When it came time for residents and staff at the New York Avenue homeless shelter in northeastern Washington, DC, to receive their first doses of Moderna’s Covid-19 vaccine, David Durham, who lived in the men’s shelter for three years , was scared.
Like many at the shelter, he was bombarded with misinformation about vaccines: conversations and rumors about the neighborhood turned into elaborate conspiracy theories, many of which contributed to the mistrust that homeless people already have in government services.
But he got the shot.
“I’ve heard so many conspiracy theories, as if they were putting a chip on you, that they would inject some kind of liquid into you, that you would be a guinea pig,” said Durham, a 34-year-old DC Native. “But I said, ‘You know what, I have to take responsibility for leading by example.'”
Across the country, many cities and large urban centers have started work on vaccinating homeless people housed in their shelter systems, but few municipalities have ventured into the streets where the issue is exacerbated by distrust, logistical obstacles and limited resources.
Johnson & Johnson’s newly authorized vaccine, however, provided a timely solution for cities that have struggled to administer the two vaccines previously available to their sheltered homeless, and especially their homeless homeless, who are more transient and at greater risk in the midst of to the pandemic.
So far, his methods have been as varied as his preparation.
In Washington, city officials implemented a multi-agency strategy to vaccinate homeless people, regardless of age or condition, but for the most part they refrained from vaccinating those who live on the streets. Durham was one of the first in his shelter to receive the vaccine and later became a peer educator, one of about two dozen homeless people or formerly tasked by the city with educating other homeless people about the safety and efficacy of different vaccines .
When asked if the program was a success, Durham admitted that it is difficult to convince people when many have already made up their minds. After all, Durham said, only about half of the peer educators in his program got the vaccine because the other half were very skeptical.
Vaccination of sheltered homeless people is supposed to be the easy part, said Dr. Patrick Kachur, a public health expert at Columbia University’s Mailman School of Public Health.
“Reaching people at a fixed point, like a homeless shelter, is much more viable than doing street evangelism,” said Kachur, adding that the Moderna and Pfizer-BioNTech vaccines have prevented many cities from making a substantial reach, as each of them needs storage at freezing temperatures, the second doses three to four weeks after the first, and can spoil if not used within a certain time window.
In Los Angeles, grassroots organizations have led the way in vaccinating people on the streets based on eligibility by age and other conditions, as city officials decide on a more coordinated approach. Los Angeles Christian Health Centers have been administering the Modern vaccine to homeless people for nearly a month and now must track patients to administer second doses – an effort fraught with obstacles.
In New York City, some 4,300 residents and employees of the city’s extensive homeless shelter system have received a vaccine, according to a spokesman for the Department of Homeless Services. Before the Johnson & Johnson vaccine, no existing vaccine was able to be delivered mobile, and the city has not yet deployed extension teams for the specific purpose of vaccinating unprotected individuals, the spokesman said.
Chicago vaccinated about 2,000 residents and staff in its shelter system, while extension teams were able to vaccinate only about 125 homeless individuals living in camps, a city spokesman said. In Boston, 57 sheltered individuals received their first dose, and street crews hope to vaccinate the homeless in the next few days, a spokesman for the city’s Public Health Commission told NBC News.
Kachur said he thinks the Johnson & Johnson vaccine is a game changer and will finally allow meaningful outreach on the streets.
For Laura Zeilinger, director of the Washington Department of Human Services, the situation could not be more pressing.
“People who live without a roof tend to have many risk factors due to their age and other health conditions that make them a particular risk for extremely poor health outcomes if they hire COVID,” said Zeilinger.
Its department, in partnership with local health care providers, used instant clinics, peer educator programs and social media campaigns to vaccinate more than 900 sheltered individuals. They are preparing for the Johnson & Johnson vaccine, which may allow them to start vaccinating those living on the streets. Peer educators like Durham are beginning the work of courting this group, so that when the time is ready, distrust is not so much of an obstacle.
Like many west coast cities, Portland, Oregon, will not start vaccinating the homeless until new phases are started, but this can be done based on age or condition. A spokesman for Multnomah County said that “the county has sent vaccine teams to our physical distance shelter to provide vaccines to some people who qualify due to age or medical condition.”
As is the case with Los Angeles and other Californian cities, San Francisco is waiting for the state’s guidance to begin the widespread vaccination of its large population of homeless people, as the shortage of vaccines prevents implementation and change in the prioritization phases.
Homeless people were originally supposed to be vaccinated along with emergency workers, childcare providers, teachers and food workers, but have since been removed by the state without a word about when they will be added to the other phases, a spokesman of said the Covid Command Center of San Francisco. In the meantime, the city has vaccinated the homeless who are eligible under the state guidelines of General Hospital Zuckerberg San Francisco.
In cities like Dallas, officials are beginning to mention the Johnson & Johnson vaccine being used specifically for homeless people.
“We want to inoculate them while we can,” Dallas County Judge Clay Jenkins told NBC affiliate KXAS. “It is for our benefit that we vaccinate those who are willing to accept the vaccine in this population. It makes us more secure. ”
Public health experts like Kachur are hopeful that the Johnson & Johnson vaccine, if prioritized for homeless people, will alleviate many of the logistical challenges that cities have faced and make significant vaccination of homeless people a reality.
Kachur also applauds efforts, such as Washington’s peer education program, to quell the growing distrust that exists among homeless people. He thinks it is necessary to prioritize this population in all possible ways for the country to achieve herd immunity.
“Sometimes it makes sense to start reaching the hardest-to-reach populations first,” said Kachur, “just because it will take longer to get good coverage in hard-to-reach populations.”