Promote equal access to COVID19 vaccination: strategies of the Local Authority Toscana SudEst, Italy

Abstract Background In the area of the Local Health Authority Toscana Sud-Est (LHA) 13,5% of residents are foreigners. We aim to assess the impact of our intervention to COVID-19 vaccination coverage. Methods Since summer 2021, LHA has promoted vaccination sessions dedicated to foreign residents with free walk-in access, multilingual forms, flyers and TV interventions, cultural mediators and trained healthcare workers. We collected data about vaccination status of residents (28 December 2020-31 January 2022) and we analysed them using the software STATA to assess vaccine coverage by nationality and the effectiveness of our intervention. The results were adjusted for age and sex. We set significance level at p < 0.05. Results On 31 July 2021, 78% of Italian residents (N = 685289) had received the first dose of vaccine, compared to only 43% of foreign residents (N = 106370). There was a 35% gap. On 31 January 2022, after our intervention, 89% of Italian residents and 71% of foreign residents had received the first dose of the vaccine. The gap was 18%. On 31 January 2022, 50% of residents of all nationalities had received two doses of the vaccine. A significant difference between Italian and foreign residents is still observed after adjustment for age and sex (OR 0.41 95% IC 0.40-0.41). Vaccination adherence is lower in females than males, for both Italian (OR 0.90 0.89-0.91) and foreign residents (OR 0.82 0.79-0.84). This is accentuated within some ethnic groups: Macedonians, Kosovars, Pakistanis. Conclusions The creation of dedicated service guaranteed to reach a high vaccination coverage in all the nationalities and to reduce the gap between host and foreign residents. In foreigners it is lower than in the hosts, so it is necessary to investigate possible cultural factors that may influence hesitancy. A lower vaccination coverage in females, especially in foreigners, may be due to an inferior participation in social and working life as a consequence of the gender gap. Key messages • The creation of dedicated interventions guaranteed to achieve high vaccination coverage in all nationalities. • A lower vaccination adherence in females than males, especially in foreigners, may be due to an inferior participation in social and working life as a consequence of the gender gap.


Background:
The countries with paid sick leave (PSL) and sickness benefits (SB) mostly provide the benefit coverage to specific categories of workers, which results in health inequalities among employees in COVID-19. The PSL and SB are key factors to achieve universal health coverage (UHC) in that they protect access to healthcare and improve population health. This study attempted to investigate whether the policies helped achieve the UHC when they were expanded. Methods: This review followed the scoping review protocol of PRISMA-ScR. On April 6, 2021, we extracted the literature using the keywords 'paid sick leave', 'sickness benefits', 'paid sick day', and 'earned sick leave' from PubMed and Web of Science and added two studies through hand-search. All articles were written in English. We did not limit the publication date.

Results:
Forty-four selected studies were based in four single countries and the European Union. Most of the studies were published after 2010 (84.1%) and were conducted as cross-sectional (72.7%) studies. Not only workers who use PSL and SB but also children whose parents use PSL and SB increased their use of healthcare services and getting flu shots. Also, using PSL and SB decreased their unmet healthcare needs and emergency use. The various health status factors, such as infectious disease incidence, mortality, and presenteeism, also decreased.

Conclusions:
The provisions of PSL and SB offer individual and public health benefits by allowing employees and their families to use healthcare services. Group of employees, we can expect similar public health impacts on newly covered groups, thus contributing to achieving the UHC. Since more than 90% of articles are published from the United States, future studies need to evaluate the outcomes of health effects in various European or Asian countries. Key messages: The provision of PSL and SB positively affects employees and their families by allowing them to use healthcare services. The expansion of PSL and SB contributes to the UHC by guaranteeing indirect medical costs that enable universal access to essential healthcare services. Background: In the area of the Local Health Authority Toscana Sud-Est (LHA) 13,5% of residents are foreigners. We aim to assess the impact of our intervention to COVID-19 vaccination coverage.

Methods:
Since summer 2021, LHA has promoted vaccination sessions dedicated to foreign residents with free walk-in access, multilingual forms, flyers and TV interventions, cultural mediators and trained healthcare workers. We collected data about vaccination status of residents (28 December 2020-31 January 2022) and we analysed them using the software STATA to assess vaccine coverage by nationality and the effectiveness of our intervention. The results were adjusted for age and sex. We set significance level at p < 0.05. cultural factors that may influence hesitancy. A lower vaccination coverage in females, especially in foreigners, may be due to an inferior participation in social and working life as a consequence of the gender gap.

Key messages:
The creation of dedicated interventions guaranteed to achieve high vaccination coverage in all nationalities.
A lower vaccination adherence in females than males, especially in foreigners, may be due to an inferior participation in social and working life as a consequence of the gender gap.

Background:
Persons experiencing homelessness (PEH) suffer a high burden of chronic diseases, yet face significant barriers in accessing health services. We describe and compare chronic diseases and multi-morbidity in PEH, housing exclusion and secure housing who lacked access to regular health services in the wake of the COVID-19 pandemic in Germany.

Methods:
Study participants were adults who sought care at clinics of the humanitarian organisation ''Ä rzte der Welt'' in Munich, Hamburg and Berlin in 2020. The patients were categorised into three groups according to the European Typology of Homelessness and Housing Exclusion (ETHOS). We described socio-demographic characteristics, self-rated health, chronic diseases, multi-morbidity and SARS-COV-2 infections in each group. Logistic regression analysis was used to identify sociodemographic factors associated with higher odds of chronic diseases and multi-morbidity.

Conclusions:
Housing was not a risk factor for chronic disease and multimorbidity in this study. However, PEH reported poorer selfrated and psychiatric health. Strategies to improve access to health services for persons experiencing homelessness and housing exclusion are much needed in Germany.

Key messages:
Research to highlight the health inequity, both in access and outcomes, in persons experiencing all forms of homelessness is much needed. This study provides data on a population disconnected from the formal healthcare system. Making such data visible is a step towards addressing the structural causes of social exclusion.