How will San Francisco vaccinate its homeless population?

Douglas Earl is a 64-year-old who lives in the Tenderloin and works as a custodian at Facebook in the Financial District. He has been in drug programs, jails, and penitentiaries, but has been off crack for 15 years. During his time in these systems, he has come to mistrust the medical community. 

Earl often waits in line for free food in the Tenderloin, surrounded by many there who often do not wear masks. His age and underlying conditions put him at high risk for contracting Covid-19. Nevertheless, he said, the covid vaccine is not for him. 

“We don’t need it down here, we’ve already been exposed to it, most of us at least,” he says. 

“Right now there are just too many variables … ”

Earl’s attitude is shared among many homeless residents, and it’s one the city will confront when it begins to vaccinate its thousands of homeless residents.

The most recent 2019 one-night count tallied 8,011 homeless people. That number is considered to be an undercount. Jeff Kositsky, the former director of the Department of Homelessness and Supportive Housing, estimates that, over the course of a year, 20,000 people will be homeless in San Francisco. 

San Francisco’s plan for vaccinating homeless residents, as it stands

The San Francisco Department of Public Health announced early last week that mobile teams will begin vaccinating homeless residents soon, but no starting date has been announced. San Francisco is following the state guidelines that started with healthcare workers and those 65 and older.

This week, vaccinations expanded to include education and childcare workers, emergency services, and agriculture and food. 

Next, on March 15, state officials announced, physicians can vaccinate anyone 16 to 65 considered high risk for morbidity.

Deborah Borne, who works for the San Francisco Department of Public Health, and is now working under the Covid Command Center that acts as a clearinghouse for all press inquiries,  said she is working closely with community organizations to make plans to vaccinate homeless residents. 

When the state expands the tiers to include homeless residents, the health department said they will start with the locations and groups at the highest risk for Covid transmission. These would include indoor, congregate settings — such as shelters and SROs — and their residents.

Santa Clara County announced yesterday that, beginning Sunday, it will vaccinate incarcerated people and homeless residents living in congregate settings, even if they are under 65.

San Francisco has yet to make this move, and officials say they are waiting on state guidelines to change. 

There is also talk that the Johnson & Johnson vaccine, which could be approved for emergency use as early as this weekend, might be a better option for the homeless population because it requires only one dose. 

Kenneth Kim, the senior director of programs at Glide, said the “one-dose vaccine makes it easier,” as homeless residents will not have to be tracked down so they can get their second dose. 

How the pandemic has impacted homeless residents thus far

So far, some 648 covid cases and two deaths have been reported among the homeless population. Some say it is mere luck that has kept this number low, and others attribute it to the fact that homeless residents often sleep outside, where transmission rates are lower.

It’s unclear how many shelter residents have tested positive since the outbreak at MSC South Shelter in April, when 70 tested positive. But the city tracks cases in Single Room Occupancy Hotels and, so far, 1,127 residents have tested positive and 11 have died from the virus. 

There are 19,000 low-income residents living in 500 so-called Single Room Occupancy Hotels, as of April 2020. 

Dr. Joshua Bamberger, a family physician and public health expert who has been working with homeless residents in San Francisco for 35 years, disagreed with the state’s decision on who should be prioritized. He says the focus should on “a very focused public health campaign to help to increase the uptake of vaccines when we roll them out.”

At present, Bamberger also works for the San Francisco Department of Health, but spoke to Mission Local as a physician. 

Once the education campaign begins, outreach workers will confront a myriad of doubts among the homeless. 

AC Brooks, a 47-year-old who lives in an apartment and was getting his free lunch at St. Anthony’s one afternoon explained that “in low-income areas, there is a basic mistrust” of the medical community. “It’s a systematic thing.”

Theo Smith, who was raised South of Market and lives in the Tenderloin, was outside of a corner store when he explained, “I’m scared, I don’t want it, I don’t know. … I don’t even know where this coronavirus came from.”

But as he continued on, he acknowledged that if the vaccine gets the world back to normal, “I’ll take it.” 

Mission Local spoke to more than 20 homeless residents and found that, although there is mistrust, many people are willing to change their minds.

Randy Bishop, a 62-year-old who lives at the Five Keys shelter-in-place hotel in the Mission, initially said he was very opposed to the vaccination. He said that, in the hotel where he lives and works, “they haven’t really said much about the vaccination.” 

“My feelings are, I’m just not taking it,” Bishop said.

But after a short conversation with Mission Local and an outreach worker from St. Anthony’s, he acknowledged that it “probably would be helpful” and said, “they need to educate the people who are educating, and then hire people like me to educate others.” 

Experts would agree with this approach. 

Karreese Rox said that a lot of homeless residents, especially Black residents, don’t trust the government. “Police shoot people and police are part of the government,” so it will be a challenge to address the mistrust within the homeless population. 

Many people experiencing homelessness have had traumatic experiences with medical professionals in the past, and experts say it will take tailored education to get the homeless population vaccinated. Experts agree that it will be important for those who educate homeless residents about vaccination be people who have trusted relationships with homeless residents, and those with lived experience of homelessness.

Dr. Margot Kushel, the director of the UCSF Center for Vulnerable Populations, which has used those with lived experience of homelessness to reach other homeless residents for testing, agreed. “Education should begin now,” Kushel said. 

One group that has begun to have conversations with people about vaccines, is the Downtown Streets Team. According to Gregory Nottage, the executive director of Streets Team Enterprise, they have collaborated with San Francisco State nursing students to have conversations with homeless residents about vaccinations.

Mike Rosso, a 72-year-old homeless man who volunteers at the Coalition on Homelessness answering phones, said he had not received any information about educating folks about vaccination. 

Since he is over 65, Rosso was offered the vaccination by his primary care physician at Health Right 360, but he said “Thank you, no gracias.” 

Rosso said “I have no intention of getting in line and getting some government shot. I don’t wanna play. I don’t believe nothing, I don’t wanna do nothing.” 

Iris Butler, a safety monitor at Glide, was also resistant. “I ain’t taking no vaccination, I don’t put nothing in my body that don’t compromise with my body,” she said. “I stay away from the people that’s coughing.” 

Larry Buckley is one of the homeless residents who said he would take the vaccine if offered it because he does not want to get sick. When asked how he would recommend educating others living on the streets about vaccination, he said: 

“I think you gotta show it to them and prove it to them. It can’t be lip service. You have to show people that this is what it is and it is gonna work.”