants aged 30-49 (aOR: 0.60; CI: 0.38-0.95) and over 50 (aOR: 0.28; CI: 0.13-0.64), compared to 18-29-year-olds. Limitations These data are cross-sectional, only providing information on a given moment in time. Conclusions Our results indicate high levels of depression among homeless persons during the COVID-19 pandemic. Predicted future instability and economic repercussions could particularly impact the mental health of this vulnerable group.

Social inequalities tended to increase in the context of the pandemic, particularly in relation to the measures taken to manage and reduce the risk of COVID-19. When lockdown measures required the general population “to stay home”, what were homeless people expected to do? The ECHO study is a cross-sectional, descriptive study with a convergent mixed-method design. Data were collected across shelters in France both during and immediately following the lockdown (April – June 2020). This article presents the study’s qualitative findings, with a focus on understanding both the experiences and perceptions among these populations of the measures taken to limit the COVID-19 infection. A total of 26 semi-directed individual interviews were conducted across seven shelters in both Lyon (42%) and Paris (58%). Data were analysed using thematic content analysis with partial blinded coding. Four key themes were identified: 1- Reactions to the introduction of lockdown: a sudden implementation reminiscent of prior violent or traumatic circumstances amongst participants, 2- Accommodation during lockdown: participants’ conflicting visions of the shelter, 3- Influence of the media and public communication: an abundant flow of information impacting participant’s wellbeing and representations on the pandemic, and 4- The individual impact of lockdown: perceived health and limitations to daily life activities. The most vulnerable populations have borne the heaviest burden during the pandemic. It is therefore crucial that we improve both the availability of information, and the health literacy of, all groups within the national population.