By Fran Kritz
Advocates for people experiencing homelessness in Colorado are worried and frustrated that neither homeless shelter residents nor people living on streets are included in the state’s current COVID-19 vaccination distribution plan.
An October 2020 draft state vaccination priority plan didn’t mention those living on streets, but did include people living in shelters during the second phase of vaccine distribution. But the current state plan, implemented effective Dec. 30, 2020, does not specifically mention how people experiencing homelessness will receive the vaccine.
“So far, the current distribution plan has been silent on the homeless,” says Cathy Alderman, chief communications and public policy officer for the Colorado Coalition for the Homeless, based in Denver.
Victoria Graham, a spokesperson for Colorado Gov. Jared Polis, did not provide a specific rationale for why unhoused people were ultimately omitted in the final state vaccination plan.
“We are focused on how we save the most lives and end the crisis as quickly as possible,” Graham wrote in an email. “We do that by prioritizing vulnerable populations and essential workers. Colorado’s prioritization is largely harmonizing with the CDC [Centers for Disease Control and Prevention] recommendations that prioritized the core functions for society.”
The current plan does put homeless shelter staff in group 1B—important so that they can reduce their risk of infection while continuing to do their jobs, says Alderman. That change may have been in response to a letter sent to Polis by a consortium of advocacy groups in December, before the current plan was released, asking that the plan “prioritize homeless services providers, including overnight emergency shelter staff, day shelter staff, [and] meal service providers in Phase 1.”
Yet the implemented plan does not address the group’s request to put people experiencing homelessness in the second vaccination phase, says Alderman, one of the signatories to the letter.
People who are experiencing homelessness are at increased risk for COVID-19 infection for a number of reasons, including the close quarters of homeless shelters. People living on the street are also more likely to have chronic health conditions such as hypertension and heart disease, which increases their risk of severe disease or death if they contract the coronavirus. As of Dec. 7, 2020, 242 of the 860 people experiencing homelessness in Denver who became ill with COVID-19 required hospitalization (28%), compared to a roughly 10% hospitalization rate in the general population, according to the coalition.
Additionally, many people experiencing homelessness are people of color, now established to be a risk factor for more severe COVID-19 disease largely due to societal factors. At the same time, people experiencing homelessness in their 50s and 60s often have “geriatric conditions” that are typically more likely to occur among housed people in their 70s, including chronic lung disease, mobility impairment and circulatory disorders, says Randall Kuhn, a professor of social work at UCLA who previously led the global health affairs program at the University of Denver.
While last year's federally required statewide count estimated about 10,000 unhoused people in the state—extrapolating from the report’s point-in-time count of 19 mostly rural Colorado counties—the Colorado Coalition for the Homeless currently estimates that the pandemic has increased the number of people experiencing homelessness in the state to upwards of 30,000.
The changes and omissions in the state vaccination priorities are just one more barrier for people experiencing homelessness to getting vaccinated, according to a recent white paper from the National Health Care Council for the Homeless, based in Nashville. Other barriers include:
- Lack of trust due to prior negative experiences with health care systems
- Racism in health care systems
- Practical barriers to care, such as transportation
- Complex logistics of storing coronavirus vaccines, which require freezers, refrigeration and/or special handling
- Difficulty in getting people who are unhoused to come back for a second dose. That situation will improve if there is a one-dose vaccine, says Alderman, but as of mid-January, the FDA hasn’t even announced a review date for a one-dose version.
Shawn Morgan, 65, a driver for the Colorado Coalition for the Homeless, lives in transitional housing in Denver operated by The Salvation Army. Morgan says he became homeless two years ago as a result of his addiction to drugs. He says the coronavirus vaccine is a regular topic of conversation among the 50-100 men who live in the transitional housing units.
“A lot of people are looking forward [to getting vaccinated] when their opportunity comes, but there seems to be a general fear from a lot of them about side effects and how it might affect them,” Morgan says. “Where they got that fear, I can’t say for sure.”
Morgan says coupled with the fear about the vaccine itself is that “a lot of people have experienced time when they weren’t given the proper medical treatment, or weren’t even able to get medical treatment at all. Some may feel they just don’t need the system, or that the vaccine is something they can do without.”
Morgan, who tested positive for COVID-19 last spring but never experienced symptoms, is worried about reported variants of the virus now in the U.S. and has decided he will get the vaccine, “whenever that is.”
There is no federal directive on prioritizing the vaccine. Rather, a CDC committee called the Advisory Committee on Immunization Practices (ACIP) drew up guidelines, published late last year. But many states are choosing their own priority groups, with some states choosing to place residents of homeless shelters among the first groups getting the vaccine, and others placing them well down the list—or, like Colorado, not on the list at all, according to analysis from the National Academy for State Health Policy.
“I don’t really know why” the ACIP recommendations do not specifically identify or prioritize unhoused populations and shelter workers, says Glen Mays, PhD, MPH, chair of the Department of Health Systems, Management & Policy at the Colorado School of Public Health. “Possibly, the committee determined that these populations would be adequately covered by virtue of fitting into other prioritized groups based on age, health conditions, or designation as critical infrastructure workers.”
Federal recommendations from last year (and subsequent state guidelines) centered around pre-existing conditions, rather than housing status, are bound to omit many people experiencing homelessness, says Alderman. Colorado’s current vaccine prioritization calls for people with chronic health conditions (e.g., obesity, diabetes, cancer, kidney disease) to be vaccinated in the second phase, but doesn’t include details on whether medical documentation will or should be required for such people.
Beverly Lampley, director of development and communication for Grand Valley Catholic Outreach, which includes a soup kitchen, food pantry, clothing depot and housing assistance in Grand Junction, says people experiencing homelessness could end up not getting vaccinated until the summer. Lampley, who is also chair of the Grand Valley Coalition for the Homeless, says there are 500 to 1,000 people in Mesa County in homeless shelters, plus about 325 in encampments in Grand Junction.
“Because so many things are closed, like the library, and there is no social distancing [among these populations], we’re just waiting for a huge outbreak,” Lampley says. “Pushing vaccination forward increases the likelihood of another outbreak, and people experiencing homelessness in our jurisdiction are scared.
“It’s hard enough to be homeless—it’s another thing to be at risk of a potentially fatal disease when you have little space to recover and barriers to care. It’s the fear of everyone times ten.”
For people who are experiencing homelessness but fit into higher priority groups because of age, occupation or chronic conditions, many advocates are helping them register to get the vaccine as soon as they are able. Lampley also remains optimistic that the incoming Biden administration will be able to distribute larger supplies of vaccines.
Says Lampley: “We’re going to the encampments and the parks and encouraging them to be registered with the health department so they can get the vaccine when it’s their turn.”