Ira Memaj and Robert Fullilove
Since the beginning of the COVID-19 pandemic, public health researchers warned state officials about the pandemic’s impact on vulnerable populations, including those incarcerated. Prisons and jails across the United States have become the epicenter of the COVID-19 pandemic, with an infection rate five times higher than the general population and mortality rates that are three times higher. At the time of writing, 2359 incarcerated people have died from coronavirus-related causes. As COVID-19 vaccines are deployed, plans for an equitable distribution include people in long-term care facilities like nursing homes, but incarcerated people, who are also confined in small spaces for a prolonged period, are not given the same priority. Continuing to neglect the incarcerated population while COVID-19 vaccine eligibility and distribution guidelines are created is a moral failure for our nation. It is also a right to health failing, in particular because outbreaks of COVID-19 will continue within and then beyond prisons, contributing to the public health system being overwhelmed.
The former Trump administration failed to keep its promise of vaccinating 20 million people by the end of 2020. In January, only 11 million first doses were administered while millions of other doses were sitting in warehouses. California and New York have both shown that vaccine eligibility and availability guidelines can complicate and slow the process of vaccine rollout. Each state has developed vaccine eligibility guidelines divided into Phases 1-3. According to Prison Policy, 39 states have included prison and jail populations in vaccine rollout plans, but only eight states have put them into Phase 1. With the CDC not prioritizing incarcerated populations for the initial rollout, it is no surprise that many states prioritize prison and jail staff before incarcerated people. There is hope this could change as states revise their vaccine guidelines under the new Biden administration.
Governor of Colorado Jared Polis expressed the view of many states when he said that “there’s no way the vaccine is going to go to prisoners before it goes to the people who haven’t committed any crime.” Such an approach will not result in a just health policy, nor respect incarcerated people’s right to health. Although states like Massachusetts and North Carolina have prioritized incarcerated populations in vaccine rollout, they are doing so by offering incentives such as telephone credits. This raises ethical issues around coercion and calls to mind the horrors of the history of science and incarcerated populations. For years, incarcerated people have been subjects of medical and scientific experimentations without their consent. As public health educators and researchers, we recognize the importance of prioritizing incarcerated populations for the COVID-19 vaccine, however, we also acknowledge the hesitancy that many incarcerated people have towards medical and public health officials because of this history.
Overcrowding, poor ventilation, inadequate PPE distribution, lack of COVID-19 testing, subpar medical resources, and poor hygiene protocols all promote the transmission of COVID-19 in correctional facilities. Furthermore, incarcerated people have higher rates of chronic disease, such as hypertension, which increase the risk of contracting COVID-19.
However, the state of New York is beginning to vaccinate incarcerated persons over the age of 65 this month. As reported in the New York Times:
New York corrections officials announced that people in prisons age 65 and older will soon be inoculated against the coronavirus, hours after a coalition of advocacy groups sued Gov. Andrew M. Cuomo and the state’s top health official demanding that all of the roughly 50,000 incarcerated people in the state be immediately offered a vaccine.
The lawsuit argued that leaving inmates out of the state’s vaccination plan, while others living in close quarters like homeless shelters are eligible, violates the equal protection clause of the 14th Amendment and contradicts the advice of health experts.
Advocacy groups’ use of courts, coupled with input from public health experts, is a critical first step to bring about the change needed to fulfill incarcerated people’s rights. But vaccine hesitancy in many vulnerable communities, due to their historic mistreatment and abuse by the healthcare system, needs to be addressed and respected. Doing so requires us to understand and overcome pathologies of power that continue to dehumanize incarcerated people. A human rights approach is needed to abandon the view that incarcerated people are indebted to society and non-deserving of adequate healthcare measures. Public health initiatives must address any misinformation about the COVID-19 vaccine and communicate clearly that although incarcerated people are a priority in vaccination rollouts, they also have the right to refuse any health or medical service.
Public health professionals specializing in vaccine hesitancy must work closely with prisons and jails to make the first and second doses of COVID-19 vaccines available to their incarcerated populations. People in jails have much shorter stays which will require systems to ensure ways of delivering a second dose. A rights-based approach would also include public health engagement with grassroot and community-based organizations to identify broader health issues and solutions specific to correctional systems. Incarcerated and vulnerable populations must be included in the decision-making processes about the vaccine to promote their confidence and understanding about this life-saving technology.
Ira Memaj is a public health educator and researcher at Columbia University Medical Center. Email: Im2556@cumc.columbia.edu
Robert Fullilove EdD., is a professor of Sociomedical Sciences at the Columbia University Medical Center. Email: Ref5@cumc.columbia.edu