Vaccines on the streets

The U.S. healthcare establishment’s plan for curbing the pandemic requires pushing the COVID-19 vaccine out to vulnerable populations as quickly as possible. Homeless people meet many states’ criteria for priority immunization but pose unique challenges for health workers who want to help them.

Some states specifically list the homeless in their vaccination plans, while others prioritize people of a certain age or with specific pre-existing conditions, which include many homeless people.

However, many homeless people don’t trust the medical system or have trouble traveling to clinics or health departments, as Centers for Disease Control and Prevention guidelines for immunizing the homeless point out. The CDC also notes that many people without permanent housing live in congregate settings in shelters or have poor health due to harsh life on the streets.

They also often move from place to place, making it hard to coordinate receiving a two-dose vaccine. Providers have trouble reaching people who lack reliable cellphone service, internet access, and home addresses. The fragile nature of the vaccines means distributors must administer them in a limited time window, but homeless people might have difficulty keeping an appointment if they lack reliable transportation. Colorado Gov. Jared Polis denied a Denver health official’s request to begin vaccinating the homeless and said that waiting for authorization of a single-dose shot, like Johnson & Johnson’s, makes more sense. The Food and Drug Administration could grant the Johnson & Johnson vaccine emergency use authorization as early as this weekend.

The CDC recommends “offering vaccination in homeless service sites and places where people experiencing homelessness visit.” Earlier this month, Los Angeles Christian Health Centers received the vaccine at their Skid Row clinic and began attempting to contact 900 possible recipients, the LA Times reported. Over the next week, elderly homeless people walked to the clinic from nearby shelters to get their shots. The health centers receive 100 doses a week to distribute across six county clinics. Some health officials set up canopies near a homeless encampment at LA’s Leimert Plaza Park and offered campers food to take the vaccine.

Meanwhile, in Houston, Texas, the nonprofit HOPE Haven is working with homeless clients to educate them and prepare them to receive the vaccine when it becomes available. “They hear all kinds of stuff, so if they think COVID-19 is some kind of hoax or conspiracy, they’re not going to want to take the vaccine,” director Kristyn Stillwell told The Houston Chronicle. “We’re [also] going to start with things like a tetanus shot and that kind of thing and then in the fall with the next round of flu shots. … We want them to get used to the medical workers.”