CURRENT/EMERGING ISSUES & STRATEGIES FOR SUCCESS

1. Scrambling to use vials of vaccine that are set to expire, and experiencing guilt for the waste because many countries still don’t have adequate access to them.
2. Offering vaccine incentives that require an address, phone number, and/or email address presents an equity issue for those who do not have these resources.
3. Communicating eligibility and availability of new booster doses is confusing and time-consuming.
4. Navigating the specific qualifications for booster doses requires staff to assess each patient for eligibility, which is more time-consuming than just offering it to all people experiencing homelessness.
5. The increasing number of congregate settings as day shelters reopen to serving the community presents new concerns around disease spread.
6. Anticipating the effect of impending vaccine mandate deadlines on morale and service provision as staff consider leaving.
7. Ensuring safety of staff who enforce COVID-19 protective measure (symptom screening, mask requirements, etc.) is requiring more resources, such as extra security personnel and higher numbers of incident reports.
8. Responding to testing and vaccination requests as other partners (such as public health authorities) scale back is becoming increasingly difficult and often not possible.
9. Running out of steam to provide the full scope of work that is needed: flu vaccines, COVID-19 vaccines, boosters, education, primary care, and other services as usual, etc.
10. Increasing vulnerability and medical need of patients discharged to shelters due to hospitals being at capacity and needing to discharge patients they previously would have tried to keep.
    

1. Collaborate with influential partners, such as hospitals and homeless service leaders, to advocate with city and state officials for expanded Isolation & Quarantine facilities.
2. Make vaccines available throughout clinics and across sites and consider any wasted doses to be “investment doses” in the people who were vaccinated (regardless of waste).
3. Use eager new medical students to provide education on flu and COVID-19 to ease the burden on staff.
4. Utilize protective action hotels as part of winter shelter planning to ensure they remain open throughout the winter season.
5. Increase security personnel to help staff feel safe during this time of elevated tension in our communities.
6. Provide monoclonal antibody treatments at medical respite and/or I&Q sites.
7. Have staff serve as points-of-contact so clients who do not have phones, addresses, or email can still be eligible for any vaccine incentives that may require them.
8. Invest in staff by having 1:1 conversations with those who have not yet been vaccinated to discuss the mandate, illustrate why it’s important, hear their concerns, and engage in motivational interviewing.
9. Offer flu vaccines within routine care if you do not have the capacity to offer additional flu clinics.
10. Conduct outreach to unvaccinated clients and provide any needed information to help boost confidence in getting the jab.
    

POLICY DEVELOPMENTS

• Vaccine boosters: The CDC recommends use of Pfizer-BioNTech COVID-19 booster doses for: 
  
  • Adults 65 years and older
  • Adults 18+ with underlying medical conditions
  • Adults 18+ who work or live in high-risk settings, including homeless shelters
    
• Money!: HHS awarded nearly $1 billion to almost 1,300 HRSA funded health centers across the country and territories for construction and capital improvements. These funds are designed to expand access and enhance pandemic response.
• Vaccines for younger children: Pfizer took the next step in seeking authorization for approval of their vaccine for children ages 5-11 by submitting data to the FDA. The data shows their two-dose vaccine produced a robust antibody response and they are expected to seek emergency-use authorization in the coming weeks.
• Vaccines for pregnant people: The CDC issued an urgent health advisory to increase vaccination rates among those who are pregnant, lactating, or may become pregnant to prevent serious health outcomes.
  

NEW RESOURCES

• CDC MMWR: Use of Pfizer-BioNTech COVID-19 Vaccine in Persons Aged ≥16 Years: Recommendations of the Advisory Committee on Immunization Practices – United States, September 2021
• CDC MMWR: Outbreak of SARS-CoV-2 B.1.617.2 (Delta) Variant Infections Among Incarcerated Persons in a Federal Prison – Texas, July-August, 2021
• CDC MMWR: Comparative Effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson & Johnson) Vaccines in Preventing COVID-19 Hospitalizations Among Adults Without Immunocompromising Conditions – United States, March-August 2021
• CDC MMWR: Safety Monitoring of an Additional Dose of COVID-19 Vaccine – United States, August 12-September 19, 2021
• CDC MMWR: Pediatric COVID-19 Cases in Counties With and Without School Mask Requirements – United States, July 1-September 4, 2021
• CDC MMWR: Disparities in COVID-19 Vaccination Status, Intent, and Perceived Access for Noninstitutionalized Adults, by Disability Status – National Immunization Survey Adult COVID Module, United States, May 30-June 26, 2021
• CDC: COVID-19 Vaccination Field Guide: 12 Strategies for Your Community
• HHS: COVID-19 Monoclonal Antibody Therapeutics Frequently Asked Questions
• HUD: Re-Housing Individuals Experiencing Homelessness from COVID-Specific Non-Congregate Shelter Webinar
• HRSA: COVID-19 Vaccine Booster Planning Checklist
  

WHAT WE'RE READING

• The Modesto Bee: Stanislaus County Doesn’t Track Homeless Death Causes. Is Knowing the Data Helpful?
• Mass Live: Doctors, Advocates Press Massachusetts Legislature for Safe Drug Consumption Sites ‘Empirically Proven to Save Lives’
• Direct Relief: How the Pandemic Has Hurt the Health of People Experiencing Homelessness
  

• KHN: COVID Is Killing Rural Americans at Twice the Rate of Urbanites
• STAT: Johnson & Johnson Says Additional Dose Boosts COVID Vaccine Efficacy
• The Conversation: Half of Unvaccinated Workers Say They’d Rather Quit Than Get a Shot – But Real-World Data Suggests Few Are Following Through