Populations at increased risk of SARS-CoV-2 infection

Collective protective measures such as lockdowns and curfews have consequences that can be particularly severe for the most vulnerable populations. They can exacerbate physical and mental health issues, as well as food, economic, and social stress, in pre-existing situations that are already cause for concern.

The specific needs of these populations have led Santé publique France to propose an initiative to mobilize knowledge on strategies for combating COVID-19 among highly vulnerable populations, with the aim of sharing proven strategies implemented abroad, the results of research conducted in France, the experiences of frontline workers, and the actions of decision-makers at various territorial levels.

The goal is to collectively identify and define the challenges ahead for these populations and to guide the implementation of best practices in response, prevention, and health promotion.

Key lessons for better support of the most vulnerable populations

This work highlighted the need for a strategy of systematic COVID-19 screening using rapid antigen tests (TROD¹⁾ for vulnerable populations. It also showed that basic needs (water, food, hygiene) and needs regarding access to digital services, education, healthcare, and improved mental health care have further increased or have been more difficult to meet for these populations.

Furthermore, accommodation and isolation protocols raised ethical and legal questions, highlighted by the testimonies of those involved. Security concerns hindered social work and the approach of “reaching out” to these populations.

The link between the social and health sectors, through the innovations of mobile teams, remains to be strengthened and sustained, as referring these populations to standard public services during a crisis was insufficient for optimal care of people in extreme vulnerability.

This work has also highlighted the need for long-term support for frontline professionals. Tailored tools that harness people’s ability to adapt as best they can, along with the development of appropriate interventions, must be co-created and involve all stakeholders.

Finally, the implementation of the vaccination program also incorporates this approach to account for the specific risks, needs, and contexts of these populations. It must closely involve the stakeholders working with them and thus draw on a better understanding of the attitudes and behaviors of the affected populations.

An approach designed to be sustainable

Santé publique France has already initiated a repeat of this exercise to adapt to the evolving health, social, and economic crisis. This work has highlighted the effectiveness of new collaborations and initiatives that go beyond the usual institutional frameworks. It has also brought to light their fragility over the long term, as well as the high expectations of stakeholders in the context of the current epidemic and future crises. It will now be important to describe how these experiences could serve as a foundation for sustainable institutional and/or professional innovations to address the depth and diversity of needs exacerbated by this unprecedented crisis.