Starting in October, a new initiative in England will offer free flu vaccinations to homeless individuals for the first time. This comes as the National Health Service (NHS) faces budget cuts and organizational changes. From October, people sleeping on the streets or staying in homeless hostels and night shelters will be able to access the vaccine at no cost. The decision was made by the UK’s Joint Committee on Vaccination and Immunisation (JCVI), which determined that homeless individuals face a similar risk of serious illness or death from the flu as people aged 65 and over. Recent data shows that over 4,793 people were recorded as sleeping rough in autumn 2025, though the actual number of people in hostels and shelters is likely much higher. Although many homeless adults were already eligible for a flu jab before this change, vaccination rates remained low. A survey in London during the 2011-12 flu season found that 42% of homeless individuals were entitled to the vaccine, but only 24% had received it—compared to over half of the general population in similar risk groups. The challenges often stem from practical barriers, such as the traditional flu vaccination process, which typically involves GP registration, a letter sent to a home address, and an appointment at a clinic. These steps can be difficult for people without a fixed address. During the COVID-19 pandemic, similar challenges were seen, even when homeless individuals were prioritized. In Wales, a study found that by November 2021, 57% of recently homeless individuals had received at least one dose of the vaccine, compared to 81% of a similar non-homeless group. It also took an average of 55 days longer to reach homeless individuals. However, successful vaccination efforts during the pandemic showed that targeted outreach can make a difference. In Liverpool, a two-day campaign brought GPs, medical students, and outreach workers into hostels and hotels, vaccinating 363 people. In Winchester, a primary care network organized two vaccination sessions at a day center, successfully vaccinating 60% of the 114 people they reached. The key to success appears to be bringing the vaccine directly to where people are, using trusted staff, offering all needed vaccines in one visit, and ensuring accurate record-keeping. NHS England has provided guidance on how to record vaccinations for unregistered individuals and has developed tools like posters, flyers, and a multi-agency toolkit. In July, the pneumococcal vaccine, which protects against serious infections like pneumonia and meningitis, was also extended to the same group and can be administered alongside the flu shot. However, there is no national requirement or funding for outreach, leaving the responsibility to local authorities and charities. While new guidance outlines how to record vaccinations for unregistered individuals, it does not address how to locate them. The future of the program is uncertain, as the NHS England body that recommended including homeless people in the vaccination list will no longer exist by 2027, and local organizations are facing budget cuts and staff reductions. For the program to succeed, it will need clear coordination, commissioning of outreach teams, and clear instructions for pharmacies and health agencies, none of which are currently guaranteed.