Now that shipments of Covid-19 vaccine are on the move and FDA approval on the fast track, the fight begins over who will get the scarce vaccine first.
States have until Friday to finalize distribution plans and submit them to the federal government, including priorities for early access to the vaccine, since manufacturers say supply of the vaccine will be limited for months. According to more than 40 draft proposals analyzed by the Covid Prison Project and The Marshall Project, in at least six states, incarcerated people will be among the “phase one” recipients of the vaccine, along with medical personnel and essential workers. In many more states, they are slated to receive the vaccine during phase two, as a member of so-called “critical populations.”
That’s a common-sense epidemiological call, say public health experts. Incarcerated people are at high risk from the disease due to cramped facilities, inadequate medical care and a disproportionately high rate of underlying conditions. Prisons and jails have been the epicenters of some of the largest outbreaks during the pandemic. Research has also shown that beyond the obvious risk to the people who live there, prisons, jails, and detention centers could serve to incubate and seed the virus back into the general community, since employees move between the institutions and their homes.
“These decisions ought to be driven by epidemiology and where the likelihood of minimizing harm is most likely,” said Holly Taylor, a bioethicist with the National Institutes of Health during a webinar hosted Wednesday by the The SEICHE Center.
“From that perspective incarcerated populations ought to be high on the list.”
Not everyone agrees. On Tuesday, Colorado Gov. Jared Polis pushed back against the recommendations of his state’s own distribution plan: “There’s no way it’s going to go to prisoners... before it goes to the people who haven’t committed any crime.” Polis, a Democrat who has championed a number of criminal justice reforms, chuckled as he said the word “prisoners,” according to the Denver Post.
That’s an attitude that has frustrated experts. Saad B. Omer, director of the Yale Institute for Global Health, called it “immoral” to promote any plan that isn’t laser-focused on mitigating the risk of infection and the risk of bad public health outcomes.
“It's not our job and shouldn't be our job to say who is more quote—unquote valued by the society or not,” Omer said during the webinar.
Polis was responding to an unusual stipulation in Colorado’s rollout plan that put incarcerated people into priority group “2A” and higher risk individuals in the general public (like those with underlying conditions) in group “2B”. A number of states may have avoided controversy by just listing all of those people in group two with no modifiers, even if their rollout plans would have fundamentally worked the same way.
Polis said that as the state vaccinates people who are 65 and older, Colorado would include prisoners in that priority category, but added in a statement through a spokesperson that “no prisoner should be placed ahead of others just because they are a prisoner.”
Generally speaking, states provided inconsistent information in their draft proposals about when specific populations would receive vaccinations. Many were unclear or had yet to determine whether certain critical populations—like prisoners and corrections officers—would have priority over others, or one another.
All the state plans are based loosely on Centers for Disease Control guidelines published in October. Lauren Brinkley-Rubinstein, director of the Covid Prison Project, said that those guidelines explicitly ask states to consider incarcerated people in their plans, and make equitable access a priority. She said it’s likely that had the CDC not made those points explicitly, the state guidelines would have been even more scattershot and unclear on priorities for incarcerated people.
As with the general public, another question that will emerge is what percentage of incarcerated people will want to receive the vaccine and whether or not those who decline will face any informal retribution—like being placed in isolation for "safety"—as a result.
The Marshall Project spoke with a handful of people in the Texas and federal prison systems who offered a range of opinions. One man said he would take it without hesitation and that all his neighbors agreed. Another said he had concerns but had been talked into it by family outside. Another said no, but only because he had already contracted the virus and had antibodies. One prison staffer in Texas said he was more worried about his coworkers “who are listening to Alex Jones" refusing to take it than he was about prisoners opposing it.
The host organization for the webinar has been corrected from a previous version of this story.