Vaccines for unsheltered a challenge

There are 8,102 homeless in­dividuals living in San Diego county and some might never receive one or both vaccine shots required for full immuni­zation against COVID-19.

“State and local vaccine dis­tribution plans should include strategies to bring vaccines to people experiencing home­lessness, including homeless service sites like shelters, day programs, or food service loca­tions. The COVID-19 vaccina­tion program implementation plans should also include strate­gies to offer vaccination in areas frequented by people experienc­ing unsheltered homelessness,” a National Academies of Scienc­es, Engineering and Medicine study said.

Both the National Institutes of Health and the Centers for Disease Control and Preven­tion specifically requested that study to assist policymakers in planning for equitable alloca­tion of vaccines against COV­ID-19, yet the county of San Di­ego has not released any plans specific to homeless outreach and vaccinations.

So far, the county appears to be relying on individuals falling under grouped cohorts regard­less of housing status.

For example, an unsheltered homeless individual over age 65 with an acute medical con­dition would receive a vaccina­tion shot before an unsheltered homeless child, although they might both reside in the same unsheltered encampment and pose equal logistical challenges.

People Assisting the Home­less (PATH) Associate Director of Outreach Brian Gruters said tracking individuals to follow up with the second battery of a two-part vaccination “is aspi­rational at this point” and poses an additional challenge if they are unsheltered.

Gruters said historically it has been challenging to en­gage some unsheltered home­less individuals in conversation and “it takes weeks, maybe months until they really speak with people” so to assume that anyone in that population can be quickly accessed and immu­nized is unrealistic.

“We don’t have an accurate sense of who is unsheltered. If someone is living unsheltered, the only way we know about them is if they’re in something like a database where you can put a note in there and sort of flag if they had a first shot. But, there are a lot of people who are not in any system,” Gruters said.

Complicating the situation, he said, there are varying pro­tocols for tracking unsheltered homeless people across “differ­ent funders and different orga­nizations” that take the lead across the county.

One identification tool the Regional Task Force on the Homeless usually has at its disposal is the annual point-in-time count, a snapshot taken over one night each year where unsheltered homeless encoun­tered in each census block are counted and connected with services. However, the 2021 count will not take place this year due to distancing mea­sures and the agency is rely­ing more than usual on data gleaned by community out­reach workers.

“Homeless data is notoriously messy with aliases and gaps in personal information,” Gruter said.

He touts regular outreach workers who learn which homeless individuals frequent particular neighborhoods and work to build trust and personal relationships.

Gruter elaborated: if the pub­lic could ease up a little bit and understand unsheltered indi­viduals “aren’t a de facto threat” it would go a long way toward easing “pressure on officials who are pressured to disburse” encampments. Allowing indi­viduals to stay in encampments might make it easier to track people for care and services, in­cluding vaccinations.

“It’s important that in every community, we have the same people covering the same areas so if 100 people are experienc­ing homelessness in one neigh­borhood we get to know those 100 people. When communities are heavily involved, it helps,” Gruter said.

His sense that trust will play a factor in ensuring homeless individuals eventually receive vaccinations is echoed in guid­ance from the Centers for Dis­ease Control and Prevention.

“People experiencing home­lessness may have a history of trauma and may have had nega­tive experiences with medical services. To improve vaccine confidence, work with staff members and community navi­gators who have trusted rela­tionships with the clients you serve,” wrote the CDC.

For now, he and other out­reach workers have no timeline specific to heltered or unshel­tered homeless residents but continue to provide outreach.

“To handle this as a public health crisis, we need to reach the people who would not other­wise walk into a clinic on their own and seek help,” Gruter said.