No longer shackled by the state's vaccine priority plan, health authorities in Denver have set out to vaccinate the city's homeless population, doling out thousands of doses across its shelters and encampments.
Advocates and experts said it's believed that there are roughly 6,000 people in Denver who are homeless or partially housed. Of that total, more than 3,000 — and possibly as many as 3,500 — have been vaccinated via a collaboration among Denver's health agencies, the Colorado Coalition for the Homeless and state efforts. Much of the push has taken place in Denver's shelters, as well as the coalition's clinic on Stout Street, officials for the city and coalition said this week.
The effort was initially stalled by Gov. Jared Polis and the state Department of Public Health and Environment's decision not to allow Denver officials to begin vaccinating all people in shelters until the entire population was eligible. Pressed about that decision, Polis said previously that the unhoused face no higher risk than their housed neighbors and that the true risks are based on age.
But data released by Denver homeless advocates and health officials contradicts that claim. Jenny Hill of the Denver Department of Public Health and Environment, said that people in shelters were more than three times as likely to be hospitalized as their housed peers.
Indeed, shortly after the city was told that it would have to wait, an outbreak emerged in one of Denver's shelters, affecting roughly 50 people. That prompted the state to let vaccine flood that site, which Hill asked not be named to avoid stigmatizing it.
The wait and logistics required to stay in line with the state's plan were onerous and frustrating, those involved said.
"We offered the first round of vaccines just to people who met the (then-current) criteria," Denver Health's Sarah Rowan said. "That was really hard because so few people met it. A lot were interested, a lot were turned away."
That refusal, even if given begrudgingly, has effects on a population that may already distrust the government, Hill said.
"When we have the opportunity to go into a shelter and we have a population that are ready to vaccinate, we shouldn’t say no," she said. "It’s not trauma-informed" to turn people away.
Those involved in the effort said it's been successful thus far but that it will be "a slow and steady effort, not a massive, 1,000-people-at-once experience," as Rowan put it.
Before general eligibility opened up earlier this month, officials developed and, with the help of volunteers, launched a survey to gauge interest in the vaccine among Denver's unhoused population. They found that 70% to 75% were interested in receiving a vaccine, enough to reach herd immunity in that group.
Now, as shelters have been allowed into the eligibility pool, Denver health officials have focused on their constellation of shelters. People staying and working there were at higher risk than those living on the street or in other housing settings, as they are in close quarters with others.
The Colorado Coalition for the Homeless has pushed vaccine at its clinic, and anyone who has an appointment there can get a dose, said Cathy Alderman, spokeswoman and public policy chief for the group.
The coalition also works closely with the city's joint homeless task force and its health agencies. The coalition can let its patients know when clinics will be set up in shelters, and it can help build trust that the vaccine — and the people providing it in shelters — is safe.
"In the shelters, there's a little more resistance to the vaccine, but I think it’s getting much better," Alderman said. "Obviously, seeing people getting vaccinated, seeing people in shelter you see regularly, gives you comfort. We provide as much info as possible when we're in the shelters."
The efforts to improve confidence among those in shelters echoes what officials have preached about reaching minority communities: using trusted faces and messengers. In the shelters, that's taken the shape of peer navigators, people who've been homeless and can speak through that experience.
There had been concern that the loss of the Johnson & Johnson vaccine, which was on pause until Friday after a tiny fraction of recipients developed rare blood clots, would affect the effort. The Johnson & Johnson jab is one dose, which makes it easier to ensure a person — homeless or otherwise — is done and won't have to reschedule.
But those involved in Denver's push say that while the Johnson & Johnson pause has been a challenge, and Rowan said getting some to come back for a second dose has been difficult, the pause hasn't really impeded efforts.
"That certainly made it easier," Rowan said. "It made it a little bit of a setback. I don't think that any vaccine events were canceled because of the Johnson & Johnson setback, the pause. All of the teams had enough Moderna vaccine to just pivot to use that instead."
While the focus has been on shelters, there's been some conversation about moving more into encampments and closer to the streets. In one clinic for those living in safe, established encampments, 32 people were vaccinated a couple of weeks ago in one clinic, said Cole Chandler, the executive director of the Village Collaborative.
He said he'd like to do more, but there are fewer people in less-established encampment sites, which may limit the impact. Plus, others said, the logistics are harder, and much would depend on the weather. Still, it appears to be part of the next phase in administration.
"I do think it’s really critical that site-based is part of the strategy, especially in these settings where people are gathered together," Chandler said. "But it’s a lot easier to do it when it comes to you and when your peers get vaccinated at the same time."
Hill, of Denver's health and environment agency, said she believed that the mobilization of advocates and city officials would last beyond the pandemic and that Denver's response to homelessness in general would advance and endure.
"People experiencing homelessness are people," she said. "They’re human beings. They’re going through a very difficult time in their lives, and it doesn’t define who they are as people. They are at greater risk from complications of COVID. I think we should really see them as the human beings they are and just really circle them with the best services possible."