As the country approaches the one year mark of a pandemic that has claimed the lives of over 400,000 Americans and more than 2 million people worldwide, many are finding some spark of hope in the new availability of new and highly effective vaccines. In the face of limited supply, states have organized a tiered rollout strategy, prioritizing particularly vulnerable groups like frontline workers, the elderly, and those with preexisting medical conditions. Overwhelming demand and haphazard distribution have also made it less clear when most Americans can expect to actually receive their immunization, and for those who are incarcerated, that precarity is particularly acute. The timeline for when people in prisons and jails might become eligible for vaccination varies widely from state to state: While some have prioritized those inside, others have yet to formally announce when—or if—incarcerated communities will have access to the vaccine at all.

In mid-November, the American Medical Association called for people in jails and prisons to be prioritized for vaccination and placed in the initial phases of distribution. As Prism has reported, correctional facilities are ripe for the rapid spread of viral infections like COVID-19. Lack of access to cleaning products, cramped quarters that do not allow for social distancing, and inadequate distribution of PPE such as face masks, all coalesce to make incarcerated people particularly vulnerable to the virus. Further, substandard medical care and living conditions along with an aging population has rendered the health profile of those inside far worse than those in the general public. That unique susceptibility to the virus shapes why advocates believe incarcerated people should be prioritized for vaccination as their own group, and given clear directives and timelines for when to expect the shots.

But the question of vaccinating people inside has either been met with silence or erupted into political debate around the country, highlighting the ongoing contention around how incarcerated populations are viewed. It also suggests a fundamental misunderstanding of how extending basic protections to incarcerated people better ensures the health of not only people inside, but also the broader public. States’ choices about whether to prioritize prison staff over incarcerated people, whether to recognize incarcerated communities as their own unique group, and the political battles that have emerged around these questions threaten serious consequences both for those inside and their surrounding communities.

Priority groups and politics

While states began crafting their vaccine protocols around October—many using data and learnings from the H1N1 vaccine rollout—those initial decisions are not set in stone. In the months since, pushback and political pressure from both conservative leaders as well as organizers advocating on behalf of those inside have led some governors to dramatically shift how they prioritize incarcerated populations.

On Jan. 20, an advisory panel for Wisconsin’s Department of Health Services (DHS) submitted the recommendation that incarcerated people be included within the first phase of the state’s vaccine rollout plan. While the panel is moving forward on the recommendation, they did receive 80 public comments in opposition to the prioritization of those in prison and jails. Further, the DHS recommendation comes on the heels of a recently proposed bill that seeks to deprioritize incarcerated individuals across the state. Senate Bill 8, introduced on Jan. 15, would direct DHS not to prioritize an incarcerated person for vaccination, but instead place them in the same allocation phase as those in their age group within the general population. Further, the bill “directs DHS not to prioritize incarcerated persons within an allocation phase.”

In other states, the debate between conservative leadership and advocates has resulted in more definitive wins on each side. In Illinois, advocacy groups successfully pushed Gov. J.B. Pritzker to advance incarcerated communities into the state’s first phase—the same category as teachers, soldiers, police, and firefighters. Pritzker says the decision was “effectuating equity.” In Colorado, however, incarcerated communities were deprioritized in early December after some conservatives opposed Gov. Jared Polis’ initial plan to include incarcerated people in the same category as others living in congregate settings. During a press conference, Polis explained to reporters “there’s no way it’s going to go to prisoners before it goes to the people who haven’t committed any crime.” Incarcerated Colorodans will now be vaccinated incrementally alongside others in their age bracket.

Contestation has also come from those inside, such as in Oregon where incarcerated people and the Oregon Justice Resource Center filed a temporary restraining order “requiring [the Oregon Department of Corrections] to offer vaccinations to adults in custody starting immediately, subject to vaccine availability, and to complete the process as promptly as practicable.” The state’s current plan places some incarcerated people within the first phase of their overall vaccine rollout plan, but the categorization only applies to incarcerated people who work within their prisons’ medical settings, rendering the overwhelming majority ineligible.

From state to state, vaccine rollout varies broadly

Amid these political debates, marked differences have emerged in how states have chosen to categorize incarcerated individuals in their vaccine rollout plans. Some recognize incarcerated communities as their own group and often place them into the same vaccine tier as other residents of “congregate settings,” such as those living in shelters or nursing homes. Other states however, have chosen not to separate out incarcerated communities and instead are folding them into the same brackets created for those in the general population—brackets based on one’s age and preexisting medical conditions. For instance, under the latter approach, instead of being among the first in her state to be vaccinated, a 25-year-old incarcerated woman would be vaccinated at the same time other people in her age bracket are and thus might be among the last in her state to receive the vaccine. Alternatively, a 70-year-old man incarcerated elsewhere in that state would be among the first vaccinated, since he would get access to the shots at the same time as people 65 years and older in the general population.

