Alameda County has begun offering COVID-19 vaccines to homeless people, in some cases flouting state guidelines that do not prioritize unhoused populations.
But identification requirements, wariness of the vaccine, and the logistics of transporting doses to encampments make it challenging to reach everyone living in shelters or on the streets, said county staff during an online information session hosted by EveryOneHome, a nonprofit working to end homelessness in Alameda County, on Monday morning.
Dr. Kathleen Clanon, the county’s vaccine director, said it’s been dizzying to keep up with the ever-changing federal and state guidelines on vaccine eligibility. California initially indicated that people living and working in shelters should be among the first to receive the shot then quickly pushed that population back to a later phase.
“Given the shifting grounds here, we actually just made a decision in the Public Health Department that we’re going to vaccinate people living in shelters first, then move on to unsheltered people,” said Clanon during Monday’s event. “We’re technically going off the roadmap to do this, but there’s strong support” from local health leaders to prioritize homeless communities, she said.
Alameda County has an estimated 8,000 homeless residents, and there was widespread fear early in the pandemic that COVID-19 would hit those populations hard, since many unhoused people live in group settings, have little ability to quarantine, and are more likely to have existing medical issues that make them more vulnerable to complications from the virus. Additionally, Black and Latino residents in Oakland and elsewhere have been disproportionately impacted by the virus—and Black people are significantly over-represented in the local homeless population.
Instead, the rate of COVID-19 cases among unhoused residents has actually been lower than that of the general population, Clanon said. Some observers credit the rapid expansion of emergency shelters and housing during the pandemic with the relatively low number of outbreaks. To date in Alameda County, 284 unhoused residents have tested positive.
According to the county, everyone living or working in Project Roomkey hotel shelters has received or been offered the vaccine, which was initially offered to residents who are 65 or older, then to everyone else. Out of the 497 current residents, 181 have gotten the first shot, with some still hesitant to be among the first to receive the vaccine.
“We’re hoping that more people will opt in over time,” said Clanon, who is sympathetic to people’s fears but also believes wholeheartedly in the safety of the vaccine. “We want people to say yes—but we want them to say yes when they’re ready to say yes,” she said. “We’re especially trying to talk to people about getting vaccinated before they leave.”
The county is now beginning to offer vaccinations at other group shelters, and trying to figure out how to bring mobile vaccine clinics to homeless camps. Because the vaccines must be used quickly after they’re removed from the freezer, and because each vial contains several doses that must be used at once, administering shots at camps is a logistical challenge, Clanon said.
“What we’re worried about is making sure we’re not wasting vaccines,” Clanon said. “That’s liquid gold. We want to make sure we have a plan to meet people at the encampment, and bring it there safely.” Some cities use an “ice cream truck” method of transporting doses in a freezer on wheels, but that kind of vehicle would be “unwieldy” to drive around town to tent sites, she said.
Individuals who are experiencing homelessness should also be able to sign up for an appointment on their own, as the county has communicated to all vaccination providers that unhoused people qualify for the shot, Clanon said. But in most cases, patients are required to show photo identification with an address when they receive a shot, information that vaccine clinics and pharmacies use to bill the government. Many unhoused people, who don’t have a permanent address, don’t have the requisite IDs.
Pastor Preston Walker, a resident of the Days Hotel Roomkey shelter in East Oakland, said the ID requirement is one of several barriers he believes will prevent other unhoused people from getting vaccinated.
Walker himself is eager to get the vaccine, and said he missed his first chance because he actually tested positive for COVID-19 recently and was transferred temporarily to another Roomkey hotel reserved for people with the virus. Walker said he plans to take advantage of another opportunity, later this month, for Days Hotel residents to get the shot.
“I have no hesitation,” he said, noting that several of his neighbors already got vaccinated.
But Walker said he worries about all the people living in tents and sleeping bags alone and out of sight. The county postponed its biannual count of homeless residents this January because of safety concerns, losing out on a data source that could have helped the county connect with people who are eligible for the vaccine, he noted.
“I know there’s outreach, but they don’t hit every spot because they don’t know where everybody is,” and the homeless population has “exploded” in recent years, Walker said. “And it still goes to the underlying issue of people not having an address.”
Outreach workers themselves were already vaccinated in December.
There are other ways that the expansion of vaccine accessibility could threaten the equitable distribution of doses in Alameda County, Clanon noted: “When you make it easy for people to get appointments who have cars and computers, you have people who are sitting around their computers all day who will snag an appointment and are willing to drive wherever to get the vaccine.”
Eventually, data on vaccines administered to people experiencing homelessness will be available on the county’s dashboard, Clanon said. That site shows that, of the county’s roughly 1.6 million residents, around 286,000 have received at least one dose so far.
Among populations that had early and widespread access to vaccines, such as residents and staff at long-term care facilities, COVID-19 death and hospitalization rates have plummeted.
“We’re able to see that in our community as in others, the vaccination is working,” Clanon said.