{"id":49894,"date":"2021-03-22T18:09:48","date_gmt":"2021-03-22T17:09:48","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49894"},"modified":"2021-03-31T19:22:39","modified_gmt":"2021-03-31T18:22:39","slug":"bringing-covid-19-vaccines-to-high-risk-populations-like-those-who-are-homeless-requires-a-tailored-approach","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/03\/22\/bringing-covid-19-vaccines-to-high-risk-populations-like-those-who-are-homeless-requires-a-tailored-approach\/","title":{"rendered":"Bringing covid-19 vaccines to high risk populations\u2014like those who are homeless\u2014requires a tailored approach"},"content":{"rendered":"

Prioritizing vaccines for people experiencing homelessness is vital to an equitable and effective public health response, write Margot Kushel, Barbara DiPietro, and Bobby Watts<\/span><\/p>\n

Ensuring effective access to vaccinations for people experiencing homelessness is essential to protecting public health and safeguarding the health of a vulnerable, yet often overlooked population. Achieving this goal with covid-19 vaccines will take more than a one size fits all, large scale approach.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/span><\/p>\n

Based on the experiences of a broad range of Health Care for the Homeless programs and many other homeless services providers across the US, we\u2019d argue that successfully vaccinating the more than <\/span>1.5 million people<\/span><\/a> who stay in shelters and encampments each year requires four elements: establishing people\u2019s eligibility to receive the vaccine, ensuring equitable access for disproportionately impacted communities, adopting a tailored approach to reaching them, and committing to being trustworthy.\u00a0<\/span><\/p>\n

Homelessness increases a person\u2019s risk of contracting and becoming ill with covid-19. Crowded living conditions in shelters and encampments make social distancing and hand hygiene difficult, and are an ideal transmission vector for infectious disease. A high prevalence of chronic illnesses (such as cancer, lung disease, diabetes) among this group increases the likelihood for severe illness, and behavioral health conditions that interfere with non-pharmacological interventions such as mask wearing also increase the risk of acquiring SARS-CoV-2 infection. Research shows there have been numerous large scale <\/span>outbreaks<\/span><\/a> at <\/span>homeless shelters<\/span><\/a>, as well as <\/span>higher case fatality rates<\/span><\/a> among people experiencing homelessness<\/span>.\u00a0<\/span><\/p>\n

Getting vaccines to this specific population is critical to stemming the pandemic\u2019s spread, yet this has been a challenge for several reasons. So far in the US, socially vulnerable areas have <\/span>received fewer covid-19 vaccines<\/span><\/a> than wealthier jurisdictions. Many US states have adopted rigid priorities <\/span>based largely on age<\/span><\/a> or specific health conditions, or placed other restrictions that prevent this population from gaining access. Most communities are also focused on large scale, drive-thru vaccination events that are not accessible to people with limited mobility, without cars or reliable transportation, or insufficient access to online registration sites. The politics around prioritization for the vaccine has also contributed to this population being <\/span>removed<\/span><\/a> from priority lists, or simply not acknowledged at all in states\u2019 plans.\u00a0\u00a0<\/span><\/p>\n

The US is expected to increase its vaccine supply, which will mitigate some of these issues. Yet a greater volume of vaccines will not automatically translate into greater vaccination rates among a group of people who have been subjected to significant stigmatization and discrimination in our society.\u00a0<\/span><\/p>\n

While much attention has been given to the concept of \u201cgaining trust,\u201d the medical community might consider what it means to be trustworthy. People who are homeless often <\/span>report<\/span><\/a> poor quality of care, a lack of respect, and incomplete (or premature) discharges when seeking healthcare services. <\/span>Over half<\/span><\/a> of those experiencing homelessness in the US are black, indigenous, or other people of color (and in many communities, it is the vast majority), where systemic racism further compounds the stigma of homelessness in the healthcare system. Increasing \u201cvaccine confidence\u201d fundamentally means that we as healthcare providers must improve our systems of care to earn our patients\u2019 trust. This concept is not limited to vaccines, but rather the delivery of all types of services.<\/span><\/p>\n

To improve vaccine access and uptake by people experiencing homelessness, policy makers, public health authorities, and service providers should take the following four actions:\u00a0\u00a0<\/span><\/p>\n