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Officials, Providers Team Up To Vaccinate Unhoused

In Multnomah County, homeless service providers are helping health officials identify and address barriers to vaccine access.
Multnomah County worked to vaccinate people of color and people experiencing homelessness. | MOTOYA NAKAMURA/MULTNOMAH COUNTY
April 5, 2021

In the final days of March, the Oregon Health Authority opened up coronavirus vaccine eligibility to more high-risk groups of Oregonians — including people experiencing homelessness.

Health officials and homeless service providers are now teaming up to roll out COVID-19 vaccination to unhoused people, in hopes of overcoming the barriers they face not only to accessing vaccines but to health care in general. The efforts come on the heels of a particularly isolating pandemic year for the homeless community.

“If you look around the city, look around the county, a lot of things are shut down. And unfortunately, that means a lot of programs and services are shut down as well,” Do Good Multnomah’s Eboni Brown told OPB.

Brown works with unhoused Multnomah County residents as director of shelter programming for the nonprofit, which focuses its services on unhoused veterans. She said that with the pandemic, a once-robust list of places people could find meals became drastically shorter. Reduced hours for day services also left unhoused people with more limited time to fulfill their daily needs.

“People that once relied heavily on these services to get a shower, to just get some rest, get some food, are no longer able to access those services,” Brown said. “So we’re seeing a hygiene shortage right now, we’re seeing more food insecurity, and we’re just seeing people be disconnected from the programs and services that they were once a part of.”

As the pandemic exacerbated housing insecurity and pushed people further into poverty and isolation, unhoused people also found themselves more vulnerable to COVID-19 itself. Living in congregate shelters or group outdoor settings such as encampments left them without the same ability to shelter in place or quarantine as their housed neighbors.

Kim Toevs, communicable disease director for Multnomah County, said that a lack of access to medical care put unhoused people at higher risk, too.

“The challenges in accessing health care to be able to manage any chronic diseases … mean that folks who are unhoused on average have a significantly high rate of some of those chronic diseases that make COVID illness much more severe if they do get infected,” Toevs said.

Despite the risks and initial concerns that the coronavirus could devastate the homeless community, Toevs said the county managed to avoid the high rates of COVID-19 amongst unhoused people seen in some other cities during the pandemic’s early months. In addition to “just sheer luck, frankly,” she credited funding for a variety of interventions the county tried, and collaboration with “tons of community partners,” including Do Good Multnomah.

Toevs said homeless outreach workers connected with people living outdoors to dispense masks and hand sanitizer and help bust misconceptions about COVID-19. Portable handwashing stations went up around Portland. Additional shelters opened up so preexisting shelters could create more space for proper distancing.

The county also opened a voluntary isolation motel where unhoused people who did get sick or came in contact with another sick person could safely quarantine. From there, six unused motels were converted into single-room physical distancing shelters for unhoused people at particularly high risk based on factors like their age or underlying health conditions. Three of those motel shelters are operated by Do Good Multnomah.

Do Good Multnomah was also contracted to provide day services at Sandy Studios, an affordable housing complex for formerly unhoused veterans. That complex is now closing and relocating its residents due to poor building conditions, including mold and deteriorating ceilings, long neglected by the building’s owner. Some of Multnomah County’s motel shelters are contracted via the same owner, local hotelier Ganesh Sonpatki. But the city-county Joint Office of Homeless Services is the leaseholder in those contracts, giving the county more freedom to access rooms and quickly handle maintenance issues.

When eligibility for COVID-19 vaccination opened up to Oregonians age 65 and older, Do Good Multnomah hosted vaccine clinics at its three motel shelters for those old enough to qualify. Now that vaccines are available to people experiencing homelessness age 16 and older, more vaccine clinics are being held at congregate shelters, like Transition Projects’ Clark Center Shelter in Southeast Portland, and low barrier health clinics, like Wallace Medical Concern, Cascadia Behavioral Healthcare’s health centers and Outside In.

Speaking with OPB the day vaccine eligibility expanded, Toevs said the county also hoped to bring vaccines to winter shelters before they closed for the season, the C3PO outdoor shelters opened in Portland early on in the pandemic, and to some locations that provide breakfast services to unhoused people. Vaccine pilots started by service providers earlier in March tried different models — walk-in versus by appointment, for instance — that Toevs hoped will inform strategy going forward.

At Do Good Multnomah, Brown and her colleagues are focused on helping the unhoused people they serve actually access vaccines, by setting up appointments and arranging transportation. After all, getting vaccinated at retail pharmacies or mass vaccination sites is a challenge if you don’t have reliable internet access.

“People typically don’t have cell phones, and if they do, they don’t have a way to charge their cell phones. So making appointments and keeping appointments is quite difficult,” Brown said. “You also have people who are at different levels in their mental health or addiction, and not able to keep track of those appointments.

“Add the barriers of not knowing what day it is, not having access to transportation or funds to get on transportation. It makes it very difficult to go for one vaccine, let alone two vaccines.”

That’s one reason the single-dose Johnson & Johnson vaccine is crucial in efforts to vaccinate people experiencing homelessness. Toevs said Multnomah County is prioritizing Johnson & Johnson doses it receives for its unhoused population, in particular, to eliminate the need to reconnect for a second appointment.

Brown said that some unhoused people, much like some housed people, feel wary about the vaccine. Medical distrust in the homeless community — not without reason — is another barrier.

“People tend to be very fearful of medical professionals, and [have] zero trust within the medical system, because [of] the way they have been treated,” Brown said. “When they’re ill, they’re hurt, they’re going into ERs or doctors’ offices and being turned away because they are houseless. How can you have trust in a system that constantly excludes you?”

Brown said a lot of unhoused people she knows have looked to friends to see if they’ve gotten the vaccine. For her part, she’s been sharing her own experience with the people she works with.

“Being like, ‘Hey, this is how I felt, this is what happened, this is how a friend felt.’ Just really expressing to them like, ‘Hey, I felt it was safe enough for myself, this is something that I wouldn’t recommend to you if I weren’t willing to do it,’” she said.

Toevs said another partner in the county’s vaccination efforts, Street Roots, has recruited some of its newspaper vendors to be “vaccine ambassadors,” sharing information about the vaccine and how to access it with unhoused people.

Working together with homeless outreach workers is going to be instrumental as Multnomah County strategizes on how to meet some people living outdoors where they are, by bringing vaccine doses to encampments. Toevs said the county’s history of bringing clinical services into camp settings, as part of past efforts to prevent HIV and syphilis, for instance, will inform its work. She also said the county would likely help map encampments, in close partnership with outreach workers.

“Camps usually tend to have people who are just the natural leaders of those camps, and it’s really pretty important to work with the homeless outreach providers who know who those folks are and can help engage those folks to welcome us into those settings,” Toevs said.

That communication will also help give people living outdoors a few days’ heads up, and an opportunity to get information about the vaccines, think it over and get some of their questions answered.

“What we’ve seen in other settings is that people tend to say no as their first reaction if you spring it on them without giving them a chance to think about it and get some of that education,” Toevs said.

Brown welcomes the county’s efforts to bring mobile clinics to congregate shelters and encampments to increase vaccine access for people experiencing homelessness.

“I’m just worried about people in congregate settings, people waiting to get into congregate settings and people who really have no interest in getting into congregate settings, who desperately need it,” Brown said.

“I am extremely hopeful, and I’m advocating every week, that we need to make sure that we’re prioritizing people in congregate settings. We need to make sure that we’re prioritizing people who might not have access to routine hygiene. I’m hoping that that will become a reality within this next month.”

This story was first published by Oregon Public Broadcasting.