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Gerry Humphrey, second left, greets registered nurse Alicia Schuurmans with an elbow bump before receiving his first dose of the Pfizer-BioNTech COVID-19 vaccine at a pop-up vaccination site at the Portland Hotel Society needle depot in the Downtown Eastside of Vancouver, on April 29, 2021.PHOTOS BY DARRYL DYCK/The Globe and Mail

The last time Guy Felicella hustled in this Downtown Eastside alley, he lived four floors above, in a cramped, single room. If clients had paid up, he would throw a baggie of heroin down from the fire escape that he had greased up so police officers wouldn’t be able to climb it.

That was 15 years ago. On Thursday, Mr. Felicella stood in the alley under his old room, peddling a different drug: the COVID-19 vaccine. As people wandered by, some accessing the sterile injection supplies offered through a walk-up window, he would beckon them over: “Did you get the vaccine?”

Guy Felicella in the Downtown Eastside of Vancouver.

“The crazy thing is, every corner that we’ve posted up on, I was selling dope on for decades,” said Mr. Felicella, who now lives a different life as a public speaker and peer clinical adviser on drug policy. “Now I’m pushing Pfizer.”

Mr. Felicella is an unlikely figure in a mass vaccination strategy that has transformed the rough and tumble Vancouver neighbourhood from one of the worst COVID-19 hot spots in the province to one that has achieved herd immunity. Weekly cases have plummeted from close to 60 to fewer than 10. An old casino that was transformed into a shelter for COVID-positive residents has been shuttered, for lack of need.

To date, more than 11,600 people in the neighbourhood have received at least one vaccine dose as part of the strategy – about 80 per cent residents and 20 per cent staff.

There is no official agreed-upon threshold of what proportion of a population needs to be vaccinated or immune to COVID-19 for herd immunity to happen. Nonetheless, the phenomenon has been achieved when a community has enough immunity that the disease can no longer spread – as has happened in the Downtown Eastside.

Since the early days of the pandemic, public-health officials had feared what would happen when the coronavirus reached the Downtown Eastside. With cramped congregate settings, large social networks and a transient population with few options for self-isolating, the neighbourhood bore the perfect conditions for COVID-19 to sweep through like wildfire.

Worse still, higher rates of underlying health issues in the community – including heart disease, chronic obstructive pulmonary disease (COPD) and smoking – meant residents were four times more likely to be admitted to hospital with COVID-19 than the general population, said Althea Hayden, medical health officer for Vancouver Coastal Health (VCH).

In 2020, the health authority assembled a mobile COVID-19 testing team and worked with housing providers to implement safety protocols in local buildings. It also partnered with BC Housing to transform a former casino into a shelter for those who tested positive, and secure several floors of a hotel for those who had been exposed to the virus and needed to quarantine. Then, as August turned to September, it happened.

“It was Labour Day weekend that we realized that the thing we had been preparing for, and working hard to prevent, was happening,” said Miranda Compton, executive director of prevention for VCH. “We had a significant number of cases in the Downtown Eastside.”

The neighbourhood, composed of just a few compact city blocks, recorded 52 cases of COVID-19 that week, to be exact.

To get a granular look at neighbourhood conditions, VCH focused on a group comprising roughly 10,000 precariously housed people. The health authority excluded condo dwellers and included a few thousand staff members who regularly work in the neighbourhood but may live outside of it.

Those parameters showed that the Downtown Eastside suddenly went from having a couple of new cases a week to more than 40, on average – a rate that continued for months. The shelter and hotel quickly filled with dozens of residents each.

“We were constantly concerned that we weren’t able to get the cases down,” Ms. Compton said. “But we were also sort of relieved that having these interventions at the ready meant that we didn’t have exponential growth.”

In February, as case counts pushed up past 50 a week, the health authority received a large shipment of COVID-19 vaccine, prioritized for the neighbourhood. That’s when efforts kicked into high gear.

Dakota Bouvier receives his first vaccine dose from registered nurse Marcela Bonilla at a pop-up site at the Portland Hotel Society in Vancouver on Thursday.

The health authority divided the area into four quadrants, dispatching teams of nurses, outreach workers and peers to vaccinate residents building by building. Bare-bones vaccine clinics were set up on the street, with folding tables and a few nurses. Members of the SRO Collaborative, a group that advocates for residents in single rooms in the neighbourhood, knocked on doors and put up flyers advertising clinics. A local graffiti artist spray-painted the information on a large wall next to a busy overdose prevention site.

Mr. Felicella, enlisted to liaise with local residents, said the question he is most commonly asked is whether he has gotten the vaccine himself.

“I say, ‘Yeah, I got it months ago. No issues. I had a sore shoulder for a couple days.’ One of the guys responded, ‘Well, I’ve had a sore back my whole life. That’s all I’ve got to worry about?’ I laughed my head off,” he said.

“I really just transferred what I was good at and used it for good now. A hustler is just a salesperson anyway.”

In March, as variants of concern pushed B.C.’s case counts to the highest levels the province had ever seen, cases in the Downtown Eastside plummeted. It has held steady since, with an average of fewer than 10 cases a week. The shelter for COVID-positive residents, no longer needed, closed in mid-March. The hotel reserved for people with potential exposures currently houses fewer than 10 people.

“We were sort of scared to believe it until we saw it sustained for several weeks,” Ms. Compton said.

Barring the introduction of vaccine-evading variants, Dr. Hayden believes the neighbourhood is now largely protected from COVID-19.

“When we talk about ‘herd immunity,’ what we mean is there’s a high enough level of immunity that it prevents ongoing, sustained transmission,” she said. “And I do believe we’ve achieved that in the Downtown Eastside.”

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