A vile of the COVID vaccine sits on a white table top.

As Bay Area healthcare workers started receiving the coronavirus vaccine at the end of December, unhoused people and their advocates are wondering when the vaccine will become available to the homeless community. While people in high risk groups are said to be next in line, at the time of publication on January 5, the question of who will be prioritized and when is still the subject of debate amongst state and local health officials. Individuals who work directly with those experiencing homelessness in the East Bay have started to receive the vaccine as well. County officials say that people who live on the street and in shelters will follow close behind—although when, exactly, the vaccine will hit the streets has yet to be determined. 

Unhoused people fall into the “high risk” category for a number of reasons: They often live with chronic illness or in congregate settings, both of which make one more susceptible to the deadly virus. According to the phased approach framework from the National Academy of Medicine, residents and staff at homeless shelters as well as prisons and jails should be vaccinated in phase two, after high-risk health workers and older adults living in congregate or overcrowded settings. 

Ultimately, the decision about who to vaccinate and when will happen at the local level. Nationally, unhoused people aren’t slated into any of the proposed vaccine distribution phases by the Advisory Committee on Immunization Practices (ACIP). Instead, the ACIP leaves room for individual states to define the specific members of the priority groups. 

In Boston, people experiencing homelessness started receiving the vaccine at the end of December. 100 doses of the Moderna vaccine specifically for the homeless community were scheduled to arrive at the end of the month, Dr. Jim O’Connell, president of Boston Health Care for the Homeless Program, which will be administering the shots, told radio station WBUR. 

“We’ve had good luck at getting homeless people living in the shelters to trust us enough to get the vaccine. But that’s always been with a single dose,” O’Connell said, “The challenge for us now, I think, is going to be … once they’ve had the first shot, make sure that 28 days later or thereabouts, we can find them and that they’re still willing to have a second shot.” 

O’Connell’s team will prioritize unhoused people with underlying health conditions first, as well as those living at the most crowded shelters. 

“Everybody has a different idea about what essential means… so you’re going to see a lot of fights about that,” Dr. John Swartzberg, a clinical professor emeritus of infectious diseases and vaccinology at the UC Berkeley-UCSF Joint Medical Program, told The Mercury News. 

According to data from the National Academy for State Health Policy, as of December 20, Massachusetts and Texas were the only states to designate homeless shelters as part of phase 1A of their vaccination plan. The following states plan to distribute COVID-19 vaccines to homeless shelters during the next phase, 1B: Arizona, Washington D.C., Maine, New Jersey, North Carolina, Pennsylvania, and Vermont. 

Alastair Boone is the Director of Street Spirit.