This week, Los Angeles County expanded into a new phase of vaccination eligibility, opening up shots to teachers, people working in food and agriculture, and child-care providers. The move means 1.2 million more people can now sign up to be inoculated against COVID-19; luckily, the current supply of shots is expected to be bolstered by the new one-dose Johnson & Johnson vaccine. Still, the county has yet to announce when vaccines will be available for one of its most vulnerable groups: the tens of thousands of homeless individuals living in Los Angeles.
Despite the particularly precarious conditions the unhoused have faced during the pandemic, the county is still working to figure out its plan to vaccinate the wider homeless population, in part due to limited vaccine quantities and shifting priorities at the state level. Initially, state’s rollout plan included vulnerable people such as inmates and homeless people staying in shelters as part of the second tier of Phase 1B. That prioritization was scrapped after Governor Gavin Newsom revised vaccine phases on January 25. According to guidelines laid out by the California Department of Public Health, the current tier does not include homeless individuals. As a result, local officials have had to rework their plans.
Currently, Los Angeles County is following guidance from the state, which is in part laying out priorities based on vaccine availability, according to John Connolly, chief strategist for the L.A. County Department of Public Health. He says that the department has, in fact, heard from advocates and stakeholders urging the county to prioritize the unhoused.
“We understand the tremendous vulnerability of those experiencing homelessness,” Connolly says. “Because we have such tremendous scarcity, we are following criteria the state set out. There’s been lots of advocacy from groups who feel they’ve been similarly left behind.”
According to the Los Angeles Homeless Services Authority’s 2020 homeless count (conducted before the pandemic hit), more than 66,000 people in the county were homeless as of that time. Despite fears of a mass outbreak of the coronavirus in encampments, cases were low until November’s catastrophic spike. Now there have been 6,927 cumulative COVID cases and 180 deaths reported among the unhoused.
Until March, vaccines had been open only to people 65 years and older, healthcare workers, and people who live and work in nursing homes. For those who are experiencing homelessness, priority has been given to those who are isolating in shelters, single-room occupancy units, and Project Roomkey hotel and motel sites in L.A. County, in part due to the ease of reaching them. Currently, there are approximately 1,000 people 65 and older living in Skid Row.
Vaccine eligibility expands again on March 15, when people ages 16 and 64 with underlying and chronic medical issues such as heart conditions, cancer, and sickle cell disease, among others, can start getting vaccinated. Connolly adds that as with previous eligibility, vaccinations for unhoused people will likely be centered around Project Roomkey sites and shelters, as many who are in those spaces meet that criteria. Connolly did note that the current vaccination registration system does not have a field for people who sign up to say if they’re homeless or not, so DPH is looking for community partners to help provide data to get a clearer picture.
Concern remains about inequality in the vaccination efforts, both in the deprioritization of homeless people in state guidelines and the emerging disparities in who gets vaccinated in Los Angeles. Data from Los Angeles County shows that wealthier neighborhoods and cities such as Brentwood and Santa Monica have higher vaccination rates than areas such as Bell and South Los Angeles. However, Troy Vaughn, CEO of Skid Row’s Los Angeles Mission, one of the many shelters and missions working with the county on its COVID response, says that there is a strategy—but the main barrier is vaccine supply, not a lack of willingness to help.
As for the rest of Los Angeles’ homeless population, the county does not yet have a full time table for when they’ll be eligible. Officials and service providers are hopeful that the Johnson & Johnson vaccine, which just received emergency use authorization, will be able to boost supply and vaccination efforts. The vaccine is 66 percent effective against moderate to severe COVID-19 cases, lower than the already authorized Pfizer and Moderna vaccines, but the benefit is that it doesn’t require extreme refrigeration like the others and is a one-and-done shot. On January 27, Public Health Director Dr. Barbara Ferrer, speaking to the Los Angeles City Council, acknowledged the difficulty that some on the streets can have in returning for a second vaccine dose. She said that the single-dose vaccine could “work well in some sites.” Vaughn echoed that, saying it could be a “game changer.” However, DPH officials said they do not plan to vaccinate unhoused people with a specific vaccine, and will use what’s available based on supply.
Essential staff, including healthcare workers at Skid Row missions and shelters, have also been vaccinated as part of earlier phases.
Over the last month, the county has been working on some pilot programs to reach older homeless people and to see how successful rollout of two-dose vaccines is for people not in fixed locations. During the first week of February, the county started vaccinations of unhoused people 65 years and older through community partners, including NoHo Home Alliance, which vaccinated 30 people at St. Matthew’s Lutheran Church in North Hollywood. The group is set to give the second dose on Wednesday, March 3, according to Reverend Stephanie Jaeger, executive director of NoHoHome Alliance, a nonprofit that provides services in the east San Fernando Valley. Jaeger says that since many of those who get aid from the nonprofit don’t have cell phones, they’ve been working on messaging to get people back for second doses.
“Because so many of them do cycle through our program and come and get resources, we have signs up, and we cross our fingers,” she explains.
Jaeger adds that the data from the pilot program, specifically the number of people who return for the second dose, is likely to inform how vaccine rollout goes for those living outdoors.
One other remaining challenge in vaccinating the homeless is trust. Jaeger says that because her organization has been actively working for years to build trust within the local community, it’s been easier to communicate about vaccines. She acknowledges some hesitation from unhoused people she’s talked to, but an equal amount of eagerness. Officials and service providers acknowledge the challenge of making sure homeless Angelenos can trust the vaccines, and Vaughn says messaging should be demonstrative, particularly in communities of color.
On Friday, February 26, state officials said that California is on pace to vaccinate 3 million people a week, and aims to get to 4 million per week by the end of April.