Are We Going to Be Able to Vaccinate Everyone?

Trying to protect those who are most vulnerable to COVID-19

According to the Centers for Disease Control and Prevention (CDC) people experiencing homelessness may have difficulty accessing basic medical services. Hence, the CDC has developed several guidelines to ensure homeless people are prioritized during vaccine implementation. One of them is to work with “continuum of care” programs, which promote community-wide efforts to end homelessness and directly address the needs of unhoused people.

In the city of San Francisco, the Department of Public Health has developed a robust system of care and support in communities hardest hit by the pandemic. In collaboration with community-based organizations, they have formed strategies to roll out COVID-19 vaccines. They have reached 82% full vaccination rates, out of the total population. According to the department, that was possible through outreach to communities of color, people of various faiths, seniors, individuals with language and technology barriers, and those experiencing housing and food insecurity. 

The department says its efforts to vaccinate people have involved mobile vaccination teams which bring vaccines directly to people with access and/or functional needs such as homebound adults, people served by behavioral health programs, people experiencing homelessness in high-risk congregate living facilities, and senior living residents. The mobile vaccination teams are also deployed in neighborhoods with limited access to health care providers or pharmacies. 

The department views vaccines as the gold standard in preventing the worst outcomes of COVID-19 such as severe illness, hospitalizations and even death. In the face of new strains, the department urges all individuals who are eligible for a booster dose and have not received it, to do it as soon as possible, especially those at higher risk for complications from COVID-19.

Across the country in Massachusetts, Avik Chatterjee, assistant professor of medicine at the Boston University School of Medicine and medical director of the Boston Health Care for the Homeless Program clinic at the Southampton Street Shelter, has been working with individuals and families affected by homelessness for over eight years. According to Chatterjee, access is more than the ability to obtain or make use of something. It is about ensuring the materials are provided in the appropriate language. It is about making sure people have access to the internet. “People often struggle with the logistics in order to obtain care and that’s where we need to support them,” he said. 

“In order to reach high numbers of vaccination rates in the community, we have to first build trust,” said Chatterjee. “What are health care institutions doing that allow people to gain trust in them?” he added. The COVID-19 pandemic has further highlighted issues in racial equity, especially in terms of access to health care. That means institutions and practitioners have to figure out appropriate solutions in order for the community to gain trust and actively combat racial inequalities.  

One strategy would be for the state to partner with local community organizations. In Massachusetts the Cambridge Health Alliance provides high quality care in neighborhoods, through partnerships with local agencies and organizations. Such organizations are trusted and known in the community, and therefore have the capacity to be able to tackle challenging issues.

According to Katie League, project manager at National Health Care for the Homeless Council, it is crucial that we distribute vaccinations to all the trusted providers and community groups that are working on vaccinations. She adds that we will not reach 100% vaccination rates by mass vaccination sites alone. “Vaccine refusal is low but vaccine hesitancy is where people currently are at,” she said. Therefore, we have to meet those people where they are to understand their perspective with sensitivity and respect. 

“Not making the vaccines mandatory is important at this time. People should have the autonomy and right to make the decision,” League said. At this time, all providers should give people the choice of which vaccines they should take and create opportunities to address barriers such as transportation to vaccination sites. 

“Reaching poor communities and communities of color at this time is crucial,” League added. “Those communities are most vulnerable and need our support.” In such cases, legislative changes are necessary and therefore, working with the government to prioritize those communities is key.

But one question remains for League: What happens after everyone is vaccinated? 

“Well, they will still need housing,” she said. “Now that we have created alternate housing options such as hotel rooms we need to make sure we continue to address those long-term needs. Each person deserves housing and that should still be our key goal. Everything else is a step along the way.” 

Julie R. Koehler, assistant professor of pediatrics at Harvard Medical School has been working with immigrant communities over the last ten years and as a result has become even more aware of the undocumented immigrants in the U.S. 

“When vaccines became available, the biggest concern was whether everyone will be able to get them. Groups like La Colaborativa in Chelsea, Massachusetts have set an excellent example as they have worked closely with families of color, mostly from the Latin community to provide information, address vaccine hesitancy, and connect them to resources to obtain the vaccines,” she proudly said. In addition to providing support for COVID-19 vaccines, La Colaborativa also asked those same families about their needs surrounding food, housing, transportation, and medications. That is what sets them apart from other groups. 

“Outreach that is culturally-appropriate is key during this time,” Koehler said, adding that government and CDC efforts will not be enough. Communities should be more empowered to bring focus to and defend their basic human rights. Our hope is that as there is more advocacy around this topic, there will be more work done to bring equity to health care accessibility.