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COVID-19 Vaccination for People Experiencing Homelessness: Frequently Asked Questions

COVID-19 Vaccination for People Experiencing Homelessness: Frequently Asked Questions

The following are frequently asked questions about COVID-19 vaccination among people experiencing homelessness. For general information about COVID-19 vaccine, please see the CDC COVID-19 Vaccine Information page. For information on COVID-19 vaccination implementation for people experiencing homelessness, see the CDC Interim Guidance for Health Departments.

Information about COVID-19 vaccines is rapidly evolving. Please check back regularly for updated information.

Summary of Recent Changes

Updates as of March 22, 2021

  • Updated information about the types of COVID-19 vaccines recommended for people experiencing homelessness
  • Updated information on ensuring follow-up for vaccines that require two doses

View Previous Updates

The goal is for everyone, including people experiencing homelessness, to be able to easily get a COVID-19 vaccine as soon as possible. The Advisory Committee on Immunization Practices (ACIP) recommends that, when supplies of COVID-19 vaccine are limited, vaccination should be offered in a phased approach. Homeless shelter staff members are considered essential workers and should be offered vaccine in Phase 1c. ACIP also recognizes that increased rates of transmission have been observed in congregate living settings, including homeless shelters. Based on local, state, or territorial epidemiologic and implementation considerations, jurisdictions may choose to vaccinate people who reside at congregate living facilities at the same time as the frontline staff because of their shared increased risk of disease. People experiencing homelessness might have additional characteristics, such as older age and employment in certain jobs, that might also influence when the vaccine will be available to them. Ultimately, state and local health departments determine the prioritization phases. Public health professionals are working on how to distribute COVID-19 vaccines in a fair, ethical, and transparent way, including considerations for people experiencing homelessness.

No. There is no preferred vaccine for people experiencing homelessness. There are currently three different COVID-19 vaccines that have been authorized and recommended in the United States. The available vaccines have differences in how they were developed, the ingredients they contain, and how easily they are administered. More information on each of the vaccines can be found here. It is difficult to compare the three vaccines because of differences in how the initial vaccine studies were conducted (such as different geographic locations, circulating variants of the virus that causes COVID-19, community transmission levels, measurements of vaccine effectiveness and side effects). We will learn more about the vaccines as more studies are conducted.

While COVID-19 vaccine supplies are limited, many people who are eligible will only have one vaccine option available to them. Fortunately, all of the currently authorized COVID-19 vaccines are safe and effective at preventing illness from COVID-19. For the earliest protection from COVID-19, the best vaccine is the first one available.

People who are experiencing homelessness may have difficulty accessing medical services in traditional settings, such as a clinic or pharmacy. Therefore, state and local vaccine distribution plans should include strategies to bring vaccines to people experiencing homelessness, including homeless service sites like shelters, day programs, or food service locations. The COVID-19 vaccination program implementation plans should also include strategies to offer vaccination in areas frequented by people experiencing unsheltered homelessness. These areas could include encampments or other known locations where people experiencing unsheltered homelessness spend time.

Creating a communication plan to reach people experiencing homelessness will be critical to successfully distributing the vaccine in this population. Use multiple communication strategies such as:

  • flyers at encampments, in shelters, and on public transportation;
  • announcements at healthcare and other service programs; or
  • messages via email, text messaging, social media, television, and radio.

Advertise in advance of vaccination events for people experiencing homelessness. Connect with trusted communicators, such as people with lived experience of homelessness, who can provide vaccination education and information to people experiencing homelessness. Engage these people in planning and implementation of vaccination events. For resources on creating a communication plan, see COVID-19 vaccination communication toolkits for different audiences.

Homeless services are critical and have continued during the pandemic. Homeless service staff and outreach teams have frequent close contact with coworkers and clients, which puts them at risk of getting and spreading the virus that causes COVID-19. Therefore, CDC recommends every person, including homeless service staff members, get vaccinated when it is available to them. Furthermore, because homeless shelter staff members are considered essential workers pdf icon[810 KB, 19 Pages]external icon, they might have the opportunity to be vaccinated earlier than the general population.

Scheduling vaccination appointments in advance can be helpful to improve vaccination clinic efficiency, plan for the appropriate number of vaccine doses, and reduce crowding at a vaccination provider site. However, it might not be possible to obtain a list of client names in advance of a vaccination event at a homeless service site (e.g., during a meal service event). Coordinators should plan for how to provide vaccine to individuals at these events who do not have appointments and also have contingency plans in place for using any remaining vaccine doses. One option for how to use remaining vaccine doses is to coordinate with nearby community organizations or other priority populations.

Recording whether people experiencing homelessness received a COVID-19 vaccine will be important for two reasons. First, it will be necessary for the person vaccinated to keep a record of their vaccination status and when they need to follow up for a second dose. Second, it will be important for vaccination programs to record housing status to estimate coverage among people experiencing homelessness. All COVID-19 vaccination providers are required to report vaccine administration data to the jurisdiction’s immunization information system (IIS) or other identified program. The address field can be used to provide information about homelessness status. Vaccine providers are also required to provide vaccine recipients with a vaccination record card. It might also be possible to include COVID-19 vaccination status in Homeless Management Information Systemsexternal icon. Finally, vaccination coverage data from vaccination campaign events at homeless service sites can be entered into the CDC and National Health Care for the Homeless dashboardexternal icon for inclusion in an aggregated dashboard.

