PITTSBURGH (AP) - Light of Life Rescue Mission had a vaccine clinic planned to help vaccinate homeless people earlier this month. The shelter, which operates short- and long-term programs for the homeless, as well as addiction recovery and employment assistance, planned to administer the single-shot Johnson & Johnson vaccine. Then, about three hours before the April 13 event was supposed to start, news broke that use of the vaccine had been paused.
The shelter quickly shifted gears and administered the Moderna vaccine instead, said Jerrel Gilliam, executive director. But the development altered Light of Life’s vaccine strategy, as clinicians had to inform patients, many of whom were had no housing, that they needed to return for a second dose.
“It is very frustrating,” Gilliam said. “For homeless shelters across the nation, this was part of our strategy to use in the camps, because of the one shot. It has yet to be seen how long this will go on and how this is going to impact that, but it definitely is a blow to those of us working in this community.”
U.S. health officials later lifted the 11-day Johnson & Johnson vaccine pause, but many of the challenges facing shelters and the homeless during the pandemic will remain. From the beginning of the pandemic, homeless individuals have been especially vulnerable to covid transmission. Congregate living in shelters poses many of the same risks of transmission as in nursing homes and correctional facilities. Studies show homeless people are more likely to contract severe cases that require hospitalization and death, due to the prevalence of several health issues and difficulty following public health guidelines.
The virus’ spread in homeless communities creates an added danger of overcrowding of hospitals and emergency rooms, Gilliam said, because homeless individuals aren’t as likely to have health insurance or a primary care physician.
Shelters have had to significantly alter their processes to keep people safe. And as vaccine availability improves, those workers are still grappling with hesitancy and difficulty reaching a transient population.
“These mass events that are happening are wonderful, but when you’re dealing with the population that we are dealing with, they have multiple barriers they have to overcome,” Gilliam said.
Early on, shelters and health providers in Pittsburgh collaborated to take a proactive approach, many reimagining how meals were served, capacity limits and strategies for outreach in homeless camps. Several partnered with the Allegheny County Health Department, the region’s hospital systems and federally-qualified health centers to provide testing and, later, the vaccine.
But shelter operators said vaccine distribution has been frustrating at times, dealing with a bureaucratic system and shifting eligibility definitions. In December, for instance, several Pittsburgh homeless organizations said they were told their populations would be included in Phase 1A. A few weeks later, a new definition of Phase 1A was released, and it didn’t include homeless people.
“We were a little bit disappointed,” said Dr. Jack Todd Wahrenburger, chief medical officer at Pittsburgh Mercy, which, in addition to operating its own shelters and outpatient services for the homeless, partnered with several other Pittsburgh-area shelters to administer covid tests and vaccines. “Although, as they expanded 1A…we found a lot of the people in shelters qualified.”
Even now, when all Pennsylvanians older than 16 are eligible, there are still challenges to getting the homeless population inoculated. Many homeless individuals don’t have adequate access to transportation, childcare or the internet – making it difficult for advocates to spread the word about clinics and get people registered. Outreach teams must make regular rounds to homeless camps and communicate with community leaders to find neighborhoods with populations that need vaccine.
“It’s been very challenging to get the word out, but we’re doing our best,” Gilliam said.
There is also prominent vaccine hesitancy in the population, said Annette Fetchko, executive director of Bethlehem Haven, a shelter offering services mostly to women.
Fetchko remembers one woman in her 50s who came to Bethlehem Haven after living in her car. The woman had come to Western Pennsylvania from Texas and had lost her housing unexpectedly. With a history of cancer, she was scared to be in a congregate setting – like a shelter – during the pandemic. Bethlehem Haven was able to help the woman receive a vaccine early in the rollout, based on her health conditions.
“But there are many individuals in shelter, who we are privileged to serve today, that continue to not consent to get the vaccine, for a whole host of reasons,” Fetchko said, citing suspicion, as well as mental health disorders.
Vaccination isn’t required to stay at a lot of shelters, but operators say they’re doing all they can to confront misconceptions and hesitation. They’ve essentially launched public relations campaigns for the vaccine, providing information from doctors, nurses and community leaders to everyone they come in contact with while providing meals and shelter.
The Johnson & Johnson vaccine promised some degree of ease. Individuals wouldn’t have to return to a clinic for a second dose, and the less stringent storage requirements would have made it easier for outreach teams to deliver shots into homeless camps.
“Oftentimes we couldn’t find individuals for the second dose,” said Fetchko. “That absolutely was a barrier that we tried to work through, but we were not successful, in all cases.”
Wahrenburger said the same at Pittsburgh Mercy. Within the first group of homeless individuals Mercy vaccinated, he said they were only able to find about 50% to give the second dose.
“People will stay for two or three days in a shelter, but it’s rare to have someone stay for 28 days,” he said.
Wahrenburger said it seemed like many shelters, Pittsburgh Mercy included, had been “holding back” up to this point, waiting for the Johnson & Johnson vaccine to become more readily available. But as cases among the homeless population rise – likely related to the presence of covid variants and pandemic fatigue – he said it’s more urgent than ever to promote widespread vaccinations.
As shelters waited for the J&J pause to end, clinicians encouraged people to get the Moderna and Pfizer shots – even if they can’t return for a second dose.
After all, one shot of Moderna is better than no shot at all, Wahrenburger said.
Despite the challenges, operators of shelters and public health officials are confident in the progress they’ve seen in vaccinating the region’s homeless, so far.
More than 70% of residents in Light of Life’s long-term program have been fully vaccinated, which provides some peace of mind, Gilliam said. But in a population with so much transience and turnover, he said the shelter can’t let its guard down.
Those barriers – to health care, mental health care, food and other basic needs – will remain, even after covid-19 is resolved.
“We don’t want – once this immediate crisis goes away – for people to just think everything is OK, because it’s not,” Gilliam said. “We know that this population is vulnerable…There is some relief, but there is some concern that this population will once again go to the back burner.”
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