What you need to know
People who use drugs have lower vaccination uptake than the general population and experience a greater burden of harm from vaccine-preventable diseases. Researchers conducted interviews with people who use drugs to identify the factors that enable and deter them from getting vaccinated against the COVID-19 virus in Canada. They also looked at possible interventions to support their decision-making related to vaccination. Results showed that many partially or unvaccinated participants said they lacked knowledge about the COVID-19 vaccine, particularly its usefulness and benefits. Reasons for getting vaccinated were to protect themselves or others and because government mandates in certain provinces required people to get vaccinated in order to access services, attend work or travel.
What is this research about?
Evidence shows that COVID-19 vaccines can significantly reduce the likelihood that a person will need to be hospitalized or die due to the virus. People who use drugs tend to get vaccinated at a lower rate than the general population and experience more harm from diseases that can be prevented through vaccination. Researchers conducted interviews with people who use drugs to identify the factors that deter people who use drugs from getting the COVID-19 vaccine and the factors that motivate and support them to do so. The researchers also aimed to identify ways to improve vaccination rates in this group.
What did the researchers do?
The researchers conducted one-on-one semi-structured telephone interviews with people who use drugs from across Canada. They also obtained information about participants’ vaccination status.
Interviewers used two interview guides, one for fully vaccinated participants (they had received two or three doses of the vaccine) and one for unvaccinated or for those who did not complete the primary series of vaccines (received only one dose of the vaccine). Questions focused mostly on understanding potential barriers and concerns about receiving vaccinations and ways to address these issues.
Questions also sought to identify those individuals that participants believed were the most appropriate and trusted sources of information and resources related to vaccination, as well as formats and platforms that would help disseminate this type of information to people who use drugs.
What did the researchers find?
The study included 78 participants who were an average of 40 years old. About half of the group identified as female and two-thirds were white. Two-thirds were vaccinated for COVID-19.
More than half said they used a variety of substances (58 per cent), and more than a quarter used stimulants (26 per cent), while one tenth used opioids (12 per cent).
Half of partially or unvaccinated participants said they lacked knowledge about the COVID-19 vaccine, particularly in usefulness and benefits. Half were skeptical about the legitimacy of COVID-19 and the vaccines. A minority of participants (one-third) said they:
- lacked knowledge of the potential long-term side effects of the vaccine
- lacked information about the impact of mixing vaccine brands, which made them hesitant or stopped them from getting a booster
- did not trust the government and healthcare system
Those who had been vaccinated did so because they wanted to protect themselves or others and due to government vaccine mandates that required them to be vaccinated to access services, attend work or travel.
Participants said they trusted information about vaccines when it was shared by people with lived and living experience of drug use, harm reduction workers or healthcare providers who work in settings commonly visited by people who use drugs.
Limitations of the research
The researchers identified several study limitations. Some of the participants had previously responded to a study on COVID-19 and may have been more likely to participate in studies, in general. This may have resulted in a study sample that does represent the population of people who use drugs. Also, interviews were conducted by telephone, which may have excluded some marginalized people, such as those who are not currently housed.
How can you use this research?
This research may be of interest to program planners in the public health sector, who may wish to use the study findings to ensure they develop interventions and materials in ways that address the concerns of people who use drugs to improve their use of vaccination. Examples may include public health strategies led by peers in settings and organizations that are frequently accessed by people who use drugs can help improve uptake. The research may also be useful to service providers who work with people with lived and living experience and have conversations around the vaccine to provide knowledge and support. The study findings might be used to inform future vaccination strategies for this population.
About the researchers
Farihah Ali1,2, Ashima Kaura1, Cayley Russell1,2, Matthew Bonn3, Julie Bruneau13,14, Nabarun Dasgupta15, Sameer Imtiaz1, Valérie Martel-Laferrière5,6, Jürgen Rehm1,2,8,9,10,11,12, Rita Shahin4, Tara Elton-Marshall2,7
- Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada
- Ontario CRISM Node Team (OCRINT), IMHPR, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
- Toronto Public Health, Toronto, Canada
- Centre de Recherche du Centre hospitalier de l’Université de Montréal, Montréal, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montréal, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Department of Psychiatry, Dalla Lana School of Public Health, & Institute of Medical Science, Toronto, Canada
- University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Institut Für Klinische Psychologie Und Psychotherapie, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA