Similar efforts are underway elsewhere. Vatican City has begun administering first doses to several dozen residents of its homeless shelters. So has Detroit, which aims to vaccinate residents of its 89 facilities by the end of next month. Denmark has moved its homeless up its priority list.
In many places, the vaccination programs remain in their early days, reaching only a tiny sliver of local homeless populations, in part because of a scarcity of doses but also because of the unique difficulties the circumstances of the homeless pose.
“This is not like rolling up in front of an old folks’ home and bringing your cooler with vaccines and saying, ‘How many folks do you have here? Line them all up. We’re going to vaccinate,’ ” said Samuel Watts, chief executive of Montreal’s Welcome Hall Mission, an organization that serves at-risk youth and those experiencing homelessness. “You have to actually organize a process on the ground to make sure that you get the right people at the right place at the right time.”
Even in the first weeks of the pandemic in March, advocates were urging governments to protect the homeless, warning that the group was particularly at risk and certain to grow as more people were made jobless. But the challenges were evident from the start.
Many people experiencing homelessness have underlying conditions that predispose them to severe illness from covid-19, lack access to reliable health care and are often unable to quarantine or self-isolate. Shutdown orders in some areas cut them off from places where they can wash their hands.
The living conditions in homeless shelters make them petri dishes. People share bathrooms and eating areas and often sleep on cots spaced dangerously close together. One Ottawa doctor who works with the Canadian capital’s homeless said people are “cheek by jowl.”
Some countries responded by temporarily halting evictions or setting up isolation facilities for those who tested positive for the virus. Others moved people off the streets or out of shelters and park encampments into hotels or private lodgings, sometimes provoking a local backlash.
Advocates and health experts say these vulnerabilities mean the homeless should be among the first groups to be vaccinated. They say the rollout will require careful planning for a population that is mobile, pushed to the margins and often distrusts the health-care system.
“We can’t have any hubris, as the health-care system, to think that you can swoop in and run vaccination campaigns with great success unless the trust is there on the ground,” said Andrew Boozary, executive director of population health and social medicine with Toronto’s University Health Network. “That’s the part that I really think we have to get right.”
Faith Fowler, executive director of Cass Community Social Services in Detroit, agrees. The first doses of a coronavirus vaccine arrived last week at a shelter the organization runs, and while they were largely greeted with “gratitude,” she said, building trust will be critical.
Fowler said many of the shelter’s Black and Latino residents have concerns about the vaccines, in part because they are new but also because of a history of unethical medical experimentation on and mistreatment of people in their communities. She said the pandemic has been a “scary spell.”
“Everybody in our shelters is related to somebody who has died or has been very sick,” she said.
Even if those hurdles are cleared, another looms: having to repeat the process several weeks later for the vaccines that require a second dose.
Chad Audi, chief executive of the Detroit Rescue Mission Ministries, said the second shot will be a “major challenge.” He said his team is considering incentives, such as providing gift cards to those who return.
Karen Weyman, chief of family and community medicine at Toronto’s St. Michael’s Hospital, has been part of a team leading pilot projects to vaccinate local homeless people and front-line workers that they hope will serve as a “playbook” for a larger rollout.
Weyman was providing first doses to 50 residents and some 20 staff at a shelter for elderly men this month. Getting doses to shelters presents challenges, she said, but will be less logistically complex than reaching those who avoid them.
“We’re going to have to think carefully about people who are not in the shelter,” she said.
Montreal began administering doses to several hundred homeless people this month amid clashes between Quebec Premier François Legault and other officials over whether the homeless should be exempt from a nightly curfew. Legault opposes the idea.
More than 190 of Montreal’s homeless, as well as 82 staff at shelters, have tested positive since December, said Drouin, the city’s health director. She began her Friday news conference by offering condolences to the loved ones of Raphaël André, a 51-year-old homeless Innu man whose body was found in a portable toilet Jan. 17, a stone’s throw from a Montreal shelter he often frequented that was forced to halt overnight services because of an outbreak.
At a downtown hotel that has been converted to an overnight shelter, coupons were handed out to residents for use at a conference center where vaccines are administered, Watts, of the Welcome Hall Mission, said. He said handling the Pfizer vaccine, which requires ultracold storage, has been an added complication.
“It does take some logistics and some planning, because the Pfizer vaccine, once you unfreeze what’s in the vials, it must be used,” Watts said.
Efforts to vaccinate the homeless in Montreal and Toronto were dealt a blow this month when Pfizer said it would be retooling a Belgium production plant and slashing the number of doses Canada had expected over the next month. The pilots in Toronto were put on hold.
Weyman called the news “devastating.” Boozary, who has also been involved in the Toronto pilots, said the disruption in supply is “like an elephant sitting on our chest.”
Advocates are encountering other challenges as well.
In Oldham, a town in Greater Manchester, England, vaccine doses were given this month to 23 people at a shelter. The effort was spearheaded by Zahid Chauhan, a doctor and local councilor in charge of health and social care, and other local clinicians.
When Chauhan appeared on BBC to discuss the Oldham initiative, the host noted there had been objections from some residents who felt “slightly exasperated” that the homeless had been prioritized ahead of them. Chauhan said he would take the backlash “as a badge of honor.”
“I’m proud that I can speak up for the people that can’t speak up for themselves,” he said.