Jeffrey Davis has spent the pandemic as a shelter guest at Boston's Pine Street Inn. By his estimate, he's been tested for the coronavirus a few dozen times. Each time, he says, he's come up negative.
Still, he's scared he'll get sick with COVID-19. And now, he's building a new defense against it.
"I was afraid of dying from it, to tell you the truth," Davis said. "So I said yeah, I want to get that shot. I had no idea I'd have the chance this quick."
On Friday, Davis, 50, received the first of two Moderna vaccine doses, in the initial day of vaccinations at Pine Street Inn. Beginning to inoculate guests is a big turning point for the organization, which saw 36% of its guests test positive for the coronavirus early in the pandemic.
"I'll be honest, it's very emotional to watch," said Pine Street Inn President and Executive Director Lyndia Downie.
Downie said she's thankful to state officials "for prioritizing people who are normally at the bottom of every list, and who this time actually got a shot at being at the top of the list and a shot at some hope."
In three days, Boston Health Care for the Homeless Program (BHCHP) has vaccinated close to 200 shelter guests and nearly 150 staff members at the city's three biggest overnight emergency shelters — the public men's and women's shelters run by Boston Public Health Commission and Pine Street Inn. There are about 2,000 people staying in Boston shelters who are 18 or older and approximately 1,500 shelter staffers eligible for the vaccine, according to BHCHP, which says it's aiming to offer first doses to all of those people by the end of February.
April Donahue, BHCHP associate director of clinical operations, is thrilled this moment has arrived.
"We're in a space where we're now preventing, and that, as a nurse, is amazing," she said.
But Donahue and other clinicians acknowledge there are big challenges in their quest to vaccinate upwards of 70% of the people experiencing homelessness in Boston.
Staff at the shelters, as well as the organization's nurses and doctors embedded in shelter clinics, have reported a high level of vaccine hesitancy among guests, according to BHCHP Medical Director Dr. Denise De Las Nueces.
"I absolutely think that for certain communities, particularly communities of color, that historic injustices that have been targeted towards communities of color by the medical establishment factor in largely in terms of vaccine hesitancy," De Las Nueces said. "But ... this is a new vaccine. When we surveyed our own staff ... there were concerns about the science feeling rushed and concerns about about safety in the setting of that rush to science."
Program leaders say they've read through the vaccine research and have held information sessions with shelter staffs, providing information to help ease guest concerns and bust myths around the vaccines. They've also held calls with their own staff to try to boost confidence.
The organization formed a vaccine equity advisory group to ensure that access to the vaccine is equitable for communities of color and people with limited English proficiency.
Finding people for their second doses will also present challenges. The vaccine being administered in Boston's homeless community is the one developed by Cambridge-based Moderna, which requires a second shot 28 days after the first one.
"We are absolutely concerned about being able to find individuals for dose number two," said De Las Nueces.
Clinicians are giving appointment reminder cards to people who receive the vaccine, with the date they'll be back exactly four weeks later, at the same time, to administer the second dose.
It might be easier than it would have been in years past to locate people experiencing homelessness, as the pandemic has led many shelters to reduce capacity and assign beds, resulting in less movement between facilities. Also, BHCHP can use the city's Homeless Management Information System, which documents people's shelter stays and their other contacts with service organizations. That means providers will know if someone has moved from one shelter to another or has made contact with an outreach worker on the street.
"That type of information sharing in a very confidential, need-to-know basis, is going to be really important to our efforts of finding people," De Las Nueces said.
The timing of the vaccinations couldn't be better, with homeless service providers concerned the new, more contagious coronavirus variant could cause widespread transmission in shelters.
According to Boston Public Health Commission, 6.9% of the 422 coronavirus tests performed in Boston's homeless community in the last week came up positive. That's up from a positive rate of 0.9% at the beginning of December.
Michael Goodman has been staying at Pine Street Inn for about a year-and-a-half. The 70-year-old says he tested positive for the coronavirus in June but was asymptomatic. He was sent into quarantine. Now, seven months later, he didn't hesitate to step up for the vaccine.
"It's a defense of not getting COVID-19," Goodman said. "I mean, I think, boy, here's my chance. You know, I don't even have to go any place for this. I don't have to pay for it or nothing. It's coming to me. And I just felt very fortunate."