Over 13,300 unaccompanied youth experience homelessness annually in Minnesota. When it comes to reducing COVID-19 risk, they have been largely left out of the conversation. Youth experiencing homelessness (YEH) are at increased risk of contracting and transmitting COVID-19 due to a range of complex social, situational, and structural factors. Over half of YEH are individuals from communities of color that experience increased risk of COVID-19 morbidity/mortality. YEH also experience practical barriers (such as lack of insurance and inconsistent access to healthcare) and psychosocial barriers (such as structural racism/marginalization and trauma associated with systems-involvement) to vaccination.
In early 2021, as COVID-19 vaccine rollout began, the Centers for Disease Control and Prevention established a Vaccine Confidence Network among the country’s 26 Prevention Research Centers. The goal was to increase vaccine confidence and uptake among communities disproportionately affected by the COVID-19 pandemic. Through this national network, the Healthy Youth Development – Prevention Research Center at the University of Minnesota received funding to support a community-partnered project to develop tailored, youth- and community-driven, anti-oppressive, and equitable strategies to increase COVID-19 vaccine confidence and access among YEH in Hennepin County, MN.
How we’re addressing COVID-19 vaccine confidence and access
Through youth focus groups, interviews with staff at youth-serving agencies, frequent tabling events, conversations with individual youth and youth boards, and monthly cross-sector planning team meetings with key partners, the team has learned that YEH have concerns about vaccine safety and long-term effects, systemic racism, whether young people really need it, and the logistics involved in accessing it. To address these concerns and improve confidence and access, we are implementing four strategies in partnership with youth:
Youth-friendly, trauma-informed, culturally-responsive messaging about COVID-19 vaccination
Fun and inclusive health events at youth-serving agencies
Vaccine aftercare kits to youth to offer physical, emotional, and educational support after vaccination
Training and resources to direct service staff at youth-serving agencies for navigating vaccine conversations with youth
Common youth concerns about COVID-19 vaccinations and how pediatricians might address them
Table 1 outlines the most salient concerns identified by youth and proposed approaches to addressing them with your adolescent patients. 
Youth and other key partners also emphasized the importance of providers creating safe spaces for young people to ask questions about vaccination. We encourage pediatricians to start by listening to their concerns, and then to engage in youth-centered conversations that address these concerns and promote their autonomy.
For many young people, conversations about vaccinations can be particularly sensitive: they often occur in the context of a legacy of historic and current trauma at the hands of healthcare systems. As with other conversations about sensitive topics, conversations about vaccinations should take place in the context of a safe and trusting, ongoing relationship with adolescent patients.
Minor consent and vaccination: Under what circumstances can youth consent to their own COVID-19 vaccination?
As parental consent may be a barrier for youth experiencing homelessness or living independently, pediatricians need to be familiar with Minnesota laws on when youth are able to consent for their own healthcare services. We’ve outlined the basics regarding vaccine consent in Table 2.
Next steps
Pediatricians are well-positioned to navigate tough conversations about vaccines with young people who have been historically marginalized. Using a trauma-informed and youth-centered approach, we can build trust and promote confidence in the COVID-19 vaccinations and in the healthcare system more broadly. For questions or to see the final products, reach out to Janna Gewirtz O’Brien, gewir007@umn.edu.
Janna R. Gewirtz O’Brien, MD, MPH, FAAP; Ingie Osman, MPH; Asha Elgonda, MPH; Lauren Vasilakos, MS1; Katherine Pierson, MA; and Renee Sieving, PhD, RN collaborated on this article.
