What We Know About How Unhoused People Can Receive COVID-19 Vaccines

by Chetanya Robinson

Medical workers, staff, and residents at long-term care facilities are starting to receive their doses of the COVID-19 vaccine as King County and the State roll out the first phase of their vaccination plan. Next in line is a group that includes residents and staff at shelters, as well as school staff, essential workers, people in jail, emergency responders, and more.

Public Health — Seattle & King County is considering multiple ways to get the vaccine to everyone, whether or not they are homeless, and plans could change at any time, said Jody Rauch, who works as the clinical quality lead for the agency's Healthcare for the Homeless Network (HCHN).

There's not a lot of detailed, specific guidance from the CDC or the State Department of Health on what the next phases of vaccination will look like, Rauch said — including, for example, in what phase all unhoused people will be vaccinated.

Another complication: Public Health will face a shortage in funding for its COVID-19 response after January that could threaten the agency's ability to serve homeless populations.

What we do know is that people living in shelters, and some people living outdoors, will probably be able to receive the vaccine on site, just as shelters have had on-site testing, Rauch said.

Mobile vaccine teams would likely come to individual sites, including shelters, day centers, housing sites, homeless service sites and encampments. Public Health already brings a mobile vaccine team to these sites to administer flu shots and vaccines for hepatitis A and B.

"This is a model that has worked really well for us, and we're hoping to build off of that success," Rauch said. The agency prefers to bring services like vaccines directly to people, she said, because "when folks are living homeless, they have a lot of competing priorities around just basic needs and things that they need to think about during the day."

Robert Bowery, Program Advisor and Interim Director of Emergency Services for the Compass Housing Alliance, said having a vaccine program available at Compass's day center would have a huge impact. Vaccine services would become directly available for residents of Compass's shelter sites, but bringing it to the day center would also allow unsheltered people living outdoors who come in for services, like hygiene, banking and mail, to get vaccinated.

"Having an on-site vaccination response there would be vitally important to our community's health," Bowery said.

But vaccinating everyone who is unsheltered will probably be a greater challenge, he said, as "it is difficult to reach people that are not coming in for services."

While Public Health has no specific guidance on when unsheltered people will be vaccinated, it will likely contract with organizations that do outreach to these people, according to Rauch. HCHN already works with organizations like REACH, which does outreach and case management for unhoused people; Neighborcare, which has been getting vaccines to unhoused people; and the Hepatitis Education Project, which has its own street medicine team.

Public Health is already doing COVID-19 outreach to encampments, offering testing and information. The agency's vaccine strategy will rest on these relationships. Public Health aims to take a "trauma-informed" and "person-centered" approach to doing vaccine outreach, Rauch said.

Rauch and Bowery said it's likely some people will be reluctant to take the vaccine or have questions, just like people who are housed.

"People's levels of mistrust go kind of hand in hand with their levels of fear, and people fear what they don't know or the gap in information," Bowery said. "So we have to do our damndest to provide the best information we can."

For some people reluctant to take the vaccine, historic community trauma could be a factor, Rauch said. "Our goal is to provide them with the information that they need to make the best decision that's right for them," she said — with the hope that people will continue having conversations with Public Health.

Public Health's vaccine distribution to homeless populations could be jeopardized by a lack of funding for its COVID-19 response. The agency had a budget of $87 million dollars for COVID-19 response in 2020, including for testing, contact tracing, isolation and quarantine, and vaccinations, according to Kate Cole, a communications specialist for Public Health.

The funding, mostly from the federal government, ran out at the end of the year. For 2021, the agency has $14 million available, which would last an estimated one month. And the amount of new funding the agency expects to receive is less than they need, Cole said.

Cole is concerned about the agency's COVID-19 operations, including services for vulnerable people and people experiencing homelessness.

"Without sustained stable funding, our COVID response activities will be impacted," Cole wrote in an email. "And, because we primarily serve residents who have been put in the most vulnerable positions — including people living homeless — these communities will likely be disproportionately impacted."

Chetanya Robinson is a South King County-based reporter.

📸 Featured Image: attributed to U.S. Indo Pacific Command under a Creative Commons 2.0 license (CC BY-NC-ND 2.0).