Gov. Jared Polis missed the mark when he said in early February that it would “cost lives” to divert COVID-19 vaccines to younger, “healthier” people because “they happen to be homeless.”
In fact, the opposite is true – it would save lives. Here’s why.
Congregate shelters, which thousands of unhoused Coloradans rely on for emergency shelter and vital services, are often crowded, poorly ventilated indoor spaces with hundreds of people passing through each day and sleeping just a few feet apart.
Not surprisingly, despite operators’ best efforts, shelters have been hot spots for COVID-19 transmission. Denver has had numerous shelter outbreaks with incidence rates as high as 32%.
It is false to claim that people experiencing homelessness are somehow “healthier,” when we know they have physical health conditions that can make their biological age as much as 20 years older than their actual age due to the trauma of experiencing homelessness.
Due to age and existing high-risk health conditions, people experiencing homelessness, or PEH, are at much greater risk for poor outcomes and are hospitalized for COVID-19 at more than triple the rate of their housed counterparts. In addition, over 50% of PEH in our community are Black, Indigenous, or people of color known to be at higher risk for severe disease and death.
The governor said it would be logistically easier to await the approval and arrival of a single-dose vaccine for PEH. While it is true that a single-dose vaccination would be simpler for everyone, PEH living in congregate settings don’t have time to wait.
An outbreak in a crowded shelter spreads quickly and would likely infect hundreds of people with detrimental impacts in shelters and throughout the community. Rampant spread of COVID-19 in congregate shelters overloads the medical system and increases viral transmission throughout the community, as PEH must leave shelters to work, to obtain personal needs, and to access health care and other services.
In addition to the contact they have with others in shelters, PEH can have many contacts with others while contagious through public transportation access, obtaining services at multiple sites, and acquiring survival needs at retail locations which spells disaster.
With cold temperatures still on the horizon for Colorado, we know more people will be forced inside already overcrowded shelters. This will increase COVID-19 transmission and further exploits people already at high-risk for harm. If the vaccines were made available to these individuals, the fear of shelter during these cold-weather days would decline substantially and provide broader protections from the many other dangers of homelessness.
Because PEH have steep barriers to access comprehensive health care and other essential services, and they suffer from deep inequities, we must take vaccinations to them. We must vaccinate shelter guests at once with the available Moderna and Pfizer mRNA vaccines which, according to recent studies, may have single-dose efficacy rates exceeding 80%.
Our experience at the Colorado Coalition for the Homeless has shown that vaccine acceptance is high among elderly PEH whom we serve (the only PEH yet eligible for vaccination in Colorado) and most have returned for their second dose.
We also know that shelter populations are actually relatively stable, and people access the same shelter night after night and can be easily contacted for second doses. And, if they happen to move, the protection from a single shot is far better than 0% for those forced to sleep in high-risk, congregate settings.
It makes far more sense to vaccinate everyone in shelter settings than asking only those who are currently eligible for vaccines to leave the shelter, find the vaccine on their own, and then return to the shelter. The same logic applies and was implemented when the state decided to bring vaccine resources directly to assisted-care facilities. It would have made no sense to ask people in these facilities to go out and find a vaccine once they met some other level of state-created prioritization level.
Analogously, such a disjointed, whack-a-mole approach for PEH in congregate shelters is setting the stage for a public health disaster with widespread COVID infections amongst those who are forced to live without housing.
For the sake of all Coloradans, including those who have the least among us, it is clear that the best way to save lives is to drive down COVID-19 transmission through vaccination of all guests in congregate shelters, as was accomplished so expertly for people residing in in long-term care facilities.
Bringing vaccines to communities most affected by COVID-19 is a public health, health-equity and moral imperative. Not doing so prolongs this pandemic and would indeed cost lives.
Dr. Ed Farrell is vice president of integrated health at Colorado Coalition for the Homeless.
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