- States differ in how they are prioritizing the COVID-19 vaccine for people experiencing homelessness.
- Incentives such as transportation, gift cards, and even socks may help convince people experiencing homelessness to get the vaccine.
Across the country, healthcare professionals are worried their patients may agree to get COVID-19 vaccine when it’s their turn in line. But few are more worried than the advocates for the approximately 600,000 homeless individuals in the United States.
“There are many reasons why people who are homeless may choose not to get the vaccine,” Courtney Pladsen, Director of Clinical and Quality Improvement at the National Health Care for the Homeless Council (NHCHC), based in Nashville, Tennessee, tells Get Meds Info. “They include lack of knowledge, fear sometimes based on misinformation on the street, and mistrust of the healthcare system based on past experience.”
Bernina Doggett, chief clinical officer at So Others Might Eat, an organization for local people experiencing homelessness in Washington, D.C., laughs nervously when asked what strategies might work in encouraging people facing homelessness to get the vaccine. “We will have to be proactive with a variety of strategies, but we also need to have the vaccine prioritized for this population,” she tells Get Meds Info.
When Will Homeless People Get the Vaccine?
At a national level, the homeless aren’t slated into any of the proposed vaccine distribution phases by the Advisory Committee on Immunization Practices (ACIP). However, the ACIP leaves room for individual states to define the specific members of the priority groups. According to data from the National Academy for State Health Policy, as of December 20, the following states plan to distribute COVID-19 vaccines to homeless shelters during the next phase, 1B:
- New Jersey
- North Carolina
Massachusetts and Texas don’t specify which segment of phase 1 homeless shelters will be given vaccines. Phase 1A is now underway. That means vaccination for the homeless could begin in the next few weeks if supplies are available.
States putting the homeless into later distribution queues worries experts. According to a white paper on vaccines and the homeless released this month by the NHCHC, shelters have been the source of significant COVID-19 outbreak.
While homelessness may not guarantee someone a higher spot on the vaccine priority list, the Centers for Disease Control and Prevention (CDC) says that “people experiencing homelessness have many additional characteristics, such as age and employment in certain jobs, that will also influence when the vaccine will be available to them.
But the CDC also highlights the need for vaccine distribution strategies specific to people experiencing homelessness, particularly people who live on the street rather than in shelters.
Vaccine Hesitancy Among the Homeless
Apprehension about the COVID-19 vaccine among homeless individuals could be high. Elizabeth Bowen, associate professor of social work at the University at Buffalo School of Social Work, tells Get Meds Info that the reason may be rooted in years of bad experiences with authority figures.
“Most people who are homeless have experienced a lot of trauma, both prior to and during homelessness,” Bowen says. “Due to that trauma, as well as ongoing stigma, people who are homeless may have good reasons for not trusting healthcare providers and people in authority.”
Bowen says a second factor to consider is logistics. Practical barriers may prevent homeless people from getting vaccinated or returning for the second dose.
Pladsen worries about how to track people who live on the street to make sure they get that second dose, which is critical for immunity.
What Can Be Done?
The NHCHC’s recommendations for increasing the vaccine’s uptake among the homeless include a focus providing clear information, offering incentives such as gift cards or socks, and advocating for those who may not be willing or able to get the vaccine.
The Council also advises that states deploy “vaccine ambassadors” to engage people who are hesitant. That’s what Arthur Rios, Sr., will be doing. Rios was homeless for 25 years, but today, lives in a home with his partner and 14-year-old son. He is a member of NHCHC’s Consumer Advisory Board and Health Services Advisory Council. Part of his role involves connecting with people who are homeless about resources such as food and health care.
“The people I’ve been talking to on the street are worried the vaccine has a chip, which means people will be spying on you,” Rios tells Get Meds Info. Pladsen confirms that fear, noting many people experiencing homelessness also deal with mental illness, including paranoia.
For the most part, however, Rios says the homeless “are concerned about the same things that everyone else is,” like side effects, and why there needs to be two shots.
But the realities of life on the street also have to be reckoned with, says Rios. “You can say to someone who is homeless that they have to come back in three weeks for the second shot, but they don’t think in blocks of three weeks,” he explains. “I didn’t when I was homeless. You’re thinking about where you’re going to sleep that night.”
Rios says that ultimately, he wants people he engages with on the street to know that someone like him, who was once homeless, will be getting the vaccine.
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.