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Prevention of COVID-19 among populations experiencing multiple social exclusions
  1. Lucy Platt1,
  2. Sujit D Rathod1,2,
  3. Paola Cinardo2,
  4. Andrew Guise3,
  5. Paniz Hosseini1,
  6. PJ Annand3,
  7. Julian Surey4,5,
  8. Martin Burrows6
  1. 1 Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  3. 3 School of Life Course and Population Sciences, King’s College London, London, UK
  4. 4 Institute of Global Health, University College London, London, UK
  5. 5 Find and Treat, UCL NHS Trust, London, UK
  6. 6 Inclusive Insight, London, UK
  1. Correspondence to Professor Lucy Platt, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1E 9SH, UK; lucy.platt{at}

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Despite the development of effective vaccines against SARS-CoV-2 and an encouraging start to its roll out in many countries, in the coming months and years targeted prevention strategies will still be vital for socially marginalised groups. People experiencing multiple levels of exclusion related to homelessness, drug use, sex work, migration and their intersection can be particularly vulnerable to infection and morbidity with SARS-CoV-2 and will be less likely to benefit from population-wide prevention approaches such as contact tracing and mass vaccination. The recommendation by the Joint Committee on Vaccine and Immunisation in the UK to prioritise vaccination of people experiencing homelessness and rough sleepers is welcome, but will require ongoing vaccination programmes to ensure optimal coverage as well as targeted testing in coming years.1 There is a high risk that individuals who are homeless or otherwise socially excluded will be unable to be vaccinated and remain vulnerable to COVID-19 infection, limiting the potential for overall UK population coverage of COVID-19 vaccination to remain below the herd immunity threshold. Below, we consider existing evidence on ‘what works’ in vaccine provision and contact tracing among socially excluded populations, as well as learning from the response so far including the provision of emergency accommodation and vaccine delivery. We set out strategies for interventions and priority research questions, emphasising the importance of co-production in research and service delivery, to prevent ongoing transmission of SARS-CoV-2 and future infectious disease outbreaks.

Barriers to COVID-19 vaccine uptake by people experiencing multiple social exclusions should be anticipated. Up to 75% of people aged 18 years and over have received two doses of vaccines in the UK.2 This compares to findings from a health …

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  • Twitter @lucyvplatt, @juliansurey

  • Contributors All authors were responsible for the content of this editorial. LP was responsible for the original idea and completed the first draft. PC completed a literature review on uptake and access to vaccination programmes. SDR and PH conducted a rapid review on contact tracing and all authors contributed to the ideas presented and to the writing.

  • Funding This study was funded by the NIHR Public Health Research Programme (17/40/44).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.