Care of the homeless population during a pandemic is a serious concern. Why is this marginalized population so vulnerable during a pandemic? The more than 200,000 Canadians who access shelters or sleep outside per year (Gaetz, Donaldson, Richter, & Gulliver, 2013) are extremely susceptible to illnesses due to poor health, compromised immune systems, inadequate nutrition and barriers to accessing health services (Frankish, Hwang, & Quantz, 2005). Sleeping in shelters, which are often dangerously overcrowded and have poor air quality and limited infection control procedures, can result in increased exposure to illness. Sleeping outside of shelters poses a different kind of risk; in addition to the increased risk posed by exposure to the elements, rough sleeping lessens the educational information that individuals receive regarding protecting themselves and vaccinations. What can be done, therefore, to ensure that homeless individuals receive health-related information about dangers and appropriate care during a pandemic?

The proposal to examine pandemic preparedness in Calgary, Alberta was given new meaning and immediacy with the onset of an outbreak of a newly identified virus, H1N1, at the start of this project. Thus the overall objective to understand the local responses by health and municipal authorities as well as the service providers in the homelessness sector was subsumed under actual responses to the outbreak of a virulent strain of influenza as the study began. In this chapter, we report the lessons learned from key informants and offer an organizing framework for pandemic preparedness developed from our findings.