Some cities in North America have started vaccinating homeless people, including in New York and Toronto. Vaccinating one of society’s most vulnerable groups is essential. However, vaccinations for homeless people present various challenges and obstacles.
Homeless people are mobile, and many tend to mistrust the vaccine and the healthcare system, focusing on more immediate needs like seeking food and warmth. Likewise, it can be challenging for healthcare providers to keep track of homeless people. This causes issues when they require their second round of the COVID-19 vaccine.
Despite the obstacles, there are ways these difficulties can be addressed.
Homeless People Represent a Vulnerable Group
It’s essential that homeless people are vaccinated promptly and efficiently.
Homeless services are often provided in close, congregate settings, which enables COVID-19 to spread more easily. In overnight shelters, people eat together, share bathrooms, and typically sleep in beds within close proximity to one another.
Many homeless people are older adults with underlying medical conditions, too. This increases their risk of severe and fatal illness if they contract COVID-19. Due to their lifestyle, homeless people are significantly more likely to have chronic health conditions like asthma and heart problems. Because they spend significant amounts of time outdoors, homeless people age faster than their housed counterparts.
Sheltered homeless people in New York are 75% more likely to die from COVID-19 than the city’s broader population.
Due to the pandemic, homeless people have no access to public spaces such as restaurants, libraries, and toilets. These are places they can typically use to stay warm and wash their hands during the day. Without access, life during COVID-19 is even tougher for this population.
Building Trust Will Help Ensure Compliance
As a group, homeless people are largely distrustful of healthcare providers and the implementation of vaccines. While clinicians and advocates say they have been successful in finding homeless people who want the vaccine, this may soon change.
Typically, it’s easier to find people who are willing to do something, like get vaccinated. But as time progresses, it becomes more challenging. People who refuse to get vaccinated will not be lining up.
There are various reasons why homeless people may refuse the vaccination:
- Conspiracy theories that question the vaccines’ authenticity and safety
- Mental health issues, such as paranoia, might make them frightened to take the vaccine
- History of trauma and/or negative experiences dealing with medical services
While homeless people are significantly more vulnerable to developing and falling ill from COVID-19, it may be hard to convince every individual to take the vaccine.
To improve confidence, vaccination providers should hold informational events to help this population understand the benefits of getting vaccinated. They must deliver clear, consistent, and transparent vaccine information to staff members, community organizers, and people experiencing homelessness.
It is essential to know the components of healthy and effective conversations surrounding the vaccination process. Trained staff must explain the vaccine to homeless people from a place of empathy and understanding. They must have the capabilities of addressing any misinformation by sharing key facts and connecting people with trusted medical providers to answer questions they cannot help with.
Easy Access to Vaccinations Is Imperative
As they are mobile, homeless people have more difficulty accessing medical settings such as clinics or pharmacies. They are also less likely to have access to the internet and mobile phones, making access to medical settings challenging.
State and local vaccine distribution plans should include strategies to provide people experiencing homelessness with vaccines. This can include the use of shelters, day programs, or food service locations. Offering vaccinations in places where homeless people typically visit is crucial to ensure that they have easy access to the vaccine.
The COVID-19 vaccination program should also include plans and strategies to deliver vaccination in locations homeless people frequent without shelter. These areas include encampments or other places where people experiencing unsheltered homelessness typically spend time.
Mobility Hinders Ability to Receive Second Vaccination
The main reason increased mobility impacts vaccination efficacy is the challenge to ensure homeless people receive their second vaccine dose. This is particularly important because the same product must be used for both doses to work effectively.
Public health workers, homeless service staff, and healthcare workers must team together to follow-up on the vaccine process with homeless people. They must ensure that dosage data and information is available to vaccine providers across sites and geographic areas. This will help ensure homeless people receive a complete COVID-19 vaccine.
Reminders can be integrated into routine interactions. Healthcare staff members can perform outreach to connect with homeless people who might not follow-up with their second dose of the vaccine. Other second-dose reminders include vaccine cards, text messaging, electronic health records, and automated reminders.
Other Barriers Homeless People Face
Lack of internet access to sign up for online vaccine portals and a lack of transportation to vaccination sites are additional barriers homeless people face.
The consequences of not vaccinating homeless people doesn’t just affect the individuals. It spreads beyond homeless people to whole communities. At the beginning of the COVID-19 pandemic, Dr. O’Connell of the Boston Health Care for the Homeless Program found a 36% positivity rate of COVID-19 among homeless people.
If homeless people are unable to self-isolate when they have COVID-19, they have no other choice but to live publicly, which increases the risk of infecting others. To ensure the safety of both homeless people and the wider public, we must vaccinate this vulnerable population safely, compassionately and promptly. Healthcare workers and shelter staff must work hard to ensure that any challenges regarding homeless people’s vaccination process are overcome.