• States categorizing incarcerated people as their own group in their rollout plans include Arizona, South Carolina, Iowa, Maine, Indiana, Kansas, Connecticut, Rhode Island, Montana, Alabama, Pennsylvania, New Mexico, Mississippi, Tennessee, Oklahoma, Hawaii, Virginia, and Nebraska. Two other states in this category, Massachusetts and New Jersey, have been particularly adamant about the necessity of vaccinating the incarcerated along with other high priority groups and thus have already begun their vaccination efforts for those inside.

• Thus far, states using the age bracketing approach include New Hampshire, Michigan, Georgia, North Carolina, Vermont, Nevada, and Colorado. Given the general prioritization of those 60 years of age and older in almost every state’s rollout plan, some states with age based tiering like Utah, Louisiana, Washington, Minnesota, and Missouri have already begun vaccinating elderly people inside.

• Meanwhile, some state rollout plans remain incomplete as they prioritize certain subsets of incarcerated people or particular correctional facilities while staying silent about their remaining incarcerated population. In Ohio, officials have allotted vaccines for people incarcerated in three of the state’s prisons—Franklin Medical Center, Pickaway Correctional Institution, and Allen-Oakwood Correctional Institution—but have not created a plan for the rest of the state’s incarcerated population. Similarly, in California, vaccination plans have been released for people incarcerated at the Central California Women’s Facility in Chowchilla, the California Health Care Facility in Stockton, and the California Medical Facility in Vacaville, but no details have been given around when other facilities might expect to receive their vaccines.

• At least six states continue to have no concrete plan for vaccine distribution to any of their incarcerated population. Texas, New York, Arkansas, Alaska, Florida, and South Dakota have remained silent on when communities might be able to expect a timeline. That silence, particularly from state officials touted as progressive like New York Gov. Andrew Cuomo has elicited strong pushback from advocates.

According to the COVID Prison Project, a tracker collecting data on COVID-19 infections and deaths amongst incarcerated people and prison staff, a majority of the largest single-site outbreaks since the onset of the pandemic have been in prisons and jails. As of Feb. 1, there have been over 360,000 recorded cases of COVID-19 amongst those incarcerated and over 2,000 deaths. Prisons and jails already have incredibly poor healthcare services and state and local departments of corrections have consistently executed prison transfers that result in infection spikes. Further, the ability to take certain protocols that have become commonplace over the past year such as washing hands, using hand sanitizer, and replacing face masks on a consistent basis are impossible to do inside. Such conditions render the experiences and risk levels of those inside incomparable to people in their same age cohort living within the general population.

Special treatment for prison staff

Quelling the spread of the virus within an entire community may hinge on stamping it out in contained spaces like prisons and jails first. After all, correctional facilities are not just deadly for those inside; they are also vectors for disease, incredibly efficient at spreading infections beyond the prison walls primarily through correctional staff who enter and exit facilities daily. As a result, some states have been adamant about prioritizing the vaccination of prison staff even above that of incarcerated people.

In Ohio, where a vaccination timeline has only been provided for just three of the state’s 28 correctional facilities, Gov. Mike DeWine has been explicit that the remaining incarcerated population will be vaccinated only after prison staff. When asked about the rollout plan for the state’s entire incarcerated population during a December press conference, DeWine replied, “If you’re asking the question, ‘When do we get to prisoners?’ I don’t know the answer yet. If you’re asking the question, ‘When do we get to prison personnel who are working there?’ It’s going to be earlier.”  

In Nevada, state officials have taken a similar approach, telling local news media that people living inside correctional facilities will receive vaccines only after the vaccination of employees has concluded. According to reporting from The Nevada Independent, the Nevada Department of Corrections has said that “given that staff members interface with their communities, they are most likely to spread the virus to other staff and to susceptible inmates. As such, the NDOC has prioritized the vaccination of employees.”

While highly unlikely, it is still not yet clear if those who are vaccinated can continue to carry and transmit the virus to others, meaning that while states have decided to explicitly focus on the vaccination of prison staff, prioritizing a physically stagnant population like those detained in prisons and jails may be the most effective strategy at preventing it’s spread. As a more transient population, prison staff might still be able to potentially introduce the virus into the facilities that they work even after vaccination. That’s a particularly troubling concern given reports from families with incarcerated loved ones who share that corrections officers often do not wear face masks.

Uncertainty defines the general conversation about COVID-19 vaccination efforts across the country. The introduction of new, effective vaccines brings hope just as news emerges about the circulation of highly contagious and potentially deadlier virus strains. The need for mass vaccine distribution under such urgent conditions underscores the necessity of protecting frontline workers, healthcare staff, the elderly, the medically vulnerable, and those living in congregate settings. However, those same exigencies may also fuel even more political debate in the coming months about the value of focusing on the over 2 million people currently inside correctional confinement. Such debates will likely continue to uplift ideas about deservedness, righteousness and morality—arguments rooted in a punitive logic that fails to reckon with readily available data about the public health imperatives of first vaccinating those most vulnerable within the facilities most liable for continuing the spread of COVID-19.