CURRENT/EMERGING ISSUES & STRATEGIES FOR SUCCESS

1. Determining what dose and how much a person should get is becoming more complicated.
2. Scrambling to identify the dosage needed when it is unclear whether a patient needs a full third dose of primary series for immuno-compromised, or a half booster dose.
3. Wasting large numbers of doses in Moderna vials since booster is a half-dose but the vials are the same volume and only allow a certain number of punctures.
4. Offering incentives for primary series only may cause a decrease in uptake for booster doses.
5. Waning interest in vaccination in general has caused low uptake on initial booster efforts.
6. Meeting demand for shelter staff to be vaccinated when health care staff are stretched thin, and vaccines are widely available at other locations.
7. Growing frustration with inability to determine vaccination rate among people experiencing homelessness because data systems do not talk to one another and/or agencies are not communicating.
8. Addressing the disparity in vaccination rates between the general public and people experiencing homelessness has been slow and is rooted in traditional barriers to care.
9. Navigating vaccine mandates without the details of federal guidance is causing anxiety and confusion.
10. Expanding telehealth may create the expectation of always being available, but there has not been a staffing increase to meet this demand.

1. Offer a single type of vaccine now that mix-and-match has been authorized to lessen administrative burden.
2. Provide booster doses to anyone who is unstably housed, regardless of their formal eligibility, because of their larger risk factors.
3. Consider lower incentive value for booster doses, but continue to offer them when possible.
4. Color code vaccines according to type: primary series, booster, and flu vaccine, to minimize chance of error.
5. Make another push for onsite vaccine events at shelters now that boosters are widely available.
6. Engage shelter staff to promote booster doses prior to vaccine events or on-site clinics by posting flyers and talking up the benefits of a third dose.
7. Prioritize vaccines for shelter residents and include shelter staff when possible; you may be the only person they will accept it from.
8. When trying to determine vaccination rate, calculate the denominator by identifying how many unique patients have been seen at the health center since the date vaccines were first offered.
9. To maximize the impact on clinical staff, offer COVID booster and flu vaccines simultaneously.
10. Give full third dose for those who are immunocompromised, regardless of how long it has been since the second dose. 
    

POLICY DEVELOPMENTS

• Vaccine Updates -- Boosters and Mix-and-Match: The FDA authorized and the CDC endorsed Moderna booster shots to be administered six months after the second dose for people 65+ and those 18-64 at high risk of severe COVID or with high exposure rates through employment or congregate living arrangements. Anyone 18+ who received a Johnson & Johnson/Janssen vaccine is eligible for a booster dose two months after the initial dose. Both organizations also authorized the use of a mix-and-match booster dose after the completion of the primary series.
• Behavioral Health Conditions Linked to Increased Likelihood of Severe COVID: The CDC updated their list of underlying medical conditions that are associated with a higher risk for severe COVID to include mood disorders and schizophrenia spectrum disorders. Individuals with any conditions listed on this list are eligible to receive the Pfizer or Moderna booster shot. Anyone who received a Johnson & Johnson/Janssen vaccine should receive an additional dose two months after their initial dose.
• Expanding Youth Eligibility: The FDA expanded Emergency Use Authorization for the use of a 10-microgram dose (1/5 that of an adult dose) of the Pfizer/BioNTech COVID-19 vaccine for youth ages 5-11. The CDC will make a final decision as early as this week.
  

NEW RESOURCES

• The White House: FACT SHEET: Biden Administration Announces Update on Operational Planning for COVID-19 Vaccinations for Kids Ages 5-11
• CDC MMWR: COVID-19 Vaccination and Non-COVID-19 Mortality Risk – Seven Integrated Health Care Organizations, United States, December 14, 2020-July 31, 2021
• CDC: Who Is Eligible for a COVID-19 Vaccine Booster Shot?
• CDC: COVID-19 Vaccination for Children 5-11 Years Old
• HRSA: COVID-19 Vaccine Booster Planning Checklist
• KFF: Vaccinating Children Ages 5-11: Policy Considerations for COVID-19 Vaccine Rollout
• Bloomberg Law: Can I Get a COVID-19 Booster Shot? Here’s How to Decide
• University of Minnesota: Conversation Guide: Breakthrough Infections
• Manatt: Incentives for COVID-19 Vaccination: Regulatory Considerations and Potential Federal Funding
  

RESEARCH

• Health Affairs: Making COVID-19 Screening Part of Routine Symptom Monitoring
  

WHAT WE'RE READING

• WMAR: Feds Offer Assistance to Help Prevent Drug Overdoses

• Sun Journal: Boston Declares Addiction, Homelessness Emergency
• Lookout Santa Cruz: What Sways Homeless People to Get COVID-19 Shots? It Could Be Other Homeless People
• STAT: Politics Is Derailing a Crucial Debate Over the Immunity You Get From Recovering From COVID-19
• STAT: Half Doses, Third Doses, Kids’ Doses: COVID Vaccine Delivery Goes Next-Level Difficult
• CBS News: Pfizer Says Its Vaccine Booster Restores Full Protection Against COVID-19