Johnson & Johnson's Covid-19 vaccine has found a niche among organizations that work with the homeless, who say the one-dose shot is better-suited for a population that can be difficult to reach twice.
The U.S. homeless population has soared during the pandemic. Shelters have become a source of spread as experts puzzle over how to stem stubbornly high infection rates despite an aggressive national vaccine rollout.
In Chicago, the Night Ministry, a group that serves the homeless, has increasingly used the J&J vaccine since it was approved by U.S. regulators in late February. Before that the group had only the Moderna Inc. vaccine, which requires two shots. But the often-transient population can be tough to find a second time, said Stephan Koruba, a nurse practitioner with the Night Ministry, especially those sleeping on the Chicago Transit Authority train system. Now, the group offers both.
"When we're out on the CTA, we're never going to see these people again, " Mr. Koruba said. "We've specifically held to J&J doses for them."
Many of the group's beneficiaries are living on the streets. Others in tent encampments. Or, for those able to pay a few hundred dollars a month to escape Chicago's frigid winter, in transient hotels.
Outside one such hotel, word spread recently that the Night Ministry had arrived, and people trickled out. As he prepared to administer the J&J vaccine, Nathan Lin, a medical resident working with the group, asked William Bryant, 67 years old, if he had a phone number. He responded that he didn't, pointing to his temporary residence above.
"Just right up there," Mr. Bryant said.
President Biden has set a goal of 200 million vaccines by April 30. About 162 million doses have been administered so far, data show, with the J&J vaccine representing about 3.8 million. The company faced a setback last week when one batch of the main ingredient for its vaccine didn't meet quality standards at a contract manufacturer, and the doses weren't distributed. J&J still plans to deliver a total of 100 million doses by the end of May.
Aside from Chicago, groups in California, Maryland and Tennessee are among those nationwide administering the J&J vaccines in encampments, shelters, and even on subways.
The number of people facing unstable housing and food scarcity has skyrocketed during the pandemic, said Salvation Army Commissioner Kenneth Hodder. The Salvation Army says it provided 1.8 million nights of shelter to people who said they needed it as a direct result of the pandemic.
Shelters and transient hotels became a source of spread around the country, according to city officials nationwide. The Salvation Army converted many of its thrift stores and administrative buildings into makeshift shelters to spread out the population. Those people were already dealing with other difficulties such as substance abuse, mental illness and comorbidities associated with poorer outcomes for Covid-19 infection.
"With respect to homelessness, we have seen a pandemic laid on top of an epidemic," Mr. Hodder said.
In the Chattanooga, Tenn., area, Christina Butler, a registered nurse and Covid-19 vaccine coordinator for the Hamilton County Health Department's Homeless Health Care Center, said the hardest part by far about getting people vaccinated is getting them the second shot. Ms. Butler said her group has been able to give a second dose to about 60% of recipients after extensive efforts to locate them on the street, at the community kitchen and at camps. Many people are now requesting the J&J shots, she added.
Some community workers have found pockets of resistance to the J&J vaccine among religious groups because it required the use of fetal cell cultures to produce and manufacture the vaccine. Some people said they were concerned that it was a less-effective, "poor person's shot."
Even so, healthcare workers say they have been surprised to find many homeless people specifically requesting the J&J vaccine, which is branded as Janssen, a unit of J&J. Some of them point out that the shot was still effective even though it was tested after Covid-19 variants entered the mix. Others say they are worried about getting a vaccine once, let alone twice, given the potential side effects.
"If you're in a shelter, or don't have a home, those side effects are different than if you can stay at home," said Bobby Watts, chief executive of the National Health Care for the Homeless Council, which supports hundreds of providers that cater to the homeless.
Nurse practitioner Mary Tornabene of Heartland Alliance Health in Chicago said that when her group received its first shipment of J&J shots, it offered both the J&J and Moderna doses at a meal program for people who mostly live on the street. Within 40 minutes, the J&J supply was used up while few had chosen the Moderna vaccine.
"They all wanted that," she said. "The thought for some people to get this shot once is hard enough, let alone twice."
The Night Ministry recently showed up where a Chicago encampment had been in place just days before to find that the people in it had been moved out by the city. The group had created a spreadsheet they had printed out and brought with them, with notes about how to find those who had received one dose of Moderna's vaccine. Locations included "tent city," or sometimes just a street corner, "Chicago and Sacramento."
Back at the transient hotel in Chicago, rooms have open ceilings -- like cubicles -- and bathrooms are shared. One man created a makeshift ceiling with plastic trash bags to protect himself from Covid-19, said Michael Bush, the hotel's manager. The hotel tries to circulate air with ceiling fans to minimize the risk of infection, he said. Others left the hotel to seek shelter elsewhere, adding to the challenge of locating those who had started a two-dose regimen, weeks after their first dose.
The Night Ministry managed to dispense a 10-dose vial of Moderna that recent day at the hotel, but on other days, with no viable way to make appointments, the group turned people away if there weren't enough takers to avoid wasting portions of a vial.
"We have some people making some very complicated calendars to try to map these shots out," said Adrienne Trustman, chief medical officer at Health Care for the Homeless in Baltimore, which is trying to move exclusively to J&J's one-dose regime. If not enough people show up for a second dose, they end up giving more first doses of the vaccine, adding to the list of people they need to track down for a second dose, she said. "When does it end?" she asked.
The five-dose J&J vial has changed everything, healthcare workers say.
"With Janssen, we can vaccinate twice as many people," Dr. Trustman said. "We have limited resources. And that math is pretty simple."
Outside the hotel, Rafael Fernandez, 41, walked up to the Night Ministry van to get a meal with his friend Dan Palmer, 35. He ended up being vaccinated after learning he would need only one shot.
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