When Will America’s Homeless Population Get the COVID-19 Vaccine?

COVID Vaccine

America’s homeless population is facing an unparalleled crisis this winter.

As COVID-19 ravages their communities, homeless people must still struggle with limited capacity at shelters, increasing numbers due to soaring evictions, and a higher vulnerability to the virus itself.

The roughly 600,000 homeless people in the United States seem to be ideal candidates to be early recipients for the newly approved vaccines. But with a limited supply of vaccines, there’s a wide variation among how states are prioritizing who should get the first shots.

On Dec. 1, 2020, the Centers for Disease Control’s Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation advising that health care workers and long-term care residents be in the first group (Phase 1a) to receive the vaccine. On Dec. 20, the recommendation was updated to recommend that vaccines be offered to those over the age of 75 and non-health care frontline essential workers (Phase 1b) and to those age 65 to 74, those 16 to 64 with high-risk medical conditions, and essential workers not included in Phase 1b (Phase 1c). Further recommendations have not been finalized.

Based on these guidelines, states adopted their own regulations. Some states—Arizona, Maine, Mississippi, Nevada, New Jersey, New York, North Carolina, Pennsylvania, and Vermont, as well as Washington, D.C.—planned to include homeless shelters in Phase 1b.

Massachusetts and Texas pledged to provide vaccines to homeless shelters during some part of Phase 1.

However, not all states see vaccinating homeless people as a priority.

On Dec. 24, Colorado Public Radio reported that Colorado Gov. Jared Polis had changed the state’s plan to prioritize shelters in its final draft, shifting people at “congregate living facilities” to Phase 3 with the general public. There is no set date yet for Phase 3 to begin.

Colorado homeless advocates are begging the governor to reconsider and move shelters at least back to Phase 2, which is set to begin in the spring.

To see the prioritization criteria in your state, visit The Kaiser Family Foundation’s website.

According to the CDC, “the goal is for everyone, including people experiencing homelessness, to be able to easily get a COVID-19 vaccine as soon as possible … Public health professionals at state and local health departments are now working on how to further distribute COVID-19 vaccines in a fair, ethical, and transparent way for additional groups, including considerations for people experiencing homelessness.”

About the Vaccine

As of Jan. 8, the U.S. Food and Drug Administration (FDA) has authorized the use of two vaccines. The Pfizer-BioNTech vaccine requires two shots, given 21 days apart. The vaccine manufactured by Moderna, also given in two doses, is administered 28 days apart.

Three other companies are conducting or planning large-scale, Phase 3 trials: AstraZeneca, Janssen and Novavax.

Both of the authorized vaccines use messenger RNA, also called mRNA. This is a relatively new kind of vaccine technology. Many vaccines, like the measles/mumps/rubella inoculation, contain weakened or inactivated versions of the disease. This allows our cells to create the appropriate antibodies to the virus. This means that, if we’re exposed to the live virus, our bodies are already prepared to respond.

Meanwhile, when patients are given mRNA vaccines, they’re injected with the genetic code used to make the COVID-19 protein. Once it encounters the foreign protein, the immune system produces a defensive response, just as it would if it encountered the live virus. Then, just as if you’d been inoculated with a traditional vaccine, if you’re exposed to the live virus, your body will produce an immune response.

Many critics questioned the speed with which the vaccines made it to market. However, blogger Edward Nirenberg, a medical student who calls himself a “vaccination advocate,” said that the pandemic itself is what made that speed possible.

“Basically every single project that needed the FDA’s attention was put on the back burner as everything to do with a vaccine for COVID-19 was pushed immediately to the front of the line,” Nirenberg writes on his blog, Deplatform Disease. “On top of this, the FDA allowed for seamless trials, meaning that if a vaccine met its phase I or II endpoints, it was permitted to immediately proceed to phase III, rather than deal with the regulatory rigamarole and paperwork required for normal progression.”

Because of the incredibly high need for a vaccine, all redundancies in the trial phases were eliminated. Funding, which can be a huge problem in vaccination studies, was immediately available, as were test subjects. Previous pandemics made researchers aware of the protocols they’d need to use for the studies and authorization process.

“So yes, the vaccines were expedited in that they are getting here much faster than anyone anticipated and via a different path, but there weren’t corners cut from the perspective of the science nor the safety,” Nirenberg writes.

Further research is being done in the field of mRNA vaccines. They’ve previously been studied for flu, rabies, Zika, and cytomegalovirus (CMV). According to the CDC, cancer researchers have used mRNA to trigger the immune system to target specific cancer cells.

Distributing the Vaccine

While the vaccine is safe and studies have shown it to be effective in preventing the virus, there are still a number of roadblocks to getting it to the nation’s homeless population. The most burdensome are logistical.

“Administering and tracking vaccines, especially those that need ultra-cold storage and/or require two doses several weeks apart, will be especially difficult serving a patient population without stable housing (even more so in smaller programs, unsheltered locations, and/or rural areas),” according to the National Health Care for the Homeless Council.

The brief also pointed out that there’s a lot of uncertainty surrounding the vaccine including:

  • Long-term effectiveness
  • Availability
  • Details of state plans and criteria for prioritization of different groups
  • How to triage a limited supply
  • The potential impact of side effects

Moreover, many people experiencing homelessness are reluctant to get the vaccine.

“Not only do they share the reservations others have expressed (e.g., safety, politics, etc.), but many in this population have had negative experiences in the health care system,” the brief reads. “Additionally, people of color are over-represented among those without homes and racism in the health care system is well-documented.”

The NHCHC emphasized open communication between advocates and people experiencing homelessness to overcome some of these barriers. It also encouraged state and local health authorities to provide as much information as possible regarding distribution and prioritization plans. Additionally, the organization suggested offering incentives like gift cards or socks and enlisting vaccine ambassadors to work with those who may be reluctant to be vaccinated.

“Focus on safety, myth-busting, and cultural/educational experiences,” the brief reads.

Most importantly, both the CDC and the NHCHC stressed that vaccination is just one tool in the fight against COVID-19. Providers and clients should continue to wear masks, practice social distancing, and wash their hands regularly.

For updates on the vaccine, visit the CDC’s website.


Sarah Hall

Sarah Hall

Sarah Hall is a freelance journalist from Upstate New York. She is especially passionate about social justice, voting rights and women’s issues.

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