Vaccination providers participating in the COVID-19 Vaccination Program are required to report specific vaccine administration information in a timely manner. Required information on vaccine recipients includes vaccine recipient name, date of birth, sex, and address. The address field can be used to provide information about homelessness status. Race and ethnicity are also reportable data elements. These data help to improve our understanding of the impact of COVID-19 on racial and ethnic minority populations.

It is important to recognize that some people experiencing homelessness might have difficulty providing certain documentation and may have concerns about data privacy. Ensure that providing documentation is not a barrier to vaccinating people experiencing homelessness by requiring only the minimum data fields for vaccination. Use open and transparent communication to explain what data are collected, how the data are used, who they are shared with, and how they are protected.

Some people experiencing homelessness might have difficulty returning at the recommended interval to get their second dose of 2-dose COVID-19 vaccine series. Vaccines that require a single dose are one option for people experiencing homelessness. However, with strong partnerships and close coordination, COVID-19 vaccines that require multiple doses can be a feasible option.

When a COVID-19 vaccine requiring multiple doses is given, public health workers, healthcare workers, and homeless service staff should work together and consider the following strategies to support follow-up:

  • Record up-to-date contact information, including back-up contact information or an alternate contact (with permission).
  • Ensure vaccine documentation (product, dose, location, date) is available to vaccine providers across sites and geographic areas.
  • Provide multiple, easy-to-access opportunities to get a COVID-19 vaccine.
  • Integrate reminders into routine interactions.
  • Conduct outreach to connect with individuals who might otherwise be lost to follow-up.

For second-dose reminders, consider innovative strategies such as prepaid phone cards, scheduled text message reminders, waterproof wallets to hold vaccination cards, or second-dose incentives (such as meals, hygiene kits, or gift cards).

Using multiple record-keeping systems (e.g., vaccination record cards, immunization information systems, electronic medical records, Homeless Management Information Systemsexternal icon) will help to ensure that vaccinations are recorded accurately and that people who receive vaccines that require multiple doses will receive the correct vaccine at the correct time. If a person arrives for a subsequent dose of COVID-19 vaccine and does not have their vaccination record card, review the immunization information system and other record-keeping systems for documentation. COVID-19 vaccines are not meant to be interchangeable. Every effort should be made to determine which vaccine product was received as the first dose in order to ensure successful completion of the vaccination series.

In exceptional situations in which the vaccine product given for the first dose cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series. For more information about the interchangeability of vaccine products, see Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States.

Organizations or healthcare providers who have agreed to participate in the COVID-19 Vaccination Program and signed the COVID-19 Vaccination Healthcare Provider Agreement will receive COVID-19 vaccines for their constituencies. Therefore, it may be possible for medical personnel at homeless service sites to administer COVID-19 vaccine through this program. Non-medical staff, such as community health workers and shelter staff, may be helpful in providing support services during vaccination events. Homeless service administrators should coordinate closely with their localexternal icon and state health departments to provide vaccination for their clients and staff.

Vaccination is an important tool to control the COVID-19 pandemic. However, because homeless services are critical to survival and well-being, service providers should take all steps possible to ensure that providing vaccination does not create a barrier to entry into homeless service sites. Building relationships and providing consistent, transparent information will be important to ensuring that clients feel comfortable receiving the COVID-19 vaccine.

People experiencing homelessness may have a history of traumatic or negative experiences with medical services. To improve vaccine confidence, work with staff members and community navigators who have trusted relationships with the clients you serve. Hosting information sessions before vaccination events can be helpful to address vaccination questions from clients and staff. Additionally, make sure vaccination providers hold multiple vaccination events to allow clients time to consider receiving the vaccine. Provide clear, consistent, and transparent vaccine information, including vaccination protocols, to staff, community organizers, and people experiencing homelessness. Provide opportunities for staff and people experiencing homelessness to share their vaccination experiences with each other to allow for a trusted exchange of information within their social support network.

Refer to the Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States for the latest information on coadministration of COVID-19 vaccines with other vaccines.

Homeless service providers should continue encouraging all precautions, including wearing a well-fitting mask that covers your mouth and nose when around others, staying at least 6 feet away from others, avoiding crowds, avoiding poorly ventilated spaces, and washing your hands often. Continue to follow the prevention recommendations for homeless service providers, including the provision of overflow sites to allow for decompression, and recommendations related to unsheltered homelessness. Additionally, reducing crowded living conditions can decrease the risk of other respiratory and skin conditions. To help with long-term decompression strategies, public health jurisdictions and homeless service providers should work with local partners to continue connecting people experiencing homelessness to permanent housing.

Not enough information is currently available to say if or when CDC will stop recommending that people wear masks and avoid close contact with others to help prevent the spread of the virus that causes COVID-19. We also do not yet know whether getting a COVID-19 vaccine will prevent you from spreading the virus to other people, even if you don’t get sick yourself. Experts are working to understand whether new variants of the virus that causes COVID-19 change the effectiveness of COVID-19 vaccines. While experts learn more about how COVID-19 vaccines work in real-world conditions, it will be important for everyone to continue using all the tools available to help stop this pandemic.

Previous Updates

As of February 17, 2021

  • Updated information about when COVID-19 vaccine will be available for people experiencing homelessness
  • Updated information about the continued use of COVID-19 protection measures
  • Additional questions about communication strategies, vaccination appointments, data and documentation, and hepatitis A vaccine coadministration