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Health

Perth's homeless population remains vulnerable to COVID-19, with many unvaccinated

Long-term rough sleeper Des worries about what will happen as COVID spreads through Perth's homeless community. (ABC News: Keane Bourke)

As one of Perth's 1,000 or so rough sleepers, Des is particularly vulnerable to the effects of COVID-19.

Getting vaccinated would almost certainly protect him against the worst of the virus, but he is just not comfortable taking that step yet.

"People just not gonna put something in their body without the information," he said.

"Information don't just go straight to the streets.

"We need to look at TVs, we need to look at internet for information, which none of our mob have."

His experience highlights something hidden in WA's high vaccination rates – a group of about 50,000 people who remain unvaccinated for various reasons.

And more than a year into WA's vaccination rollout, many of them feel left behind.

A third of Perth's homeless population unvaccinated

Lisa Wood has been studying the rollout into Perth's homeless community, and recently compiled the best picture to date of the group's vaccination rates.

About a third were completely unvaccinated, and only about half had received two doses.

Less than seven per cent have had a booster.

While those numbers would have risen in recent weeks, it still sits in stark contrast to overall rates in the community, where 61 per cent of people aged over 16 have received their third dose.

"That's a particular concern because we know the evidence in terms of Omicron is that the third booster dose is really critical for [getting] people protected," Professor Wood said.

More than 98 per cent of West Australians have had at least one dose of a COVID-19 vaccine. (ABC News: Keane Bourke)

"This is a group that is highly vulnerable in terms of underlying health conditions and not being able to isolate."

In the shade of Perth's Weld Square, Des made it clear he wanted to feel comfortable enough to get vaccinated.

"How can I be a part of the community when I don't get the information?"

Distrust of authority adds to hesitancy

Professor Wood said Des's experience was not unique.

"What we've found, speaking with people who are homeless and the services who work with them is that word of mouth is often how they hear information," she said.

"In this community there's much more reliance on that, and what people they trust say, as opposed to going off or looking at a government website or reading a brochure."

Professor Wood has studied both vaccination rates and obstacles to vaccination in Perth's homeless community. (ABC News: Keane Bourke)

On top of that, many on the streets have experienced deep trauma that has left them with distrust of government and authority.

It means the rollout can take much longer, even for a relatively small population.

"It can take a long time of just gradually talking to people, chipping away at what some of their concerns might be, before they're ready to say I'll take the needle," Professor Wood said.

Health authorities have rolled out a range of programs to try to increase WA's vaccination rates. (ABC News: Keane Bourke)

Many of the programs that have been trying to break down those barriers did not start until the last half of 2021.

"Heaven forbid we have another pandemic, but I really hope that if we did or there's another variant after Omicron that we would see a really proactive effort to build on what's working now," she said.

"Which is working with Aboriginal elders, working with homelessness services."

Taking the vaccine to those left behind

Since November, Indigo Junction has been going door-to-door in Perth's suburbs to try to vaccinate those who would otherwise have been left behind.

Case workers with strong relationships in the community start by going into people's homes and talking about the vaccine.

In some cases, it means they can reach those who don't live there permanently, but are staying temporarily.

Indigo Junction's teams have been working with people at their homes in Perth's suburbs to try to boost vaccination rates. (ABC News: Keane Bourke)

They answer questions, dispel misinformation and allay fears.

Once people are comfortable, they can then call in nurses from WA Health.

Out come the camping chairs and a trolley carrying everything needed to bring the vaccine literally to people's doorsteps.

It's an approach that has helped vaccinate about 600 people in the last four months.

WA Health nurses working with Indigo Junction can deliver the vaccine anywhere, including in people's driveways. (ABC News: Keane Bourke)

"We find that by visiting them face-to-face, we can provide that information to them and make sure it's accessible for them to reach that vaccine," said Ella Chiari, one of the service's case workers.

And while information is the key concern for some, others find access the biggest obstacle.

"They might not be able to make appointments or stay [for a] period of time where they're lining up," Ms Chiari said.

Ms Chiari says the program has helped increase the vaccination rate in and around Midland. (ABC News: Keane Bourke)

"We're providing vaccines to people that may live in a refuge environment where it's not safe for them to be out in the community.

A slightly different approach has seen success at St Patrick's Community Support Centre, where a pop-up clinic has been running each week.

The city boasts a double-dose vaccination rate of above 95 per cent, but it is a radically different story for those who sleep rough.

Fred received his booster at St Patrick's. He is one of hundreds to be vaccinated there so far. (ABC News: Keane Bourke)

The centre has already vaccinated about 400 people across more than a dozen pop-up clinics since September.

Is the vaccination push coming too late?

Chief operating officer Traci Cascioli puts that down to the connection people have with the centre and its staff.

"For many of them, this is a trusted site, it's a place that they're familiar with, they feel comfortable," she said.

Ms Cascioli says the trust people have in St Patrick's and its staff has made a big difference. (ABC News: Keane Bourke)

"We have staff that have a relationship with many of them already and can provide that encouragement and that support in helping them receive their vaccination."

Professor Lisa Wood said both programs are important, because they bring the vaccine to where people already are.

"Until more recently, [they] haven't been able to get vaccination in settings where they feel comfortable, and being delivered by people that they trust and know," she said.

Bringing vaccines to people where they are most comfortable will be key to vaccinating those who haven't yet had the jab. (ABC News: Keane Bourke)

"That's the really critical thing that we're seeing in Perth and in other places."

But with Omicron already spreading through the community, and at least one case already putting a rough sleeper in hospital, there are fears the vaccination push is coming too late.

Government urged to act now

Fiona Stanley, former CEO of the Aboriginal Medical Service Ted Wilkes, and homelessness campaigner Betsy Buchanan raised those concerns in an open letter to Premier Mark McGowan on Friday.

"We understand that there is a plan to rapidly accommodate large numbers of rough sleepers in the event of an outbreak," the letter reads.

"It is imperative that the government act now to ensure the safety of this highly vulnerable, largely unvaccinated population and the health and wellbeing of the whole community."

There are estimated to be about 1,000 homeless people across Perth. (ABC News: Hugh Sando)

The ABC has seen a draft version of the plan from December, which aims to protect rough sleepers and minimise community transmission by placing them in emergency accommodation.

Hotels are preferred under the plan, but camps and evacuation centres have also been considered.

The document acknowledges there is no one trigger for the plan to be activated, a point Health Minister Amber-Jade Sanderson emphasised in Parliament on Thursday.

"There's a range of factors that the Chief Health Officer takes into consideration around triggering that outbreak plan," she said.

Ms Sanderson says it's not yet necessary to activate a plan to take homeless people off the streets and into emergency accommodation.  (ABC News: Keane Bourke)

"He is working and the public health team are working hand-in-hand with the Department of Communities to support that rough sleeping community through this difficult time."

Ms Sanderson said a number of hotel rooms had already been purchased by the Department of Communities for people to isolate, or recover from COVID, if they had nowhere else to go.

"We don't need to trigger the outbreak plan to do that," she said.

No-one deserves 'to die alone on the streets'

As case numbers continue to grow, so too does concern over what will happen when the virus inevitably spreads through WA's vulnerable communities.

"It's very difficult that we, as homeless people, have to be out on the street while the pandemic is taking place," Des said.

"We are finding it hard to cope with what's going on."

Des is worried people may die alone on the streets during the pandemic. (ABC News: Keane Bourke)

One of his biggest fears, which is shared by many, is that COVID will only add to the number of those already dying on Perth's streets.

"No-one should deserve to die alone on the streets," he said.

"That's terrible, to just slowly slip away, no-one not even knowing nothing."

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