Cities face barriers to vaccinating people experiencing homelessness
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Study results have shown that individuals experiencing homelessness are particularly vulnerable to COVID-19 and face heightened transmission risks in shelters.
The CDC recommends several ways to communicate vaccination information effectively to people experiencing homelessness, including posting flyers at encampments, in shelters and on public transit, and advertising in advance of targeted vaccination events. The CDC also suggests recruiting “trusted communicators, such as people with lived experience of homelessness” and engaging them in the planning and implementation of the events.
Source: Adobe Stock.
As the nation’s vaccine rollout continues, cities continue to find new ways to address vaccination challenges in vulnerable groups, including people experiencing homelessness.
Sarah E. Rowan, MD, associate director of HIV and viral hepatitis prevention at Denver Public Health, said policy regulations, logistical challenges and vaccine hesitancy and refusal are all barriers to vaccinating individuals experiencing homelessness.
Rowan said homeless populations were not initially given special consideration for access to COVID-19 vaccines despite high rates of infection, hospitalization, death and emerging variants. This, she told Healio, was a “public health misstep” that complicated vaccination efforts in shelters.
All adults, including people experiencing homelessness, now qualify for vaccination, “but the patchwork distribution of day shelters, overnight shelters, outdoor encampments — sanctioned
and unsanctioned — and other homeless service providers means that offering vaccines to people experiencing homelessness involves many separate outreach events,” Rowan said.
“This is further complicated by the need for second clinics for individuals at various locations who received one of the approved messenger RNA vaccines offered by public health teams before the Johnson & Johnson vaccines were available,” she said.
Rowan said single-dose vaccines, such as the Johnson & Johnson vaccine, are “ideal for individuals who have less predictable lives, such as those experiencing homelessness or those who are incarcerated, particularly in jail or detention settings.”
“Not only do they avoid the need to return for a second dose in 3 to 4 weeks or find a place to receive a second dose if the scheduled follow-up is missed, they also may provide immunity to COVID-19 sooner, decreasing rates of community transmission and serious illness,” she said.
Federal officials have recommended that the rollout of the Johnson & Johnson’s vaccine be paused in the U.S. while experts review a small number of rare but severe blood clots that occurred in people who received the shot. The CDC’s Advisory Committee on Immunization Practices will reconvene on Friday to decide whether to alter recommendations for the vaccine’s use in the U.S. after adjourning last week without a vote.
Rowan called the pause “a bit of a setback” but said it should not slow down efforts to vaccinate people experiencing homelessness.
“Here in Denver, we switched to using the other approved vaccines and scheduling follow-ups
for second doses,” Rowan said. “Second doses are a challenge but through our local collaborations, we’re working together to ensure people get what they need.”
Cities have been attempting to vaccinate vulnerable groups in various ways. In Denver, Rowan said a joint task force organized efforts to offer testing, temporary hotel and motel rooms, and vaccine events. They also printed information materials and held an information session to tackle concerns regarding vaccine efficacy and safety.
“Understanding how best to promote vaccines in a respectful way for people experiencing homelessness is a unique need,” Rowan said. “Research into how to safely begin to lift restrictions for vaccinated individuals in these settings is also needed, including a research into how to assess herd immunity or critical thresholds for various prevention measures.”
Elsewhere, San Francisco has coordinated mobile vaccination programs at various shelters.
“None of this would be possible without the cooperation of nongovernmental organizations and community-based organizations,” Deborah Borne, MD, MSW, operations section deputy of the City College of San Francisco’s COVID-19 Command Center, told Healio. “They are the center of all of the work that we're doing.”
“Many shelters are run by nonprofit agencies,” Rowan explained. “Thus, their support for vaccine efforts is necessary for hosting on-site vaccine events for shelter guests. Nonprofits may also contribute to COVID-19 vaccination efforts by funding marketing or incentives or even providing food at vaccine events.”
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CDC. COVID-19 vaccination for people experiencing homelessness: frequently asked questions. https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/vaccine-faqs.html. Accessed April 20, 2021.
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