Vaccination schedules, and at what point states are in them, vary wildly across the country in the fight against COVID-19, and affecting who, exactly, is getting their shots before others. Now, some states and regions are prioritizing a population that’s often overlooked: people without homes.
In Los Angeles County, anyone homeless is currently eligible for vaccination. But that’s not the case in some other California counties: San Mateo and Sonoma, for example, are vaccinating people who are homeless only if they meet the state’s eligibility under other areas, such as being at least 65 years old, or a frontline worker.
Oklahoma is now vaccinating people who live and work in congregate settings — including homeless shelters — while Maryland has explicitly opened up vaccination to homeless people, even partnering with non-profit organization Health Care for the Homeless to help make the vaccine more easily accessible to patients. New York is also vaccinating both people who are homeless and those who work or volunteer in homeless shelters.
But, according to data from the National Academy for State Health Policy, only 19 states are prioritizing homeless populations for COVID-19 vaccinations — and experts say that’s a problem. “It’s important to prioritize homeless populations because they’re hard to reach and often living in situations where there’s high risk for COVID-19 spread,” infectious disease expert Dr. Amesh A. Adalja, senior scholar at the Johns Hopkins Center for Health Security, tells Yahoo Life.
Many homeless people also have other health conditions or factors that put them at risk for severe complications from COVID-19, Pamela Valera, assistant professor in the Department of Urban-Global Public Health at the Rutgers School of Public Health, tells Yahoo Life. “People experiencing homelessness are more likely to be older, are people of color, have underlying medical conditions such as heart disease and diabetes and mental disorders,” she says. And, Valera adds, the “harsh conditions of homelessness” put these populations “at increased risk for severe illness, even death.” Homeless people also often have trouble accessing healthcare services and are uninsured, making it difficult for them to seek care if they do become infected with the virus, Valera says.
Many people in the homeless population are at a disadvantage simply when it comes to being able to follow COVID-19 prevention protocols, Donald Whitehead Jr., executive director of the National Coalition for the Homeless and one of the country's top experts on homelessness, tells Yahoo Life. “They’re often isolated and don’t have the same ability as others to meet the basic guidelines that are promoted by the CDC,” he says. “They also don’t have the opportunity to get resources like masks.”
Social distancing is an issue, too, Jacquelyn Simone, senior policy analyst at the Coalition for the Homeless, tells Yahoo Life. “Folks who are sleeping in congregate shelters with shared sleeping, dining and bathing facilities are not able to follow basic public guidance to stay safe,” she says. “There is utility in specifically making homeless people eligible for vaccination.”
Vaccinating people experiencing homelessness doesn’t just benefit this vulnerable group, though, says Adalja, noting that this can benefit the larger community, as well. If COVID-19 takes hold in a homeless population, it can spread through congregate settings, like shelters, he explains. From there, it can infect people who work at the shelters and spread through the greater community.
Whitehead says “it’s a mixed bag” when it comes to how well states are vaccinating their homeless populations. “Maryland in general is doing a good job, and some communities in California are also doing well,” he says. “But it’s kind of all over the place.” Whitehead says he has "real concerns" that, in some areas, shelter workers and residents aren’t being prioritized for vaccination.
Simone praises New York for the work officials have done so far, but says the state's plan isn't perfect. “Homeless people in congregate shelters have been eligible under category 1B for a while now,” she says. But, she adds, “people who are unsheltered are not explicitly eligible.”
Like other populations, there are issues with vaccine supply, Simone says. “There is also a general hesitancy among clients who might not understand the benefits of vaccination or are skeptical of healthcare,” she says. “We’re trying to ensure that we’re answering people’s questions, gaining their trust and encouraging them to get vaccinated in a way that’s effective.”
But Valera says making moves such as bringing back mobile clinics — many of which were discontinued at the start of the pandemic — and increasing outreach at homeless shelters, encampments and soup kitchens can help. Many states just aren't doing it.
Ultimately, Valera says, “reaching people who are experiencing homelessness for COVID-19 vaccinations should be a public health priority.”
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