At The Sophia Way, a women’s shelter on the Eastside with more than 60 residents, director Alisa Chatinsky estimates about a quarter of the women are over 65 and eligible for vaccines. But even though clinics take place at the nearby Microsoft campus and volunteers have offered to drive shelter residents, few women have gotten vaccinated.

They have to make an appointment, then drive or get transportation to the clinic, walk in to the appointment alone — and then do it all again weeks later.

“Getting it done once is difficult. Getting it done twice?” Chatinsky said. “Darn near impossible.”

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.

Any effort that doesn’t come right to the shelter will never have success, Chatinsky added.

On Feb. 27, the FDA approved the use of the Johnson & Johnson vaccine, a potential game-changer for a population that could be uniquely tough to immunize. In the last week, cities across the country, from San Diego to Tulsa, Oklahoma, have begun distributing it to homeless shelters.

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Chatinsky wants Washington to follow their lead.

Local public health officials and homelessness advocates have been quietly lobbying the state to fast-track vaccinations for homeless people but most people living and working in homeless shelters won’t be eligible for more than a month — the state’s current timeline estimates April 26.

Even when people 50 years or older with multiple diseases or underlying conditions are eligible around April 12, the estimated quarter of the homeless population who would qualify might still be left out, according to public health officials.

“What we don’t want to do is go into a shelter or housing setting, with 50% of the people eligible and 50% not eligible, and only vaccinate a portion of them,” said TJ Cosgrove, King County’s homelessness COVID-19 response lead. “We believe that that is both an equity issue and potentially will increase vaccine hesitancy.”

Chatinsky said vaccinating everyone at once could be key. “They have to see their friends getting vaccinated, they have to see people they respect in the shelter, other people of color, the staff that serve them,” Chatinsky said.

Homeless people tend to be vaccine-hesitant and highly transient, which is why officials have struggled to figure out how to get two doses, several weeks apart, into the arms of people who might move or be moved in that time frame. Some previous vaccines also had to be kept at subfreezing temperatures, making them less mobile.

That’s why the new one-dose vaccine, which can be kept at simple refrigerator temperatures for up to three months, could make it much easier to store and potentially take to a shelter.

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Few homeless shelter-stayers have been vaccinated so far: Only 11 have at one of the biggest shelter organizations in the county, the Downtown Emergency Service Center, according to executive director Dan Malone.

And that’s just people in shelter, who are only around half of the county’s homeless population. People who live outside or in vehicles aren’t explicitly written into the state’s current plans.

How public health will get a majority of the homeless population immunized is still a big question: A draft of their homelessness vaccination strategy suggested offering incentives or using pop-up clinics. Cosgrove said all that is “still being formulated.

But the county also needs state approval to begin.

King County’s public health officer Dr. Jeff Duchin and others in the public health and homelessness spheres in other counties have been advocating the state to move up its timeline, said Jody Rauch, a public health nurse who coordinates the King County’s homelessness response, in a call with homeless service providers on March 3.

“I am holding out hope that they’re listening to us,” Rauch said. “We have been doing some pretty heavy advocacy … to push that timeline up and communicating the lower than average life expectancy [among people living homeless].”

The death rate from COVID-19 among the homeless population, nationally, may be 1.3 times that of the general population, according to a draft study from UCLA researchers released this month.

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Locally, few homeless people appear to have died of COVID-19: King County has so far tracked four deaths in emergency shelters and 10 among encampment-dwellers, people living in vehicles, and people who were homeless in the last year but have recently been housed, according to public health data.

After a December all-time spike in homeless COVID-19 cases, the numbers have lowered in recent weeks.

The lobbying has all happened behind closed doors, however: Cosgrove said in an interview that public health employees “don’t advocate.”

“What we’ve been trying to do, to many stakeholders, is educate and inform them around the complexity … as well as the vulnerability of this population,” Cosgrove said.

Alison Eisinger, director of the Seattle-King County Coalition on Homelessness, said in another meeting with homeless service providers this week that she’s not sure Department of Health decision-makers understand what it’s like in shelters, even when people are spaced out like they have been for the last year.

“We’re trying to be coordinated and keep the pressure on,” Eisinger said.

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Shelby Anderson, a spokesperson for the state Department of Health, said that the department recognizes homeless people are particularly vulnerable, but didn’t say if they were heeding calls for moving them up the priority list.

“When considering how to prioritize this population, we consulted experts on COVID-19 and engaged communities who have been disproportionately impacted by COVID-19, including people experiencing homelessness,” Anderson wrote in an email.

Cosgrove and Anderson both stressed that supply is one of their biggest hurdles. Last week, the state received over 60,000 doses of the Johnson & Johnson vaccine, but so far they aren’t sure when the next shipment of that specific vaccine will come. On Wednesday, President Joe Biden announced the United States is ordering 100 million more Johnson & Johnson vaccines, on top of an earlier order for 100 million, which the company said will arrive before June.

Even with a one-shot vaccine, inoculating homeless populations is still going to be complicated. Homeless people, often because of how they’ve been treated by health care providers in the past, can be skeptical of vaccines: Early numbers from the Seattle Flu Study show that perhaps more than half of homeless people surveyed are hesitant to getting the COVID-19 vaccine, according to Dr. Helen Chu, the lead researcher.

“And it doesn’t seem to be going up, it seems to be going down,” Chu said. “We were alarmed by what we saw at a first pass.”

Between the possible hesitancy and potential supply issues, the county could be vaccinating homeless people far into 2021, Cosgrove said.