Important Vaccines for Homeless Persons
COVID-19, boosters, the “new” booster, MPOX (article updated 12/28/22)
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HOMELESS IN CHICAGO
Those who help the homeless in Chicago can do a great service to humanity by not only helping them understand the vaccines but also by helping them locate those resources. Vaccines are available in many places, but some homeless need to be convinced to seek help and to follow through with their appointments.
Lots is happening—from the streets to the White House and from the CDC to the clinics. The need for vaccination of the homeless is increasing.
The homeless make up a huge population in distress in this inhospitable city of windy nights. We know there are 10,000 homeless families here and there are 80,000 individuals, mostly men, wandering the streets, doubled-up indoors, or hunkered down in some other location—shelters, streets, dumpsters, and other places not intended for hunkering down (https://s6624.pcdn.co/wp-content/uploads/2018/07/2018-Fact-Sheet.pdf).
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THREE STEPS FORWARD
Lost in the literature is the fact that at the beginning of the vaccination processes for COVID-19 the homeless were pushed out of clinics and other vaccine providers because there were not considered “priority” patients for treatment.
Other advocates—myself included—pressured individual providers to make vaccines available to the unhoused, explaining that they were at a huge risk for infection since they were housed with and thrown together with persons without consistent health care, without insurance, and without masks. All of these factors, and the fact that going to a shelter to get vaccinated was a death sentence, were used as arguments to get vaccination for the unhoused.
Homeless people working in schools, and fitting other categories of priorities, slowly started getting access to the vaccine—in some cases with strong letters from their doctors. A small letter-writing group of social workers, students, and their professors helped plead the case.
Slowly but surely, homeless persons were welcomed into the fold of “regular” citizens receiving vaccinations. Many others attended group vaccination events, with permission given to them to use the mailing address of friends or acquaintances with the correct zip code to gain entrance into the location.
Some others became a priority, and they received vaccinations at or through churches and other entities helping the unhoused.
Still other unhoused persons were welcomed into Chicago homeowners and renters’ homes during the campaign to give people $100 gift cards to get their vaccines. The city made it clear it did not matter if “other people present” at a family’s get-tother-for-vaccination parties were related to the family members or not. Many generous and decent persons invited unroofed acquaintances into their fold. Those unroofed folks got their shots alongside a family and later received their gift card at the address where the party had occurred.
Total strangers walked into a home, sat down in the living room, and rolled up their sleeve. They filled out their cards and got jabbed in the arm, elated they would be spared the pandemic’s reach, roaring through the city.
Chalk another one up to the loving, wise, generous, friendly advocates to the homeless. Those helpers are to be commended for their embracing this idea and making it a part of their legacy. “Remember when those homeless people came over and got their vaccination with all of us at grandmas’s house?” — that will be a beautiful memory mentioned someday in the future.
The “invited-homeless-family-member” effort was a Chicago-style success!
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THREE STEPS BACK
The grouping of unhoused persons into the city shelters was a terrible nightmare—and in many cases, in fact, a death sentence.
COVID-19 infection raced through the shelters—grabbing residents and staff members alike. A report from the Cook County Department of Public Health reported on the very high number of staff and homeless who tested positive for COVID-19 at the beginning of the outbreak. 60% of the people in one shelter tested positive for the virus. I have been writing about COVID-19, masks, vaccines, and other public health topics to better inform persons out there—and the people who help them—since the beginning of the pandemic.
Early on, shelter administrators realized the mistake of throwing the unhoused together—already in distress health-wise and at high risk for infection because of being around so very many people on the bus and train not wearing masks. Several shelters, such as Pacific Garden Mission, launched vaccination programs for both staff and residents (More than 2,200 homeless Chicagoans, shelter staff get COVID-19 vaccine (chicagotribune.com)).
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THREE STEPS FORWARD
Because persons without a roof may have no place to keep records of vaccination, they have often felt in danger of not being able to secure additional shots, it has come out in discussions on the street. Many of them did not know they are in luck: Illinois has vaccination records online! Residents need to set up an account and then they can check back on it whenever needed (Vax Verify (illinois.gov)). They must use their email address at various points of the process, so they need one of those too. Unroofed people may access them anywhere they can get at the internet.
This includes churches, community centers, Chicago Public Library locations, and many social service agencies.
Assistance is available at many of the above locations helping the homeless. Many social service agencies can point the unhoused in the right direction—to services they require—kind of a “we don’t do that but XYZ does” sort of arrangement. There are also county and other resources to help from the Cook County officials responsible for assisting (Immunization Resources - Cook County Department of Public Health (cookcountypublichealth.org)).
