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What People in Prison Need to Know About the COVID-19 Vaccine

Over 100 incarcerated people around the country told us their questions about the vaccine. Here’s information about whether it’s safe, when it could be available and more.

Medical worker Robert Gilbertson loads a syringe with the Moderna COVID-19 vaccine to be administered at Kedren Community Health Center in South Central Los Angeles, Calif., in February.
Medical worker Robert Gilbertson loads a syringe with the Moderna COVID-19 vaccine to be administered at Kedren Community Health Center in South Central Los Angeles, Calif., in February.

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Incarcerated people have been among the hardest hit by the coronavirus in the United States. At least one in every five people in state and federal prisons have caught the virus since the pandemic began, and over 2,000 have died.

Since COVID-19 vaccines became available, incarcerated people and their families have been telling The Marshall Project that they’re not getting key information. So we surveyed 136 imprisoned people to collect the most common questions. Then we got answers from vaccine experts, Centers for Disease Control and Prevention (CDC) fact sheets and other reliable sources.

How does the vaccine work?

There are two COVID-19 vaccine brands widely distributed in the U.S.: Pfizer-BioNTech, which requires two shots 21 days apart, and Moderna, which requires two shots 28 days apart.

Both work by injecting a small piece of genetic material called “messenger RNA” into your body. Messenger RNA teaches the body to make a harmless “spike protein” like the one found on the coronavirus. Your body learns to recognize the spike protein as something foreign and produces virus-fighting antibodies to protect you against it.

The Federal Drug Administration (FDA) authorized a Johnson & Johnson vaccine on February 27, and distribution will ramp up in March. Unlike the other two vaccines, it only requires one shot. It works by injecting an inactive version of a common virus called an adenovirus into your body. The adenovirus carries instructions to your cells to create the spike protein, which sparks an immune response.

All three vaccines are highly effective in preventing hospitalization and death from COVID-19. Because the vaccine supply is so scarce, most people in or outside of prisons can’t choose which brand they get.

What are the most common side effects of the vaccine?

All three vaccines can cause mild side effects one to three days after receiving a shot. Some common side effects are irritation, swelling, tenderness and muscle pain in the area of your arm where you got the shot. Some people have reported fever, chills, headache and tiredness, especially after the second dose. Experts suggest you plan for a day of rest and take a pain reliever.

Are there any serious side effects?

A tiny percentage of people who received the Pfizer-BioNTech and Moderna vaccines had a severe allergic reaction called anaphylaxis. Most of these reactions occurred shortly after the shot, which is why you should wait about 15 minutes before you leave the place where you were vaccinated. Be sure to tell the person giving you the shot if you have a history of severe allergic reactions or if you’ve ever had to use an EpiPen.

While no one who participated in the Johnson & Johnson clinical trial had an anaphylactic reaction after receiving the vaccine, a small percentage of people experienced blood clotting. Experts are still studying whether this was related to the vaccine.

How do I know the vaccine is safe?

Health officials have not reported any deaths caused by the COVID-19 vaccines. Compare this with over 500,000 people who have died of coronavirus in this country. “COVID is a very severe disease,” said Larry Corey, a virus expert who leads the COVID-19 Prevention Network. “The vaccines are effective in preventing death, hospitalization and being on a ventilator.”

Some people who took our survey said they feared companies were using prisoners as guinea pigs. More than 100,000 people participated in clinical trials for the Moderna, Pfizer-BioNTech or Johnson & Johnson vaccines before they were released to the public. The overwhelming majority of those participants were in the free world. The clinical trials for all the vaccines showed that they have an equal effect on people from different racial and ethnic groups.

At publication time, more than 75 million people—roughly 15 percent of the U.S. population—have received at least one dose.

How are prisons distributing the COVID-19 vaccine?

The first thing to note is that it’s up to states to decide when their residents get the vaccine. Most states are distributing the shots in three phases. The phases are based on whom the state government determines is most at risk of contracting COVID-19.

Medical experts have argued that incarcerated people should be in the first phase because they are at such high risk. But so far, only nine states have explicitly included imprisoned people in Phase 1. Eighteen states have placed them in Phase 2. Many of the remaining states have vaguely-worded plans that may include incarcerated people. To find out where incarcerated people fall in your state’s vaccination plan, search this list compiled by the Prison Policy Initiative.

Who gets the vaccine first in prison?

There are no universal distribution guidelines for state prisons, local jails and detention centers. According to the CDC, jurisdictions will make their own plans.

The Federal Bureau of Prisons does have clinical guidelines that they’ve made public. According to those guidelines, federal prisons will distribute the shots to people based on four “priority levels.” People who work in “health service unit jobs” or live in nursing care centers are the first priority. Second priority are people 65 and older, and those with health conditions that put them at a high risk of being hospitalized or dying from COVID-19, such as cancer, heart disease, sickle cell anemia or type 2 diabetes. On the third priority level are people ages 50 through 64, and those with medical conditions that may put them at risk of severe COVID-19 infection such as asthma, high blood pressure and liver disease. After these three groups get their shots, prison officials are instructed to give them to anyone else who wants to take it.

Should I take the vaccine if I’ve already had COVID-19?

When you recover from COVID-19, your body begins to produce protective antibodies. If you are exposed to it again, these antibodies can identify and, in most cases, defeat the virus. This is called “natural immunity.”

But the amount of natural immunity that people build up varies, and experts are still studying how effective it is in preventing future COVID-19 infections. That’s why the CDC advises that people wait to take the vaccine at least 90 days after recovering from the virus.

“We don't know how long [natural] immunity is going to last,” said Monica Gandhi, a professor of Medicine at the University of San Francisco. “It could be really long, but the current recommendations are still to get the vaccine. That’s not because we don't think you're immune after you've gotten COVID, but because it could just boost your response so that you have lifelong immunity.”

Does the vaccine prevent me from contracting the new strains of the coronavirus?

Experts are still researching how well each vaccine protects against the new coronavirus strains that have emerged in different parts of the world. Though every strain is different, early studies have shown all three vaccines to be effective in preventing severe infection. “The only real tool we have to combat the virus, besides not acquiring COVID, is vaccination,” said Corey, of the COVID-19 Prevention Network.

So if I get the vaccine can I still spread the coronavirus?

Maybe. Experts are still studying whether vaccinated people can carry and transmit the coronavirus to others. For that reason, the CDC still recommends using precautions such as masks, social distancing and frequent hand-washing even if you are vaccinated.

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Ariel Goodman is a Tow audience engagement fellow at The Marshall Project. She is bilingual, works in multiple mediums, and centers her work around community media, collaborative journalism, and engagement to uplift the voices and stories of those most affected by injustice.