As the government moves into the next phase of vaccinations, there have been changes to vaccine eligibility. Who should be prioritised for the vaccine and how best to increase the uptake has been a hot topic of debate for months as the vaccine rollout progresses.
When January saw an explosion of cases among London’s homeless, it was clear there needed to be an addition to the vaccination scheme.
Matt Hancock confirmed that ‘local teams will be given flexibility to vaccinate all homeless people and rough sleepers alongside cohort 6.’
People experiencing homelessness may fall into the cohort 6 category anyway and this blanket offer of the vaccine is key in ensuring no one is missed.
‘Homelessness and health are inextricably linked and must be addressed together – starting with prioritising access to the Coronavirus vaccine’
Health inequalities along class lines are precisely why this addition to the vaccination scheme was needed. Lack of regular access to healthcare means that homeless people may have undiagnosed underlying conditions that put them at higher risk of death from COVID-19.
The reason the homeless population is being vaccinated along with cohort 6 is that their health conditions may not be accurately reflected in GP records. As their records may be incomplete and underlying conditions undiagnosed, it is much safer to assume they are highly vulnerable than risk missing anyone out.
Without space to safely isolate from others homeless people are also at greater risk of catching the virus. The usual short term shelter options are also difficult to make COVID secure, with hostels having to adapt to safety measures which in turn has impacts on capacity.
The Joint Committee on Vaccination and Immunisation (JCVI) advises that the vaccine should be offered without requiring a GP registration or an NHS number. The need for an NHS number ‘systematically excludes a vulnerable group of the population’ (JCVI).
Though this could be a great opportunity to register people with GPs and update their records, registrations tend to require proof of address – a barrier to entry for those who don’t have a permanent address.
Perhaps then this is an opportunity to address this barrier by registering homeless people with healthcare providers without the need of a fixed address.
It’s possible that homeless people may be given their two doses closer together than the typical 12 weeks. With irregular access to services there are concerns that people may not return for their second doses after such a long wait.
The Everybody In scheme has seen 37,000 people housed by local authorities in England. The scheme sought to prevent them facing the pandemic on the streets, according to Homelessness Minister Luke Hall. This figure includes those who were sleeping rough and those who were at risk of rough sleeping due to the pandemic.
‘The ‘Everyone In’ initiative saw a multi-agency, multi-faceted, multi-skilled emergency response and prompted partnership working between central and local government, health and housing, homelessness charities and housing associations on a scale never seen before, in towns and cities across the country.’ (St Mungo’s )
The scheme presents a ‘unique opportunity’ to begin the program of vaccinating the homeless population as it alleviates some of the challenges of contacting eligible people. The scheme has shown that ending rough sleeping is possible, with a 37% drop in people sleeping on the streets. This data has been met with mixed responses; it is an impressive feat, but it should not have taken a pandemic for the issue to be tackled.
The blanket ruling of all homeless people being eligible makes the logistics of the vaccine rollout slightly easier but it still faces huge challenges. People with fixed addresses are being contacted by mail to invite them for vaccine appointments, but this is much harder to arrange when people do not have consistent points of contact. It is reliant on people attending vaccine clinics themselves and on the work of outreach workers.
The rollout is being organised on a local level with individual councils and authorities making decisions on how best to deliver these vaccines. This flexibility is a bit of a double edged sword – on the one hand it allows for the process to be adapted to the needs of the homeless people in each area. On the other hand, the lack of uniformity creates challenges for people who may move between authorities – another reason to have a smaller gap between doses.
Vaccine uptake concerns
101 guests at Glass Door Homeless Charity’s London hostels were recently offered the vaccine. Glass Door needed to secure a space for this to take place and also had other concerns. Many of their guests generally have a high distrust of institutions, meaning that extra care had to be taken to ensure uptake would be as high as possible. Misinformation needed to be countered and conspiracy theories set aside. They found that a sense of community responsibility was what motivated even some skeptics to have the vaccine.
This vaccine rollout also presents an opportunity for those experiencing homelessness to positively connect with outreach programs. St Mungo’s said that during the pandemic people ‘who have never engaged with [them], have finally taken up offers of [their] help.’ Hopefully this can lead to longer lasting connections with services like these that will continue to have benefits beyond these vaccinations.
The government aims to vaccinate England’s homeless population alongside cohort 6. The Everybody In scheme will aid in the efficiency of this vaccine rollout and charities such as St Mungo’s, The Big Issue, and Glass Door Homeless Charity will continue to support the people receiving it.
Time to prepare for having the vaccine is key in increasing uptake, as well as receiving the types of support offered by the above charities. Tackling health inequalities is a big step towards improving the lives of those experiencing homelessness.
About the Author: Leo Hynett
Leo Hynett is a contributing Features Writer, with a particular interest in Culture, the Arts and LGBTQ+ Politics.
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