Bay Area Counties Take Scattershot Approach to Vaccinating Homeless People Against COVID-19

San Francisco Chronicle | Shwanika Narayan

Several people who received a single-dose vaccine Thursday at People’s Park said they felt relieved to be fully vaccinated.

On a chilly Thursday morning, Marcus Lowe sat on a chair contemplating his plans for the day after getting his second Moderna shot at Oakland’s Trust Health Center.

“I think I’m just going to rest with some aspirin and Tiger Balm,” said Lowe, 61, who lives alone in transitional housing in the city.

Lowe was one of 15 shelter residents and unhoused people lined up at 10 a.m. to receive COVID-19 vaccines at the clinic for underserved people. Organizers of the vaccination site, set up in a parking lot behind the clinic, expected more than 50 people that morning, after Alameda County expanded vaccine access to the broader homeless population on March 5.

Lowe said he was lucky to hear about the vaccination site. Despite accumulating financial woes from an onslaught of medical issues during the pandemic, he still had a working cellphone and could be reached by his doctors, who reminded him of his appointment that day, he said.

At least three Bay Area counties — Alameda, Contra Costa and Santa Clara — have already expanded vaccination distribution to all unhoused people. San Francisco planned to do so starting Monday.

As of Friday, Alameda and Santa Clara counties were also sending mobile street teams to outdoor encampments to inoculate those often left out of the vaccine’s reach because they aren’t connected to shelters or safety-net programs.

These counties are diverging from a California vaccine plan that hasn’t prioritized people experiencing homelessness unless they meet age or occupation requirements. That’s a mistake, some local health officials say.

“The burden of COVID is mostly felt by these vulnerable people,” said Dr. Michael Stacey, chief medical officer of LifeLong Medical Care, which runs the Trust Health Center. “By not having a targeted approach in testing and vaccine distribution for the homeless, it exacerbates the inequity that already exists.”

Nurse Cy Martens prepares a dose of the Johnson & Johnson vaccine for clients of the Trust Health Center in Oakland.
Nurse Cy Martens prepares a dose of the Johnson & Johnson vaccine for clients of the Trust Health Center in Oakland. (Gabrielle Lurie/The Chronicle)

San Mateo and Sonoma are vaccinating homeless people only if they fall under the state’s eligibility tiers of being at least 65 or holding jobs as frontline workers, county officials confirmed. Marin, Napa and Solano did not respond to requests for information about whether their vaccine distribution plans account for people experiencing homelessness.

Some local health representatives cite the state’s guidance as the reason they’re not prioritizing homeless people for vaccines.

“Because the unhoused are not a distinct eligible group within the state’s framework, we have not had the flexibility to adapt other efforts targeting the homeless for vaccination,” Srija Srinivasan, deputy chief of San Mateo County’s health department, said in an email.

California initially included vulnerable populations such as the incarcerated and unhoused in the second tier of Phase 1B of its vaccine distribution plan, which is currently under way, but those plans were scrapped Jan. 25. The state’s current plan does not include people experiencing homelessness as a distinct category, and the state is not tracking who’s unhoused in its vaccine registry, making it hard to quantify how many have received the nearly 11 million shots delivered statewide as of March 10.

The nine-county Bay Area has a baseline homeless population of just under 40,000, according to one- or two-night surveys in 2019 and 2020, which do not account for all sheltered and unsheltered people experiencing homelessness. It’s unclear how many have been vaccinated.

Sonoma County, for example, counted 2,745 individuals experiencing homeless in its 2020 survey. The county doesn’t know how many have been vaccinated, a spokesperson said. In Contra Costa County, 1,892 unhoused people were given at least first doses of the vaccine, representing more than half of its known homeless population, a spokesperson said.

Requiring identification to receive the inoculation, vaccine hesitancy and the logistics of delivering two doses spaced weeks apart make it challenging to reach people in shelters, transitional housing and in encampments who may not have access to smartphones, internet or transportation, homeless advocates say.

“When you have a vaccine system that’s so reliant on technology, it’s a huge barrier for unhoused people,” said Jennifer Friedenbach, executive director of the Coalition on Homelessness in San Francisco.

“Set up walk-in sites that require no ID and go to the encampments and administer vaccines on the spot,” Friedenbach added. “We need this to be as simple and low-tech as possible.”

Dr. Deborah Borne, who oversees San Francisco County’s vaccine rollout to people experiencing homelessness, wants to set up mobile vaccine units as soon as possible. Last week, she did rapid COVID testing on a 68-year-old homeless man who refused to go to a clinic for a vaccination afterward because he feared losing his belongings, she said.

“He would be someone we’d be able to serve right away if we did targeted vaccinations,” Borne said. “We’re working on that now.”

Compounding the challenges are the logistics of administering two-dose vaccines, which are in short supply and have to be kept frozen, unshaken while in the vial and injected soon after defrosting.

But logistical challenges shouldn’t be a reason for delay, according to the National Healthcare for Homeless Council, an advocacy group in Nashville. In a letter sent last month to every state governor, the council said delaying vaccines for homeless populations until Johnson & Johnson’s single-dose vaccine was available would undermine both access and trust.

“All states should immediately prioritize homeless populations and use currently available vaccines. There is no reason to delay care or wait for another vaccine,” the letter read.

For now, efforts to inoculate people experiencing homelessness remain scattershot but growing.

San Francisco announced it would expand its limited vaccine supply to all people experiencing homelessness, as well as those who live or work in correctional facilities, homeless shelters and other congregate residential care and treatment facilities, starting Monday. While people would need to make appointments to get the vaccine through health care providers or by booking them online, the county said in a release that its public health department would work “with organizations serving people experiencing homelessness and with disabilities to reach these communities.”

Some medical centers, such as UCSF, offer vaccines to all unhoused people at its clinics, Borne said.

LifeLong Medical Care in Oakland sent five street teams this week to outdoor dwellings and encampments to deliver the Johnson & Johnson vaccine, said Rina Breakstone, a social worker at the clinic.

For Andrea Osibin, 58, getting the one-shot vaccine at the Trust Health Center on Thursday was ideal. She moved into transitional housing in Oakland a month and half ago. She had been in a hotel that was part of the Project Roomkey program, and before that she was in a shelter, she said.

“Because my living situation changes every few months, I like the one shot,” she told The Chronicle. “I don’t have to come back, and that saves me a lot of time and worry.”

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