Should Homeless, Service Providers Be Higher on Vaccine Priority List?

The primary homeless service providers in Denver are urging Governor Jared Polis to reconsider vaccine priority rankings and place both providers and homeless individuals higher on the list.

"We function as essential workers, and we have a lot of prolonged exposure in small congregate settings for folks who are high-risk," says Christina Carlson, CEO of Urban Peak, a nonprofit that operates multiple homeless shelters in Denver. "I really hope that the state and the governor will pay attention and respond to us and prioritize us."

The Denver Homeless Leadership Council, which comprises the largest service providers in the metro area, including Urban Peak, sent Polis a letter on December 14, imploring him to move both shelter staff and people experiencing homeless up on the vaccination prioritization list. The council has not heard back from Polis; Conor Cahill, a spokesperson for the governor's office, offers this: "The Governor believes it is our moral obligation to prioritize vaccinating seniors and the elderly living in nursing homes, as they are at the greatest risk of death from this virus, and simultaneously to inoculate our frontline healthcare heroes who treat COVID-19 patients in a direct way on a day-to-day basis. If a person is over 65 or has another health condition that puts them at an increased risk, they are prioritized to get the vaccine before the general population."

Right now, homeless shelter staff are included in phase 2 of the vaccination distribution list, while people experiencing homelessness fall in phase 3, which is when the general population will receive the vaccine in Colorado. The Denver Homeless Leadership Council wants to see shelter staff moved to phase 1 and people experiencing homelessness moved to phase 2. Carlson would also like administrative staff moved up from phase 3, since many administrators are having to staff congregate settings with workers stretched thin.

"In congregate settings, while we're all working hard to have space where we can socially distance, there's only so much we can do," Carlson says. "People sleep there and they eat there." There have been periodic COVID-19 outbreaks among staff and residents at shelters across the state.

The Polis administration has assigned the highest-risk health-care workers and nursing home staff and residents to phase 1A of the vaccine distribution, which has already started. Phase 1B, set to take place later this winter, includes health-care workers who don't have frequent contact with COVID-19 patients; workers in home health, hospice and dental settings; and first responders, such as EMTs, firefighters, police and correctional workers.

Some people experiencing homelessness are already eligible for vaccinations in phase 2, as higher-risk individuals, including those over the age of 65 and people with certain comorbidities, like diabetes or lung disease, can get vaccinations during that phase. People experiencing homelessness are much more likely to have these types of comorbidities than individuals of the same age in the general population.

Asked about the Denver Homeless Leadership Council's proposal, Scott Bookman, COVID-19 incident commander for the Colorado Department of Public Health and Environment, responds: "We think it's really critical that we look at individual risk factors for who should get the vaccine first, so those who are over 75 are at extreme risk for bad outcomes with COVID, those who have pre-existing conditions are at risk for bad outcomes from COVID. And then really looking at our front-line workers, those who are at risk because of the work they have to do in person, rather than so many of us who are able to work from our basement."

Bookman does note that the state could continue tinkering with the phases going forward.

There's already been some tinkering, and service providers point out that previous versions of the vaccine distribution list had shelter staff and people experiencing homelessness higher on the list.

Carlson speculates that the move had something to do with the governor's recent decision to downgrade inmates and detainees in correctional settings on the vaccine priority list. "There's been the discussion of people that are incarcerated and all of that," she says, "and I think there's been a big grouping of all congregate settings. The need is very high across all congregate settings. It's struck me that, at times, there hasn't been enough differentiation."

Read the full letter from the Denver Homeless Leadership Council here: