In Philly’s suburbs, the people who need COVID-19 vaccines the most may be the toughest to reach

The workers staffing a Doylestown vaccine clinic lit up when Richard Valier walked through the doors on a recent evening.

“Richard! How did you get here?” one called across the room. “I took the bus,” Valier said, smiling behind a surgical mask.

For the outreach workers, his arrival was an accomplishment. Valier, who is 72 and has lived on and off the street for seven years, is one of about two dozen homeless Doylestown residents for whom the clinic was specially designed.

In Bucks County and the other suburban communities that ring Philadelphia, homeless residents tend to be less visible and harder to reach than in such urban centers as Philly and Camden, where there are more centralized services. Yet these are some of the counties’ most vulnerable people, as many suffer from other health conditions that put them at particular risk for the virus. At the same time, quarantining can be impossible for those who have no home, meaning that they could pose more of a transmission threat to others.

Transportation, too, is a major challenge. At Bucks County’s previous clinics for homeless residents, about 35% of the people who had signed up to get a vaccine actually made it to their appointment.

At the Doylestown clinic, hosted at a Lutheran church in the borough, staffers had hoped about 20 homeless residents would show up for a vaccine. But they knew that with limited public transportation — Valier was the only client who managed to arrive by bus — and spotty phone contact, it was likely many clients would miss their appointment.

So outreach workers spent the evening driving through the borough, stopping at the usual gathering spots, hoping to offer rides to the clinic.

It was one of the many tactics outreach workers in Philadelphia’s suburban counties have deployed over the last few months to reach people whose plight is often overlooked.

In Montgomery County, social workers and physicians have been taking drives around the county together, looking for people to whom they can offer the vaccine on the spot.

An apparent success story is Chester County, where a vaccination effort at shelters and emergency housing has gotten shots into the arms of about 75% of the county’s homeless population, officials there say.

Besides access challenges, some homeless residents express the same hesitancy around the vaccine that health workers encounter in the general population.

The one-dose Johnson & Johnson vaccine seemed a crucial tool for inoculating people who may not be able to make it to two appointments. But then J&J vaccinations were briefly put on hold as federal officials investigated a handful of blood-clot disorder cases associated with the shot.

Like their counterparts in Philadelphia and Camden, Bucks County officials paused a series of planned vaccination clinics for homeless residents. And when the J&J vaccines were again deemed safe and the county’s clinics started back up, some clients were still worried about getting the shot.

At Good Samaritan Services, which runs several shelters in Phoenixville, Chester County, a vaccine clinic at a 40-bed men’s shelter managed to give shots to only six or seven residents, said Tyler Logan, Good Samaritan’s shelter resource coordinator. Some residents had already gotten their shots, he said. Others were still wary.

“A couple guys asked, ‘Which vaccine is it?’ It wasn’t everybody. But you are getting a lot of hesitancy around J&J just because of that scare,” he said. “We just say, ‘You should get it, but it’s up to you.’ Some guys say, ‘Oh, no, I got one.’ Or, ‘I don’t want mine.’ There was one guy who just didn’t want to put his name in the system. It’s a trust thing.”

For his part, Valier, who received his J&J shot at the Doylestown clinic that night, said he was eager to be vaccinated. “It was the first time one was offered to me, and it seemed like the natural thing to do,” he said.

The pandemic, and the lockdown, had upended the routines he cobbled together over the last several years. “It was terrible. You couldn’t hang out in places with anyone — that made it very difficult,” he said.

After his vaccination, he was preparing for a two-night stay in a hotel in town — another incentive the county had set up for people nervous about potential vaccine side effects being especially hard to handle on their own, outside.

“We wanted to eliminate every barrier we can,” said Kim Everett, executive director of the Bucks County Health Improvement Partnership, which helped organize the clinic where Valier was vaccinated.

By the end of the evening, 15 people had received vaccinations at the church clinic; some were homeless clients, and the rest other Doylestown residents who walked in for a shot.

Neighboring counties are also looking for ways to break down barriers that keep homeless residents from getting vaccinated.

“Because the suburbs are a little bit more spread out, it can be a little bit harder in certain areas to connect with these individuals as a group,” said Alvin Wang, a physician who is Montgomery County’s regional EMS director and is overseeing efforts to vaccinate homeless residents. About 75 people in the county’s shelters had been vaccinated as of last week, he said.

“We’ve been using shelter environments as well as food pantries and our various community partners to really engage with as many of these individuals as we can,” he said.

On that score, outreach workers are finding that homeless residents share much in common with people who haven’t wanted to be vaccinated except by their own physician’s office or pharmacy.

“We’ve had individuals come up to us and said some really kind words about being able to get vaccinated in an environment they’re most familiar with.”