More than three million French people have already received the vaccine against Covid-19. But while the vaccination campaign slowly takes its course, a population, yet largely at risk, remains in the dark. According to the High Authority for Health (HAS), the vaccination of homeless people (SDF) is not planned before phase 3 of the vaccination strategy, which should begin, at best, at the end of March. But in view of the delays already accumulated, everything suggests that this deadline will be postponed.

Yet homeless people are a population at risk. Their situation was already “Extremely deleterious” before the start of the pandemic according to Dr Philippe de Botton, president of Médecins du Monde. But since the end of the summer, it’s getting worse and worse. “These are populations whose state of health is generally deplorable”, confirms Corinne Torre, head of mission for France at Médecins sans Frontières (MSF). “There are a lot of chronic diseases, addiction problems, pathologies like tuberculosis etc.”, she explains. These are all factors that make homeless populations at high risk of developing “Extremely severe forms of Covid-19”, concludes Dr de Botton.

The living conditions of the homeless also play a role in their health precariousness. Crowded accommodation centers, difficult access to water points, soap, lack of protective masks, this context makes it difficult to respect barrier gestures for these extremely poor people. For Corinne Torre, “As long as there is a notion of life on the street or in precarious accommodation, there is a high risk.” In terms of vulnerability to the coronavirus, the criterion of extreme poverty exceeds the age criterion.

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A double challenge

For Dr de Botton, what slows down the vaccination of the poorest people today is the scale of the logistical challenge. Because the homeless are not a population like the others. Often totally outside the health system, it is difficult to identify the most vulnerable. And when you live on the street, the priority is not necessarily vaccination against the coronavirus. “You first have to survive, eat, find a safe place to sleep…”, explains Corinne Torre. “There is real awareness work to be done, and it takes time.”

Reaching out to these populations requires a certain expertise, adds Philippe de Botton: “We do not enter like that in a squat, a camp or a slum… We must give the means to the mobile teams who know the terrain,” he insists. If the NGOs refuse to take the place of the Ministry of Health, they are ready to help to ensure the best possible access to the vaccine.

Another major challenge: the issue of medical monitoring. For now, authorized vaccines are given in two injections. A real headache for these populations unaccustomed to health monitoring and difficult to trace: “A migrant who receives the first dose of the vaccine and who crosses the border, we will not find him” asserts Dr de Botton. For Corinne Torre, “To protect is first of all to host. If we want to be sure of finding a patient, he must be accommodated and kept under observation until the second dose ”. In a context of serious health crisis, the issue of unconditional accommodation for all “Shouldn’t even arise”, she sighs.

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How many doses for the homeless?

The hypothesis of an upcoming authorization of the Johnson & Johnson vaccine, which is done in a single injection, is a line of thought. But it raises another question: “How many doses will be available for the poorest?” worries the president of Médecins du Monde. “When we see the few doses currently available, the very low vaccination rate… What can we expect for the homeless? Associations and NGOs are standing by. But we need resources ”, insists Philippe de Botton.

“Today, our first problem is that we don’t know where to direct people who need a vaccine”, confirms the MSF head of mission. “If I have a patient in front of me who meets all the criteria, who has been informed and who wants to be vaccinated, I am unable to refer him.” The associations deplore a total vagueness on the places of vaccination, very difficult to find without going through the Doctolib application, inaccessible to the most vulnerable populations. Mainly, they worry about the lack of doses. And until there are enough doses for the “regular” population, homeless people are unlikely to have access to the vaccine.

Between political goodwill and disorganization

During a meeting with NGOs and social actors last week, Olivier Véran allegedly said he wanted to make the most precarious a priority. If the associations want to believe in the goodwill of the Minister of Health, the disorganization that reigns around the vaccination campaign seems to dominate for the moment.

For the president of Médecins du Monde, the issue of vaccination is only the tip of the iceberg. “The situation of the homeless is not new, it’s been going on for 20, 30 years! The coronavirus is simply an indicator of dramatic inequalities. ” The doctor even speaks of an ethical and deontological failure: “Everyone should have equal access to immunization”.