Can those who need it rely on King County's in-home vaccination program moving forward?

The Covid-19 pandemic has had painful and devastating impacts, including lost lives, lost health, lost jobs, and disproportionate burdens in communities of color.

But the past few years have also brought about changes that filled previously unmet needs and offered solutions. One such change is a push to make sure some of King County’s most vulnerable residents have access to vaccines.

During the pandemic, Public Health – Seattle & King County started offering a new service, bringing Covid-19 vaccine doses into people’s homes.

From April 2021 through February of this year, the county says 14,361 doses were given this way, in private homes and in care facilities like adult family homes.

King County’s in-home vaccination program is one arm of the larger mobile vaccination efforts. It was started to ensure that people who are homebound were not forgotten as the first doses were rolled out. The shots provide vital protection against the worst outcomes of Covid. Thousands of people who would otherwise have struggled to access the vaccine have now been immunized.

But like many other pandemic-era efforts funded with emergency dollars, the future of the program is far from certain.

For 82-year-old Barbara Birnbaum, a visit from public health workers is a treat.

"I'm glad to have people here. I'm alone 362 and a half days a year,” Birnbaum said.

The mobile vaccination team visited Birnbaum’s Seattle apartment on a cold but sunny Monday to deliver an updated, omicron booster shot.

They’re one of five teams that drive to every corner of King County, from rural homes to bustling downtown apartments, to provide in-home vaccinations.

Birnbaum had a stroke in 2015 and has become increasingly homebound since then. She relies on services that bring meals, books, and other necessities to her door.

She said she struggles to get anywhere these days, public transportation doesn’t work for her, she doesn’t have the apps to call a ride-share and they’re too expensive anyway.

When Covi-19 vaccines began to roll out, Birnbaum wanted a shot. But getting to a pharmacy or a public site seemed like a tall order.

“I used to get very angry listening to everyone on TV say, ‘Oh, everyone can get a shot’,” Birnbaum said. “I used to sit there and feel well, 'No, not everybody can get up and go.' It isn't a question always of wanting, it's being able to.”

Without the in-home service, Birnbaum said she likely wouldn’t have gotten the Covid shots, trusting to the fact that she rarely gets to see people or go anywhere. Still, on the off chance she gets lucky and is able to get out of her apartment, Birnbaum said she’d much rather be vaccinated.

“I feel a lot better having the vaccine,” Birnbaum said. “It's very reassuring and makes you think that you're still alive, that people know that you have needs.”

Birnbaum’s one complaint about the program is that it wasn’t easy for her to find. She wasn’t referred through her doctor or a pharmacy, her neighbor just happened across it online and signed her up.

According to the county, people have come to this service through a range of avenues. To begin with, county staff looked to programs that deliver meals to people’s homes to get an initial idea of who may struggle to get out to get a shot.

“That yielded an initial, I think, list of about 1,000 names that were then cold called and to see if they needed vaccine,” said Caren Goldenberg, manager of special populations within King County public health’s vaccine program.

That was nearly two years ago. Since then, the program has taken referrals from a range of sources like visiting nurses, hospice workers, housing authorities, and the county’s vaccine hotline.

Goldenberg said eligibility for the program has been kept deliberately loose so the county can serve people in a range of situations.

It’s designed for people who are homebound — whether short or long-term — due to injury, illness, age, or things like developmental, behavioral, and psychiatric disorders.

To date, the people served by vaccinators include people with injuries that make it impossible to travel without an ambulance, children with autism who may be distressed getting the shots in a public space, older adults, and people with mental health conditions that make it difficult to leave home.

“For people who have really no other practical way to access a vaccine, this is essential,” Goldenberg said.

“We really want to make sure that just because people aren't out in the community, that doesn't mean that they're invisible to us.”

According to Goldenberg, King County is not unique in offering in-home vaccinations, but the county was a leader in this space.

“King County was one of the first programs like this in the country,” she said.

Other programs have also popped up around Washington. Goldenberg and others would like to see this effort continued, and there’s a wish to expand it to include other vaccines.

Covid-19 vaccines are currently the only ones covered by funding. But the future of this program is unclear. Funding is only secured through the end of this year.

"The fear that funding is going to dry up is a constant concern for any public health program, really, and certainly, for ours,” Goldenberg said.

“Our funding initially came from FEMA, and as emergency orders end that money is going to dry up," she said.

According to the county, it’s difficult to break out how much has been spent on this particular service bringing vaccines into people’s homes. About $3 million has been spent on the county’s broader mobile vaccine efforts, which include other services like community events, since Covid-19 vaccines first became available.

Despite the uncertainty, there’s a desire to continue serving those stuck at home.

Stephen Pan is a clinical pharmacist and one of the public health staff who deliver vaccines in homes. He said programs like this one are essential to the mission of public health. And, he said, the desire in the community is clearly there.

"A lot of people are expecting this to continue for the next season, not just for Cove but for flu, and … we've had requests for other vaccines as well,” Pan said. “There is definitely forgotten population that wants it."

Goldenberg said she and Pan share a concern that if this program ends, there won’t be anything to fill the gap.

“We do not think that the healthcare system we have will be able to provide all of the vaccinations needed by our population, especially for the most vulnerable who may need doses more often in order to build immunity. Folks with disabilities and people who are older will have a harder time accessing care, leading many to not get the doses they need, and ultimately leading to preventable illness and death,” Goldenberg said via email.

Anyone wishing to contact the county to request in-home vaccination can call 206-848-0243.