The City of Chicago has specific pages on their website for information, resources, and locations related to COVID-19 and to vaccination sites. Persons helping the homeless would do well to stay current on the resources by checking such pages daily. News about the new boosters, for example, will be forthcoming (COVID-19 Vaccine Home (chicago.gov)).
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VACCINES AT WORK
A quick reminder of how vaccines work is in order. Once germs start to invade the body, the body produces white blood cells to fight them. What vaccines do is get the body to practice killing a certain virus. This is a quick way to explain what goes on. The Centers for Disease Control (CDC) tells us: “Vaccines can help protect against certain diseases by imitating an infection. This type of imitation infection, helps teach the immune system how to fight off a future infection. Sometimes, after getting a vaccine, the imitation infection can cause minor symptoms, such as fever. Such minor symptoms are normal and should be expected as the body builds immunity” (Understanding How Vaccines Work | CDC).
Essential to tell the homeless, however, is that there is NO live virus in the COVID-19 vaccines.
It is also important to inform them that while the body builds that immunity, the vaccine can wear off over time. That is why boosters are required. This is NOT an uncommon occurrence—many vaccines require boosters. The vaccine that protects young children against meningitis needs two or three shots to be effective. This is true for measles, mumps, and rubella vaccines also (Understanding How Vaccines Work | CDC). Explaining this to people may help them be less hesitant to get the vaccine for the COVID-19 vaccine.
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COVID-19 VACCINES
The vaccines for COVID-19 come in two different arrangements: two initial doses for Pfizer or Moderna or one dose for the Johnson & Johnson variety. This information comes from the Centers for Disease Control (Frequently Asked Questions about COVID-19 Vaccination | CDC).
There may be discomfort, slight fever, or other symptoms such as general dyspepsia for a few days after one or the other shot. This is common and is not to be confused with the disease itself. Unhoused folks—some of whom who may not be accustomed to getting vaccinated often—may think they “have COVID-19 now.” This is a common fear on the streets.
Some unhoused people have been heard saying the vaccine “gives you COVID-19.”
Others have been heard saying the vaccine “has killed a lot of people.”
Telling people YOU yourself have gotten vaccinated—and you are not sick or dead—is just one way to help convince them to do so themselves.
Remind them of the safety of the vaccine, telling them that as of September 12, 2022, 81% of Illinois residents over five years have received one dose, and 73% have received one dose (Vaccine Data (illinois.gov)).
Important to remember that vaccination for COVID-19—and other diseases—is not a brief and easy event always. We are reminded that many people need some time to relax, sleep and generally convalesce after vaccination. For unhoused people this may be very difficult—where can they do this? Vaccination for COVID-19 can be one more difficult treatment—but essential for the unhoused. We need to think about this also: “Individuals experiencing homelessness may also be at higher risk of severe illness and death from COVID-19 due to underlying health conditions, lack of access to health care, and other factors” (https://www.thenightministry.org/blog/covid-continues-to-create-barriers-for-chicago-s-homeless-population).
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ONE COVID-19 BOOSTER? TWO BOOSTERS FOR SENIORS?
The CDC has been recommending that all vaccinated persons received at least one of the booster shots—available already—in addition to the basic shots they have had to fight COVID-19. Seniors were advised to get a second booster.
However, there has been an “upgrade” in the booster world!
Next-generation COVID-19 boosters by Pfizer and Moderna are replacing the original booster formula.
Persons ready for a booster now should be getting the “new” one at this point — not the former boosters.
Good news indeed comes along with this upgrade: “The booster vaccines are modified to better protect vaccinated people against hospitalization and death from newer viral variants. They are bivalent, meaning they can target the original COVID-19 strain as well as Omicron BA.5, the dominant variant in the United States” (What You Need to Know About the Updated COVID-19 Boosters (verywellhealth.com)).
Here is the specific information about availability for adults:
8 to 49 years old: You can receive a dose of the updated booster from either Moderna or Pfizer at least two months after your primary series or your last booster shot.
50 years and older: You can get an updated booster from either company at least two months after your primary series shot or last booster. Anyone in this group may receive the booster, regardless of how many shots you’ve had previously (What You Need to Know About the Updated COVID-19 Boosters (verywellhealth.com)).
The new booster will be available soon… but not quite yet. A quick check with Howard Brown staff (September 9, 2022), for example, revealed they do not have it yet and do not have a protocol or info on their plans yet.
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THE MPOX VACCINE
The vaccine for the MPOX (formerly called “Monkeypox Virus”) has been available for a couple months, and various healthcare providers, gay bars, and community centers have been vaccinating persons for some time now. Two doses are recommended, 28 days apart.
