When the British government released its guidance on who should be first in line for the Covid-19 vaccine last year, Dr. Zahid Chauhan was surprised to see that one particularly vulnerable group of his patients had been left off the priority list: The homeless.
The pandemic has had a huge impact on the homeless community in the UK and around the world, because many services normally available to them have been shut.
Studies conducted in – among others – Paris, Boston, Chicago and Ontario, Canada have all shown that homeless people and those who have recently experienced homelessness are more likely to become infected, more likely to require intensive care treatment and more likely to die of the virus, compared to the general population.
“They are an extremely vulnerable group, they die at the age of 43, 44 – their life expectancy is that low,” said Chauhan, a general practitioner (GP) in the northern English town of Oldham. “It was very clear that that group has been missed.”
In the UK alone, 976 people died homeless in 2020 – an increase of 37% compared to 2019, according to the Dying Homeless Project.
Homeless people are slipping through the cracks in the UK’s otherwise successful vaccine rollout. The vaccine, and health care in general, are free in the UK. But to receive the shot, one must be registered with a doctor. And that can be difficult for people with no permanent address.
When he realized the omission, Chauhan, a long-time homeless rights activist, started working the phones. As a member of Oldham Council, he was able to convince the local authority to prioritize the town’s homeless population in its vaccination program. Then he wrote to the government urging it to do the same nationwide.
Melissa Kerschen, a senior communications manager at Glass Door Homeless Charity, said the public and policy makers need to understand that homelessness is a health issue. “The two are inextricably linked, and we know people who are homeless suffer health complications at a far greater rate than the general population, and these health problems often go undetected,” she said.
Glass Door is one of the groups working alongside Chauhan and other campaigners to get vaccines to homeless people. The organization runs two hostels in central London, providing winter accommodation to more than 100 people. Thanks to its long-term partnership with a local homeless-friendly GP practice, the charity has been able to offer the vaccine to all of them.
Dr. Justin Hammond, principal GP at the surgery – the Good Practice – is working through his patient lists to find homeless people who are eligible for the vaccine. He said 64 of the 346 homeless patients registered with him have received the shot so far.
But Hammond said turning up for an appointment at a vaccination center can be a major challenge. “People are traveling from all over and they have other priorities as well: Food, shelter, money … and these can come above things like health and vaccinations,” he said
Because demand for shots still outweighs supply, the ability to turn up at a short notice is key – another barrier for many homeless people.
“The program here is based on people answering their phones, [being] willing to have the vaccination and turning up … for the homeless [this] makes it very hard to have a vaccination,” Hammond added.
‘A game changer’
The campaign by Chauhan and others has worked: The UK’s Joint Committee on Vaccination released new guidance earlier this month, saying homeless people should be prioritized in the rollout.
“There have been some great efforts already, charities and cities being proactive in rolling [the vaccine] out because they have the resources and the networks and relationships to do that, but this is more of a game changer overall because there may not be those really great setups and health inclusion teams in different parts of the country,” said Becky Evans, fundraising and communications manager at charity Groundswell. “To be able to say these people have the right [to a vaccine] now … is definitely really, really valuable.”
But making the vaccine available to the homeless is just one part of the rollout. Ensuring the shots end up in arms is another challenge. Vaccine hesitancy is often a problem.
“There is a mistrust of authority, because people who are homeless have been let down by the system in so many different ways in the past, that there is a mistrust … of some of these bodies that might be putting out the information,” Evans said, explaining that this is why Groundswell relies on people who have experienced homelessness first-hand to share vaccine information among its clients: All of its volunteers and more than two thirds of its staff have been homeless in the past.
“It’s the peer element,” she said. “Talking to people about the vaccine, saying, you know, ‘I’ve had the vaccine too, and this is why I got it’ – just being a trusted presence.”
The approach appears to be working. Groundswell is part of a team that has vaccinated about 750 people in the Westminster borough of London in just three weeks. Getting information to the people who face the highest risk is part of its success.
“When we talk to people, if we don’t get a standard ‘No,’ if people are willing to talk, then we’ve always been able to persuade people to have the vaccinations,” Hammond said. He added that making it as easy as possible for people to access the vaccine will be key in the coming weeks and months.
“It’s about working with charities who work with the homeless, and making sure we make the vaccine easy to access, have flexible access at drop-in services near their accommodation, or even roaming services,” he added.
Oldham has already completed its first round of vaccinations among the homeless.
Chauhan admits that he got emotional at the first clinic. “I can’t explain the feeling, these are people who have been historically denied access, they’ve been historically treated unfairly, they don’t have a voice,” said the doctor, who has been working with the homeless for many years, and received an honor from Queen Elizabeth for his efforts in 2019.
“This is our moral duty, but it makes economical sense as well, you can prevent death and you can stop the coronavirus from circulating,” Chauhan said.
He says his campaign to prioritize the homeless has faced a backlash. But his message is simple: It is in everyone’s interest, because when a virus is the enemy, nobody is safe until everybody is safe.