The Case For Vaccinating Prisoners Early

A prison health expert explains why incarcerated people should be near the front of the line for the coronavirus vaccine.
Prisoners in Chicago's Cook County Jail plead for help by posting a sign in window.
Prisoners in Chicago's Cook County Jail plead for help by posting a sign in window.
Jim Vondruska / Reuters

Prisons and jails are among the most dangerous places to be in a pandemic. People housed within them cannot socially distance or quarantine. Mask-wearing is optional in many institutions, which leaves prisoners even more vulnerable to the coronavirus. Compounding these conditions, prisoners are already far sicker than the general population, making them extra vulnerable to the virus.

Since the pandemic began, correctional facilities have been home to some of the biggest outbreaks in the nation. Roughly 250,000 people in prison have been infected with the virus and at least 1,647 have died, according to data collected by The Marshall Project.

The risks for incarcerated people, who are infected by the virus at a rate more than five times higher than the nation’s overall average, are clear and undeniable. But where should they rank when it comes to vaccine distribution?

As governors work with health officials to devise each state’s distribution plan, they will have to make tough calls about who qualifies to get the vaccine and when, decisions that are doomed to be fraught with political considerations.

An analysis of state draft plans by the Prison Policy Initiative found that while the majority of states considered incarcerated people as a priority group in their vaccination plans, many of them were still prioritizing correctional staff before incarcerated people. Twelve states did not include incarcerated people in any phase of their vaccine allotment plans.

HuffPost spoke with Marc Stern, a physician who formerly served as the top medical officer for the Washington State Department of Corrections, about why prisons have been hotbeds for the virus, and why it makes sense to vaccinate incarcerated populations sooner rather than later.

Why do you think it is important that states prioritize people who live and work in prisons for the vaccine?

So, there’s a few reasons. People in prison and in jails are in congregate environments, which means a place where infection spreads much more easily. You and I, we’re both probably telecommuting, we can stay home and stay out of other people’s way for the large part. But when you’re in an environment like a jail or prison or ICE facility or even a nursing home, you don’t have that ability. You can’t send granny home. You can’t send the person who’s been convicted of a serious crime home.

These [incarcerated] folks are already at higher risk because they’re older and they have more comorbidities. We have more people with diabetes and hypertension and respiratory diseases per capita in a jail or prison than we do in the community.

We know that there’s a high risk of transmission in [correctional facilities] because of the staff who come in and out. Nurses, doctors, custody officers, cooks, etc., are going back and forth between their place of work and their community. Infection spreads more easily, and when it does, because it’s not a closed vessel, it will spread into the community.

What would you say to those who object to people in prison getting the vaccine before the general public?

The humanitarian reason is that people who committed crimes should not be punished twice. You are sent to prison as punishment, not for punishment. The sentence that was prescribed was being locked up in a cell. It was not to be locked up in a cell and then let’s do what we can to help you die. That’s the humanitarian and legal answer.

Beyond that, the reason why the public should be supportive of vaccinations in the jails and prisons is that infection spreads more easily there and it will spread into the community. We’ve seen that happen in places like Chicago, where we know that because of infections in the jail, there were more infections in the community. [Editor’s note: One study found that nearly 16% of Illinois COVID-19 cases were linked to spread from a Chicago jail.]

“The sentence that was prescribed was being locked up in a cell. It was not to be locked up in a cell and then let’s do what we can to help you die.”

When [incarcerated people] get COVID-19 and become very sick, where do they go? They’re going to go to the community hospital for their intensive care. You as John Q. Public want to make sure that there’s a hospital bed for you when you get sick. A good way of doing that is making sure that the high-risk people, like nursing homes and prisons and jails are protected ― that’s the best way to keep those beds open.

Another reason is that this is a population with a high percentage of people who are homeless or who have mental illness. If you want to protect yourself, you’re going to want these populations to be coming out of jail and prison protected. They’re going to be the hamburger flipper, they’re going to be the person packaging your groceries at the store. Wouldn’t you want them to be protected so that you are protected?

There are indications that some states are planning to vaccinate correctional workers before the incarcerated residents. Federal prisons, too, are gearing up to vaccinate staff but not prisoners. What do you think about that?

So there are the residents of the facilities and the staff, which has two components: medical staff and custody staff. In most of the plans, I think medical staff will be prioritized, as many of them are taking care of COVID-19 patients who are in isolation in prison. But the custody staff are accompanying the nurses and doctors when they see these patients, so they are working on a daily basis with patients who have COVID-19, just like our front-line health care workers. It’s important that they be prioritized, and when I say prioritize, I don’t mean the first in the line but higher than the ordinary person.

Certainly people at higher risk should be prioritized, which means people with comorbidities, including elevated age. You’ve probably seen the age limit of 65 used in some of the national documents. After age 65, risks go up. What most people don’t know is that people in jail and in prison are older than their stated age, physiologically older. [Editor’s note: Some studies suggest that prisoners age more quickly than their counterparts in the community.] When you look at the policies and procedures of many jails and prisons around the U.S., when they define “older population” people who need to have more frequent physical exams, and need certain accommodations, they use a lower age, 50 or 55.

If national and state authorities want to use age as a tool for prioritization, they need to be using a lower age limit for people who are in jail and prison than in the community. A 50-year-old in prison is maybe equivalent in risk factor to a 65-year-old in the community.

Anything else you want the public to know?

The most valuable way of reducing risk right now in correctional facilities is reducing populations. Jails across the country have been very good at doing that. We have some jails here in Washington that have simply closed. Other jails are down to 50%, 40% of their normal operating population. Prisons, whether you’re talking about state or federal prisons, have not gotten nearly that close to reducing the population.

I don’t want to empty the jails and prisons ― there are people in there who need to be in there for our safety and they need to be in there for rehabilitation ― but there are some people, who right now given the risks of staying in prison, and the risks of being released to the public, where the risk-benefit balance is in favor of letting them out. It has not been done to the extent that it needs to be done in the prisons in our country.

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