An unfortunate error was made by many key players at the start of the vaccination (in response to the discovery of infections). The media pushed the fact that most persons being infected by—and showing symptoms of—the MPOX have been gay men, bi men, and men who have sex with men (MSM) in general. Chicago is at the center of the scene—as infections showed up, it became clear the persons impacted were members of various MSM communities.
Note that the Centers for Disease Control have CHANGED how they refer to the virus. They are now calling it the “MPOX” virus and trying to play down, and move away from, it being considered a gay or bisexual or MSM illness (Mpox | doh (dc.gov)).
One major problem is there has been a huge stigma of the MPOX infection—in addition to the possibility men can be outed as being MSM members—and therefore many individuals have been actively shunning treatment. Many of them are ignoring the need to get vaccinated, and many are thinking that their perhaps their only limited or infrequent sexual contact with men will mean they are safe from infection.
This is not the case. Ignoring their susceptibility to the virus is based on secrets in their personal life, a side of themselves they do not reveal to all.
It is very difficult to explain to a wife or a girlfriend why a man feels he should get vaccinated against MVP—if this is a visur prevalent among the MSM communities.
Hand of a woman who is infected with the MPOX Virus.
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However, those same women who are sleeping with, or spending time near, MSM members need the vaccination as much as the men do. The phrase “it only takes one time” reminds us of a variety of predicaments. The fact that the MSM men do not want to divulge their activities with men to family or friends complicates—and threatens—the process of getting all players vaccinated (StreetSense | Thomas Hansen | Substack).
Even early reports of the need for the MVP vaccine do NOT specify it should be only men who seek vaccination. It has been understood that women who have sex with MSM members are at risk also (Monkeypox Vaccine Being Offered in US: Who Should Get It? (today.com)).
Figuring out a way to lure reluctant gay, bi, fluid, and other men from the MSM community to vaccination may take a great deal of energy and planning indeed.
In response to the need for immediate vaccination, a variety of entities have rolled out their plans—from gay bars: Touche’ on North Clark Street—to Howard Brown (Here's Where You Can Get Vaccinated Against Monkeypox In Chicago (blockclubchicago.org)).
The Center on Halsted has been hosting MVP vaccinations and will continue to do so at least through September (https://www.centeronhalsted.org/mpvaccine.html?bbeml=tp-pQDG1976-0GYhmEMz8qXcg.jTP1dupeHTEmst0V-XOFs3Q.rgNJd2aAytUGEbH305JPTEQ.lzST3f1yHBEWwsNXlzcAy2g). Email and phone are available on that link, as are the two locations being used for the vax. clinics.
Now the vaccine is available many places in Cook County and elsewhere (Monkeypox 2022 - Cook County Department of Public Health (cookcountypublichealth.org)).
The City of Chicago has resources available also (MPV (Monkeypox) Home (chicago.gov)).
Chicago has sessions scheduled to provide the vaccine (MPV Vaccine (chicago.gov)).
Homeless men who are members of the MSM communities need the vaccine as much as others. This could be a particular challenge to persons helping the unhoused get vaccinated against yet another disease.
Stepping up the need for MVP vaccination is the news that two deaths from the diseases have now been reported, September 8, in the United States (Second person in the U.S. dies after contracting monkeypox - CBS News).
There have been more deaths suspected to be related to MVP infection reported in other countries. The White House has rolled out a new plan to combat the disease, seeing over 20,000 cases reported.
There have been two deaths reported on in the media—both referred to as deaths due to “mokeypox” because this all happened before the CDC decided to try to “destigmatize” the virus by calling it “MPOX” (City of Chicago :: Statement from Chicago Department of Public Health on Deaths of Two Chicagoans with Monkeypox)
While Chicago reportedly has a lower rate of MVP infection than some cities, it is still of great concern. Everyone should know it is foolish to assume all men—or women—are heterosexual. There are many MSM members among the ranks of the homeless.
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CONCLUSION
Approaching the topic of vaccination with the unhoused is sometimes a difficult endeavor but in other cases is a discussion that people welcome. Connecting unroofed people with needed resources is an honorable activity and a needed part of survival for them.
Over 10,000 homeless families in Chicago. Over 54,000 homeless children in Illinois. Over 16,000 homeless students in the Chicago Public Schools. As the numbers go up, advocates will have more work to do.
Helpers to the homeless are to be congratulated for their advocacy and hard work—sometimes dangerous work—as the streets remain an inhospitable home for so many people.
Thank you, helpers, advocates, counselors, social workers, word-of-mouth advisors, and all those who encourage and help the unhoused!