Vaccine delivery to homeless la county residents

1. Vaccine delivery to homeless la county residents • Lessons learned from administering 3800 doses of pneumococcal polysaccharide vaccine.

2. Fay Russell, RN • 18 years experience vaccinating homeless residents in la county • Organized and led campaign to deliver 3800 doses of short-dated pnuemovax to homeless in la county in 2011.

3. Why ppsv23 (pneumovax)? • Pnuemococcus is an ubiquitous germ • Hundreds of thousands of cases of pneumococcal pneumonia in the us annually • Tens of thousands of cases of invasive pneumococcal disease in the us annually • Thousands of deaths from ipd, as well as survivors with catastrophic sequelae such as brain damage, gangrene, and multi-organ failure

4. Elevated risk among homeless population • Anecdotal evidence and research indicate increased risk among homeless population • 5 year Toronto study showed 30 fold higher rate of ipd among homeless than general population

6. Ppsv23 is suitable for a mass campaign • Very safe vaccine • Recommended to give if prior vaccine status unknown • Long lasting “A one shot deal”

7. Lesson one: Trust and respect

8. Think about which of these interactions is more respectful “I would like to inject something into your body that you may have never heard of…You have questions about it? I don’t really know the answers to a lot of those questions…here’s a paper to read.” “ I respect the fact that you’re making a decision about what to put in your body. I’m happy to discuss this vaccine as long as you want in order to answer your questions. I wouldn’t be encouraging this if I didn’t believe in it enough to have carefully studied respected sources of information and have become convinced that this is important.”

9. Trust and respect are major issues among most of the chronically homeless Respect those you approach enough to have thoroughly prepared to answer questions. At a minimum, have carefully read the pink book on pneumococcal disease. Believe in what you’re doing Invite people one to one, face to face to receive the vaccine . Connecting with each person shows that you respect them as an individual.

12. Be honest about the limitations of the vaccine • More likely to weaken pneumonia than to completely prevent it. • but usually very successful in preventing invasive pneumococcal disease, the real reason we give it

13. It’s important to know There is a high level of distrust about vaccines among the homeless population. They are seen as experimental and unsafe. Don’t offer flu shots at the same time. Most people have already made up their mind about the flu vaccine and have strong opinions. Flu shots should be offered at a different time.

14. You could say: • “If you only ever take one vaccine, take this one. It’s a very safe shot that gives protection against catastrophic consequences and it lasts for years.”

15. Lesson two: Avoid incentives

16. Think about this question • Mike called himself Dan last week. He has been to two different groups of nurses to get the same vaccine, because he wants the gift cards they’re giving out. • Question: Is Mike/Dan manipulating?

17. Let’s reframe the question • Is Mike/ Dan manipulating… • …or were the nurses manipulating him, and he is counter-manipulating? • Who started it?

18. Problems with “Incentives” • Inherently manipulative and condescending • Incentives reframe providing vaccinations to the public from something we are offering them to something we want them to do for us. • Paying people to accept vaccination triggers issues of trust (“We’ll pay you to drink our kool aid… Heh Heh Heh”)

19. You could say: • “The incentive is protection against a serious illness that may have very grave consequences.”

20. Word of Mouth builds during a vaccine campaign • Information given respectfully can spread • Someone who declines once may accept at another time or place • Please remember that how you approach people may affect other vaccinators approaching people elsewhere in a positive or a negative way.

21. Lesson three: connecting

22. Go where they are—Especially where they eat • Meal programs • 24 hour AA meetings • Encampments • Parks where people sleep • Shelters • Needle exchanges…

23. Go off the grid • There are many informal meal programs that are not on your referral lists • Homeless guests at one place can lead you to another

24. Go with someone They know • Known or trusted service provider or volunteer • Another homeless person

25. Enlist volunteers • Medical and nursing students and professionals can help with outreach education • Volunteers usually bring high levels of enthusiasm and concern for the public • Volunteers can be homeless

26. Lesson four: You’ve got to make it easy • Minimal necessary screening • Brief screening consent • Workarounds for unwanted questions • Think about how to handle CAIR

27. LESSON FIVE: IF I COULD DO IT • ONE NURSE AND SOME COLLEAGUES AND VOLUNTEERS DELIVERED 3,800 DOSES OVER ABOUT SIX MONTHS (AND SHE KEPT DOING HER DAY JOB.) IT CAN BE DONE. • THE INITIAL PILOT OF 3,800 DOSES HAS ALREADY BEEN COMPLETED • A REASONABLE NEXT STEP WOULD BE 10,000 DOSES