SASKATOON -- Advocates are urging public health workers to have concrete plans to ensure the homeless population gets priority access to the vaccine, given how likely they are to contract COVID-19 and become severely ill.

“They’re having to face the tough choice of being outside on the streets -- exposed to the cold -- or being indoors, where they’re exposed to COVID,” Dr. Monty Ghosh, co-chair of the Canadian Network for the Health & Housing of People Experiencing Homelessness, told CTV’s Your Morning on Monday.

In Ontario, homeless people were 20 times more likely than the general population to be hospitalized from COVID-19; 10 times more likely to wind up in intensive care; and five times more likely to die within 21 days of testing positive, according to research published in Canadian Medical Association Journal Open.

So Ghosh stresses that specific strategies are needed for this at-risk population, which he said has been on the rise as a result of the pandemic.

Prioritization is already underway after Montreal public health officials began to administer vaccines to the city’s homeless population last month. Officials there stress health-care workers and long-term care residents remain a top priority.

Last month, Toronto followed suit, launching a pilot project to vaccinate people in 100 shelters in the city. Dr. Stephen Hwang of St. Michael's Hospital, which is helping run the project with the city and several other organizations, said the initial rollout was, "overall, a resounding success.”

"The goal is to develop a playbook so that we can have a plan that we can go out to immunize people in shelters across the city," he told the Canadian Press in January.

Despite an eager group of residents and staff at the shelters who wanted to be vaccinated, Hwang did note there were a small number of residents refusing the vaccine. But Ghosh said there are ways to handle hesitancy.

He urged groups and organizations on the ground to enlist ambassadors with lived experiences of being homeless to be “early adopters of the vaccine” who can go on to “educate others on getting the vaccine.”

Ghosh said another “extremely difficult” challenge was keeping track of the homeless population and who was receiving the shots. But to pull this off would require the help of nurses who are “familiar faces” to the target groups.

“[They] should be ones providing the vaccine to them in the first place,” he urged, saying they could help navigate them through the vaccine process and check in with them between doses.

“[The homeless] population is often facing significant trauma in the past, mental health concerns, they have mistrust in the system, so having nurses who are familiar with them in place can be a huge win.”

Ghosh explained shelters, hospitals and organizations coordinating the vaccine rollout need to ensure there are multiple points in which homeless people could be encouraged to take the vaccine.

“This includes having and making sure the vaccine is available when they enter the system, whether they’re coming in for a meal or whether they’re coming in for the night or whether they’re interacting with the emergency department or supervised [drug] consumption services,” he said.