Multnomah County Health Department staff are creating a vaccine distribution plan for people experiencing homelessness that will launch March 29, when anyone living on the streets or in a shelter across the state will be eligible to receive a shot.

Homeless shelter staff and houseless individuals 65 years and older already began receiving inoculations earlier this year. That distribution acted as a test-run as officials prepare to reach Oregon’s nearly 16,000 homeless residents in the coming weeks.

On Friday morning, Cascadia Behavioral Healthcare’s Garlington Health Center in Northeast Portland was bustling with energy. A sign outside of the clinic advertised available COVID-19 vaccines for seniors experiencing homelessness and anyone else who qualified.

Pastor J.W. Matt Hennessee, who presides over Vancouver Avenue First Baptist Church of Portland, was among those vaccinated. During nonpandemic times, his church offers a mobile kitchen where volunteers head out every Saturday to feed people.

“We have long gone into parks, like Dawson Park, to spend time with our neighbors but we haven’t been doing that because of COVID,” Hennessee said.

Aside from that clinic, more than 123 people experiencing homelessness have already received their jab in Multnomah County. Those individuals were mostly seniors living in motel shelter programs.

But once the vaccination effort scales up, staff will face the extra challenge of delivering two separate doses to individuals living in unstable housing conditions. County officials are continuing to discuss mobile vaccine outreach, subsidizing transportation services and securing Johnson & Johnson vaccines, which requires just one shot to make the task easier for all.

“I think all of us are aware of the challenges physically, mentally and emotionally that come with living outdoors or in shelters,” said Kim Toevs, the county’s communicable disease director. “Accessing health care is hard when it is not on top of your survival list, especially if you have to leave your possessions to go to a clinic.”

Vaccine strategy for this population is a priority given that many individuals are living clustered together and hygiene practices like hand-washing are more challenging since access to running water is scarce.

Dorothy Pepper, 44, who currently is living in a shelter in Portland, said she believes homeless individuals should be a vaccine priority since those living in either shelters or encampments have a higher chance of being exposed to the coronavirus. However, that doesn’t mean she wants the vaccine herself.

“I am afraid to take it because I heard it makes you sick and I can’t be lying in bed sick because I have work to do … I also hate needles,” she said. She would be willing to learn more about the vaccine from qualified health care workers, though.

Indeed, education is a first hurdle. The county is working with Street Roots, a homelessness advocacy group, to train vaccine ambassadors who will fan the streets to provide vaccine education. People are more likely to say yes to the shot if given time to learn and think about it first, Toevs said.

In an effort to build trust and scale up the number of vaccine providers, the health department is working with organizations that already provide homeless services. Cascadia Behavioral Health, Do Good Multnomah, Transitional Projects and Human Solutions, among others, have already hosted vaccination clinics.

Planners are also discussing ways to bring vaccines to where people are already living. The county has eyed 37 potential shelter locations that account for about 1,600 shelter guests in Portland, including large congregate shelters as well as alternative shelters such as tiny home villages.

“We have had experience now at the county vaccinating a lot of adult care homes and groups homes and have experience sending small teams to those congregate sites to vaccinate,” Toevs said. Shelter vaccinations will likely mimic those efforts.

On top of shelter guests, there’s an estimated additional 2,000 people in Multnomah County who are experiencing unsheltered homelessness. This population is typically harder to reach.

By early April, the county plans to pilot mobile vaccine distribution, likely in the Springwater Corridor area, to fine-tune the process before expanding it across Portland.

The county is hopeful that more one-dose Johnson & Johnson vaccines will be distributed to the state, though they won’t know what they are working with until the doses arrive. Already, the county sent the Johnson & Johnson shots they have to vaccine events for homeless senior citizens. They are hopeful more will arrive for the mobile distribution efforts.

“Unfortunately, with everything in flux right now, we don’t have any specifics to share on vaccine distribution plans beyond (Friday’s event),” said Nicole Rideout, Cascadia communications specialist. “However, our teams are committed to doing vaccine outreach and predict as more vaccines become available for this population, we’ll be involved in those efforts.”

In the meantime, the health department and coordinating organizations have purchased bus passes, coordinated shuttle services and have received some offers from ride-hailing services to help people make it to either one of the mass vaccination sites or one of the homeless-specific sites as mobile street distribution kinks are ironed out.