Health

J&J’s ‘one and done’ made it easier to vaccinate homeless Vermonters. The CDC’s 2nd dose guideline complicates things.

Note: This story is more than a week old. Given how quickly the Covid-19 pandemic is evolving, we recommend that you read our latest coverage here.

A Walgreens employee prepares a syringe of the Johnson & Johnson Covid-19 vaccine during a walk-in clinic in Burlington on May 20. Photo by Mike Dougherty/VTDigger

When it came to inoculating hard-to-track people against Covid-19, Johnson & Johnson’s single-dose vaccine was an obvious choice. 

Unlike Pfizer and Moderna’s two-dose series, J&J was a one-and-done deal. It granted full immunity with half the effort — no follow-up appointments needed. That, in addition to easier storage and handling guidelines, solidified J&J as the go-to choice in clinics for people experiencing homelessness. 

But a key part of that equation changed late last month after the U.S. Centers for Disease Control and Prevention recommended people who received the J&J shot get a booster after two months

The decision creates some challenges for service providers and their clients, not only when it comes to getting the word out but also for tracking down people who qualify.

“Especially with a group of people that do not have a fixed address — either they’re living on the street or in a shelter or a hotel room — it presents a logistical challenge to get them back for a second shot,” said Rick DeAngelis, executive director of Good Samaritan Haven, the largest emergency shelter provider in central Vermont.

The state of Vermont does not collect data on housing status and coronavirus vaccination, so it’s unclear how many Vermonters experiencing homelessness may be due for a J&J booster. But the National Health Care for the Homeless Council estimates that 20% to 50% of people experiencing homelessness are unvaccinated, though the actual number could be much higher. Of those who are vaccinated, however, the vast majority got the J&J shot. 

The public health implications for people living in shelters could be significant, said Elizabeth Bowen, who studies homelessness at the University at Buffalo School of Social Work.

“You have a population that is at greater risk for Covid and other diseases and at risk for Covid being more severe. … So if people have to stay in a shelter, especially over the winter as it gets cold, for example, it’s very easy for the illness to be transmitted,” she said.

While shared sleeping and eating quarters could be fertile grounds for an outbreak, the Vermont Department of Health has documented fewer than 50 coronavirus cases in the state’s shelters since the pandemic began. 

Mike Smith, secretary of the Agency of Human Services, said last month that the state has led the nation in its coronavirus response for people experiencing homelessness. Part of that strategy involved holding state-run clinics in shelters. It’s a relationship that draws on the ties that homeless service providers have built in communities.

But that arrangement may be changing, at least at Good Samaritan. According to DeAngelis, the state’s public health personnel have discontinued those clinics in preparation for the next major vaccination push — an effort to vaccinate as many as 60% of Vermont children ages 5-11 in mere weeks

[Looking for data on breakthrough cases? See our reporting on the latest available statistics.]

DeAngelis wrote in an email this week that state staff will focus on vaccination clinics in schools. In the interim, Good Samaritan will offer vaccine clinics through a partnership with People's Health and Wellness Clinic, a Barre-based clinic. State staff, DeAngelis said, “would be glad to support” that collaboration. 

Either way, he said, the vaccination effort, including the delivery of boosters, is a project his organization cannot undertake on its own. 

“Our strategy is ‘let's just have clinics.’ Even if only a couple of people come to the clinics, that’s better than nothing,” he said. 

Smith said this week that the campaign to vaccinate children would not take away from ongoing vaccine outreach to shelters. However, representatives from the state health department have not responded in recent days to requests to share the specifics of the plan. They also did not say whether they’ll employ additional strategies to deliver boosters to people experiencing homelessness. 

“We aren't giving up on other efforts,” Smith said. “… We will reach out and continue to reach out as we move forward.”

To register for a vaccine appointment or get information on walk-in clinics, visit healthvermont.gov/MyVaccine or call 855-722-7878. 

You will be asked to provide your name, date of birth, address, email (if available), phone number, and health insurance information (if available, but not required).

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Liora Engel-Smith

About Liora

Liora Engel-Smith covers health care for VTDigger. She previously covered rural health at NC Health News in North Carolina and the Keene Sentinel in New Hampshire. She also had been at the Muscatine Journal in rural Iowa. Engel-Smith has master's degrees in public health from Drexel University and journalism from Temple University. Before moving to journalism, she was a scientist who briefly worked in the pharmaceutical industry.

Email: lengel-smith@vtdigger.org

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