Last week, Dallas County began distributing the one-shot Johnson & Johnson vaccine after it was endorsed by the Food and Drug Administration. Public health officials praised the vaccine, but not everyone was happy with the news.
For one, Johnson & Johnson came under fire for using fetal cell lines during the vaccine's development. Many were also upset that authorities planned to allocate the vaccine to the incarcerated and to homeless people.
Some argue it’s not fair to prioritize those vulnerable populations ahead of “law-abiding citizens.” Comedian and The Man Show star Adam Carolla, for instance, slammed California for its own distribution plans. (Later, USA Today challenged his claim, writing that while California is distributing to those groups, the state’s plan shifted to no longer prioritize them.)
“In California the homeless and prisoners are getting the vaccine before taxpayers,” Carolla wrote in a tweet. “It sounds like something out of Idiocracy. If that isn't the most California way of doing things I don't know what is.”
Yet the decision to vaccinate the homeless and jail populations comes out of concern for the entire community, said Dr. Erin Carlson, an associate clinical professor in the College of Nursing and Health Innovation at the University of Texas at Arlington.
Those groups spend time in congregate settings, where the disease can spread like wildfire, Carlson said. It seeps into the broader community when they leave the shelter or are released from jail.
“Thus, mitigating disease in these locations is critical to protecting the whole community,” Carlson said.
It’s important for the incarcerated and homeless populations to receive the Johnson & Johnson vaccine because it’s only one shot, Dallas County Judge Clay Jenkins said. Unsheltered people, and those who are serving short-term jail sentences, could be harder to find three to four weeks later to administer a booster shot, such as with the Pfizer and Moderna vaccines.
Dallas County received 6,000 Johnson & Johnson vaccines last week, and officials planned to find around 600 people in those populations to accept it, Jenkins said. The remaining 5,400 were reserved for others with underlying conditions driving through the Fair Park vaccination site.
Many homeless people also lack a way to travel to vaccination hubs, said Daniel Roby, CEO of the local shelter Austin Street Center. Those staying in shelters are made to share a space with others, making rampant spread all the more likely.
“They don’t have the ability to isolate within their own home,” Roby said. “They’re forced to be in these kind of public settings, and so it’s important that they receive protection.”
The unhoused population is particularly vulnerable to COVID-19, Roby added. They’re twice as likely to die from the disease than the general population, and are up to three times as likely to have a severe case and to need critical care.
Plus, a large portion of Austin Street Center clients are considered high-risk: 60% have chronic health conditions, such as type 2 diabetes and hypertension, 25% have a physical disability and around half have been diagnosed with mental illness.
“When they have come and said, ‘Hey, people who are homeless should be prioritized,’ there’s a good reason for that,” he said.
Still, Jenkins said many homeless people are already resistant to taking flu shots or having medical checkups. He hopes more people sign up as they see their friends having a good outcome from the vaccine.
In Dallas County, there are between 3,500 to 4,500 people experiencing homelessness annually, and the jail population hovers around 5,400, Jenkins said. Some will refuse the vaccine, but every bit helps in reaching herd immunity.
Jail health is particularly important to public health because the national average jail stay is between 10 and 20 days, Carlson said. The average Texan should care that vaccines are available for the incarcerated and unsheltered because slowing spread in those populations is critical to protecting everyone else.
“This has nothing to do with who comes before somebody else,” she said. “This is a decision made purely and exclusively about the larger community’s health.”