Efforts to vaccinate the roughly 1,000 people in Montana experiencing homelessness against COVID-19 have been ramping up since the state opened up eligibility earlier this month. The recent pause on use of the Johnson & Johnson vaccine has complicated those efforts.
At Kalispell's Flathead Warming Center, a local community health center nurse is ready to administer COVID-19 vaccines to anyone willing to take one. Kevin Dieudonnem, sitting on one of the center's several cots, said he quickly jumped at the opportunity. He has been concerned about COVID.
"You know, I haven’t had it or even been exposed to it, but I don’t want to be either," Dieudonnem said.
It has been hard for him to follow the latest eligibility requirements throughout the pandemic — or even book an appointment without phone or internet access.
"I was in North Dakota for a while and recently came here within the last couple of months — it’s been hard everywhere to get [the vaccine]," Dieudonnem explained.
Flathead Community Health Center CEO Mary Sterhan says it’s important to vaccinate homeless populations. They are frequently in communal situations such as shelters and also frequent gas stations, grocery stores and other places with a lot of close contact with other people.
"They are also at greater risk because they frequently have more health issues in general, less ability to care for themselves, less access to the things that we’re using to protect ourselves — like washing our hands and those kinds of things," Sterhan said.
The health center's visit to the warming center resulted in just a few vaccinations but Sterhan said it was mainly a trust-building mission. So far, the center has vaccinated about one-fourth of the nearly 170 homeless patients they treated in 2020.
Sterhan added that partnerships with the warming center and other shelters will be key to gaining trust of those who’ve had bad experiences with the medical system.
"It’s really just that sort of repetitive presence, where really the Samaritan House staff and warming center staff— as they get to know people, they probably are as at least as effective for us as our staff coming in for an occasional clinic," she explained.
Flathead County is not alone in its approach. According to Jody White with the Montana Primary Care Association, county health departments across the state are reaching out to Montana's 19 federally-qualified urban Indian and community health centers — centers that have historical expertise in treating hard-to-reach populations.
"Especially those who might have transportation issues, be in really rural areas, not have access to phones or computers to register for these large vaccine events," White explained. "So centers are really looking and responding to those needs in their communities, and again at various levels."
Health centers had been relying on the one-dose Johnson & Johnson vaccine to catch the highly transient homeless population, White said. Federal health officials recommended a pause in the shot’s use last week because of a potential link to rare blood clot cases in a handful of women.
Health centers are now using the two-dose Pfizer and Moderna vaccines for those experiencing homelessness. Because some of those vaccinated might not be in the area in two to three weeks, White said the health centers are working on ways to get the second dose into arms.
"The state is actually really encouraging all of the different counties, jurisdictions, to be open to doing second doses for those who maybe they didn’t do a first dose for."
She said state health officials have offered guidance to providers administering COVID vaccines: to give second shots to people, even if it’s long after the recommended three-to-four-week gap. While White acknowledged there will be some people who never return for their second vaccine, she said providing some immunity through one shot is better than none.
Abby Berow, director of clinical operations at Partnership Health Center in Missoula, agrees, but said it would be nice for the Johnson & Johnson shot to return if possible. It has been a big help in vaccinating roughly 300 homeless people in the county.
"So we’re hopeful that here in the coming days, that we’ll get some additional guidance on the Johnson & Johnson vaccine and seeing if that’s a feasible alternative for us to resume administering— again, based on the CDC investigations," Berow said.
Dr. Anthony Fauci, chief medical advisor to President Joe Biden, said over the weekend that the federal Centers for Disease Control and Prevention could provide updated guidance on the J&J vaccine by Friday.
With summer approaching, Berow and others say it is important that the efforts to vaccinate the homeless population continue no matter what those recommendations are: Homeless populations will become even harder to reach as individuals disperse in the warmer summer months.
Correction: A previous version of this story misspelled Abby Berow’s last name.