Are we going to be able to vaccinate everyone, especially those who are most vulnerable to COVID-19?

Rupal Ramesh Shah

People experiencing homelessness often have difficulty accessing basic medical services, and the Centers for Disease Control and Prevention (CDC) has developed several guidelines to ensure the unhoused are prioritized during vaccine implementation. One of them is to work with Continuum of Care Programs, which promote community-wide efforts to end homelessness and address their direct needs.

Dr. Avik Chatterjee, assistant professor of medicine at Boston University, School of Medicine, and medical director of the Boston Health Care for the Homeless Program clinic at the Southampton Street Shelter, has been working with individuals and families affected by homelessness for over eight years. He’s seen firsthand that access to healthcare is about more than making resources available.

“In order to reach high numbers of vaccination rates in the community, we have to first build trust,” said Chatterjee. “What are healthcare institutions doing that allow people to gain trust in them?”

The COVID-19 pandemic has further highlighted racial inequity, especially in terms of access to healthcare. That means institutions and practitioners have to figure out appropriate solutions in order for the community to gain trust and actively combat racial inequalities that affect whole communities’ ability to get the information it needs. Access is also about ensuring materials are provided in the appropriate language and that people have access to the internet, if that’s how certain resources will be offered. 

“People often struggle with the logistics in order to obtain care and that’s where we need to support them,” Chatterjee insisted earnestly during a recent conversation. 

One strategy would be for the state to partner with local community organizations such as Cambridge Health Alliance. Cambridge Health Alliance’s focus is to provide high quality care in neighborhoods, through partnerships with local agencies and organizations. Such organizations are trusted and known in the community, and therefore have the capacity to be able to tackle challenging issues.

According to Katie League, project manager at National Health Care for the Homeless Council, it is crucial that we distribute vaccinations to all the trusted providers and community groups that are working on vaccinations. She adds that we will not reach 100% vaccination rates by mass vaccination sites alone. 

“Vaccine refusal is low but vaccine hesitancy is where people currently are at,” League stated. 

Therefore, we have to meet those people where they are to understand their perspective with sensitivity and respect. 

“Not making the vaccines mandatory is important at this time. People should have the autonomy and right to make the decision,” League said. She says that all providers should give people the choice of which vaccines they should take and create opportunities to address barriers such as transportation to vaccination sites. 

“Reaching poor communities and communities of color at this time is crucial,” League said.Those communities are most vulnerable and need our support.” 

In such cases, legislative changes are necessary and therefore, working with the government to prioritize those communities is key.

“What happens after everyone is vaccinated?” League asked rhetorically. “Well, they will still need housing. Now that we have created alternate housing options such as hotel rooms we need to make sure we continue to address those long-term needs. Each person deserves housing and that should still be our key goal. Everything else is a step along the way.”

Julie R. Koehler, assistant professor of pediatrics at Harvard Medical School has been working with immigrant communities over the last 10 years and as a result has become even more aware of the undocumented immigrants in the USA. 

“When vaccines became available, the biggest concern was whether everyone will be able to get them. Groups like La Colaborativa have set an excellent example as they have worked closely with families of color, mostly from the Latin community to provide information, address vaccine hesitancy, and connect them to resources to obtain the vaccines,” she proudly said. 

In addition to providing support for COVID-19 vaccines, La Colaborativa also asked those same families about their needs surrounding food, housing, transportation, and medications. That is what sets them apart from other groups. 

“Outreach that is culturally-appropriate is key during this time,” stated Koehler. Additionally, she mentioned that the work of the government and CDC alone will not be enough. Communities should be more empowered to defend their basic human rights, and in this new world that will need to be a focus. Our hope is that as there is more advocacy around this topic, there will be more work done to bring in equity to healthcare accessibility.”