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Background/Objective:

There is limited data on the prevalence and reasons for vaccine hesitancy or acceptance among people experiencing houselessness (PEH) in Los Angeles, California. Los Angeles County has the highest concentration of PEH in the country, and this community is at increased risk for many vaccine-preventable diseases. Furthermore, it is unclear if vaccine attitudes have changed at 5 years past introduction of the COVID-19 vaccine. This study investigated vaccine acceptance, attitudes, and desire among clients at Mobile Clinic Project, a street-side clinic for PEH in Los Angeles, California. The goal was to understand how clients feel about vaccines to identify potential strategies to improve vaccination services at the clinic.  

Methods:

Participants were recruited from the client base of Mobile Clinic Project at UCLA between January and April 2026 at Wednesday evening and Sunday afternoon clinics. Both clinic sites are in the Hollywood neighborhood of Los Angeles. Participants were consented and asked to complete a paper survey by trained research staff. Data was stored in REDCap and analyzed using IBM SPSS.

Results:

In total, 41 participants took the survey. The group was predominantly male (82.5%); median age was 43 years old (IQR: 37 to 54 years old). Just under half (42.1%) of participants identified with the LGBTQ+ community, and 18.4% identified as transgender. General attitudes towards vaccination among participants were mostly positive (“positive”, 39.0%; “very positive”, 26.8%), though those who felt negatively about vaccines were twice as likely to report strong attitudes (“negative”, 2.4%; “very negative”, 4.9%). Only 5.1% of participants disagreed with getting a vaccine if a healthcare provider recommended it to them. Healthcare providers were the most trusted source for medical advice (68.4%), and healthcare provider recommendation was the second most common reason to receive the influenza and COVID-19 vaccines (35.7% and 35.5%, respectively). Fear of feeling sick (33.3%) and belief in ineffectiveness (25.0%) were the most common reasons to not receive influenza vaccination, while belief that vaccine ingredients are not safe was the most common reason to not receive COVID-19 vaccination (28.6%). Many participants (56.4%) received COVID-19 vaccination in the past but do not get annual boosters. About half (52.8%) of clients reported a change in their feelings about vaccination since the COVID-19 pandemic, with 58% feeling more negatively. Interest in vaccination at clinic ranged from 40.5% to 57.9% for common vaccines recommended in the adult population.

Conclusions:

In general, there is a positive attitude towards and desire for vaccination among Mobile Clinic Project clients. This data suggests a critical role for healthcare providers in recommending vaccination to clients at Mobile Clinic Project. Vaccine services at clinic may be improved by dedicated conversations between clients and healthcare providers prior to vaccination, though it is unclear whether this finding extends to medical student volunteers. Another finding was low rates of annual COVID-19 vaccination among clients, who commonly believed that the vaccine or its ingredients were not safe. This suggests that educational materials on COVID-19 ingredients could provide valuable information to clients who are recommended for annual COVID-19 boosters.