When public health officials told Eddy Matlock-Mahon on Tuesday they could no longer bring Johnson & Johnson vaccines to the downtown shelter he oversees, but that they could bring the first dose of the Moderna vaccine, he said yes right away.

The transitional Catholic Community Services shelter is more stable than most shelters: Clients have reservations and can stay for quite a while, so Matlock-Mahon was pretty certain shelter staff could make sure everyone gets a second dose.

That’s not the case for many homeless people in King County, who are in much more unstable situations and will likely struggle to get a second dose.

The Seattle Times’ Project Homeless is funded by BECU, The Bernier McCaw Foundation, Campion Foundation, the Paul G. Allen Family Foundation, Raikes Foundation, Schultz Family Foundation, Seattle Foundation, Starbucks and the University of Washington. The Seattle Times maintains editorial control over Project Homeless content.

While King County homeless vaccination clinics are continuing as planned this week, the statewide Johnson & Johnson pause complicates an already-difficult task ahead: immunizing homeless people outside of the shelter system who live in tents and vehicles, many of whom move frequently and have wider than average distrust of institutional medicine.

King County had just begun to roll out vaccines in the last couple of weeks to a wide swath of newly eligible people living in homeless shelters and housing facilities. Public health officials, emergency medical personnel and Seattle Fire crews have vaccinated 820 people currently and formerly experiencing homelessness in King County as of Wednesday. That is out of more than 11,751 estimated to live in the county.

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On Tuesday, federal public health officials recommended that states temporarily suspend using the Johnson & Johnson vaccine after six of the 6.8 million people to receive the shot in the U.S. developed blood clots.

Across the country, vaccine providers working to inoculate people who live outside have heavily relied on the Johnson & Johnson vaccine, said National Health Care for the Homeless Council CEO Bobby Watts. The relative ease in storing Johnson & Johnson doses, and the fact that immunization only required one shot, made it easier to bring the vaccines to people in hard-to-reach places. 

“Johnson & Johnson was a really valuable tool in the toolkit of reaching vulnerable populations, and without that it will be harder to achieve our common goal and this administration’s goal of health equity in our COVID response,” Watts said.

Local public health officials plan to start specifically vaccinating people who live outside in tents or vehicles later this month, said Health Care for the Homeless Network clinical quality lead Jody Rauch.

“It is certainly a little more complicated when you’re talking about delivering vaccines tent-by-tent or car-by-car,” Rauch said.  

Seattle homeless health care nonprofit Hepatitis Education Project, which works with people living in encampments, planned to wait on administering vaccines until more Johnson & Johnson doses were available. Many of the people the organization serves don’t have a way to follow up with a health care provider for a second shot. 

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“I think we’re going to have to rethink that a lot,” said Sarah Deutsch, director of programs at the Hepatitis Education Project.  

A two-dose vaccine could deter people from getting a shot at all, Deutsch said. 

“The more times people are told they’ll need to come back, the less they’ll come in the first place,” she said. 

In a Wednesday call with King County public health officials, local nonprofit workers expressed fear that the pause could fuel distrust of the vaccines among homeless clients, many of whom have experienced racism or stigma within medical institutions.

“It’s a very concerning situation,” Dr. Mia Shim, Public Health – Seattle & King County’s chief medical officer for community health services, responded on the call. “We need to really step back and really state what we know and be transparent with it.”

Shim stressed that complications so far have been very rare for people who get the Johnson & Johnson vaccine, and encouraged nonprofit workers to share that information with worried clients who recently received the vaccine.

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Darcie Bye didn’t plan on getting a COVID-19 vaccine leading up to Wednesday morning; conspiracy theories have been floating for months around the Catholic Communty Services transitional shelter where she lives, which is located in downtown Seattle in a former comics shop whose name, “ZANADU,” is still in neon lettering above the door.

Bye had heard people say the vaccine had a microchip in it, or it was the “mark of the beast” described in the Bible as an omen of Jesus Christ’s second return.

But Bye’s father passed away last year from COVID, she said, and she wants to be able to see her mom and son again. When a staffer offered her a $10 gift card Wednesday morning for getting vaccinated, she decided to go for it.

Steffon Wallace has only been working at the shelter for seven months as a front-line staff member, but the energetic 24-year-old already knows everyone and they like him, a key to overcoming hesitancy, experts say. So it took little persuasion for Wallace to talk three people into getting the vaccine at Zanadu Wednesday.

“I just asked, ‘Why not?… It’s good for you,'” Wallace said.