2021-1-2 Are We Our Brothers’ Keepers?

The Ethics of Vaccine Administration: The Incarcerated

“The subject [of vaccination priority] has become a contentious and political issue, particularly in the USA, with experts worrying that prisoners will be excluded from vaccination plans all together. Last week, Colorado Governor Jared Polis said, “there’s no way [the COVID-19 vaccine] is going to go to prisoners before it goes to the people who haven’t committed any crime. That’s obvious”.

As of mid-December 2020, just a week before the Pfizer-BioNTech COVID-19 vaccine was made available, the CDC hadn’t yet issued a firm recommendation about the order in which federal and state prisoners, as well as those being (temporarily) incarcerated in local and county jails, should be vaccinated. The U.S. has prioritized two groups for its Phase1a rollout, namely front-line healthcare workers and the staff and residents of long-term care facilities (nursing homes, assisted living, homes for the developmentally disabled, and others).

This, despite the fact that inmates are on average nearly four times more likely to contract and twice as likely to die of Covid-19 as members of the general population. Prisoners are at higher risk of contracting and succumbing to the virus for several reasons: first, the congregate setting of jails and prisons, which make social distancing impossible – and when it is attempted, prisoners are placed in quarantine or solitary confinement, endangering their mental health. Second, prisoners suffer from a higher rate of comorbidities than the general population. Third, the U.S. prison population is aging, and older than the general population. Fourth, prison healthcare is inadequate in the best of times. Fifth, early on in the pandemic, supplies of PPE, masks, hand sanitizer and even soap were limited to unavailable in prisons and jails, making them an early viral hotspot. Sixth, although most people think of prisons as places hermetically sealed off from the communities in which they are located, this is not true; prisons – and even more so, jails – are “high-churn” populations, with inmates being moved in and out constantly. This means that inevitably prisons increase community transmission.

One of the many disheartening aspects of the underwhelming vaccine rollout in the U.S. (as of Jan. 1, just 2.8 million people had received the vaccine, less than 1% of the population – at that rate, it would require something like 3 years to vaccinate the entire population) is that both the CDC and state departments of health have been remiss in prioritizing state prison inmates for receiving the vaccine; just seven states have explicitly included inmates in Phase 1 of vaccine delivery. Nineteen states have explicitly listed prisoners in Phase 2 (when there is a “large number of vaccines available” and “supply is likely to meet demand”). But others have left it to be inferred when they plan to vaccinate prisoners or made no reference to prisons at all in their official vaccination plans, on the assumption that prisoners will receive no priority and be vaccinated along with the under-65 general population who are not considered high risk.

Once more, we are witnessing the failure of national leadership to establish clear, science-based criteria for the order of priority in vaccinating the entire population of the country, which has resulted in the governors and health departments of individual states being forced to take decisions which are in many cases being guided not by science, but by political expediency. It is therefore very much to the credit of the departments of health/governors of Connecticut, Delaware, Maryland, Massachusetts, Nebraska, New Mexico, and Pennsylvania, all of which/whom have put incarcerated persons in Phase 1 (or a subcategory of this Phase) for vaccination. And it’s very much to the discredit of leadership in no fewer than 11 states whose vaccination plans make no reference whatsoever to incarcerated individuals.

In some sense, this is understandable and predictable; the fact that vaccine supplies are limited – and that there are still many difficulties involving distribution and administration – means that even frontline healthcare workers and the staff and residents of long-term care facilities (nursing homes, primarily, where around 1 million people live) will take up most, maybe all, of the initial Phase 1 supply.

New York’s plan (as of early December) called for residents and staff of nursing homes to be vaccinated first, ahead of frontline healthcare workers who come into direct contact with coronavirus patients; the next stage of its Phase 1 included all those living in congregate facilities – including prisons and jails, although the latter present difficulties with a vaccine requiring two dosages at least 21 days apart, given how unstable and fluctuating jail populations are.

This seems to us an approach suited to both science and ethics: all those living in congregate facilities are particularly vulnerable to COVID-19 due to the fact that they cannot control the environment in which they live.

But: a dearth of supply, fragmented shipping and delivery and distribution plans, with prioritization dependent on supply availability, meaning that state health departments are forced to constantly change priorities and shift supplies – rather than relying on regular, pre-determined supplies, delivered at pre-determined dates – means that the 2-million odd incarcerated persons in the U.S. prison and jail system may get shorted and subjected to yet one more unconscionable injustice.

We recall here a story from Matthew 25:35-40:

³⁵For I was an hungered, and ye gave me meat: I was thirsty, and ye gave me drink: I was a stranger, and ye took me in: ³⁶Naked, and ye clothed me: I was sick, and ye visited me: I was in prison, and ye came unto me.³⁷Then shall the righteous answer him, saying, Lord, when saw we thee an hungred, and fed thee? or thirsty, and gave thee drink? ³⁸When saw we thee a stranger, and took thee in? or naked, and clothed thee? ³⁹Or when saw we thee sick, or in prison, and came unto thee? ⁴⁰And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.

A country is judged not by how it treats its most, but how it treats its least privileged.

Further reading:

Prioritizing the Incarcerated for the COVID-19 Vaccine:

Jail, Prison Populations Must Be Among First to Get COVID-19 Vaccine: Advocacy Groups

Incarcerated People and Corrections Staff Should Be Prioritized in COVID-19 Vaccination Plans

COVID vaccines: Prisoners excluded from U.S. plans

Prisons, Jails Are Covid-19 Hotspots: Is Vaccinating Inmates a Priority?

Experts Call to Include Prisoners in COVID-19 Vaccine Plans

Prisoners Have Been Excluded from Covid Vaccine Plans, and Health Experts Are Sounding the Alarm

National Commissions Says Prison Inmates, Guards Should Be among First to Get COVID-19 Vaccine

The Need for Decarceration:

States Say They’re Decarcerating, Yet 1 in 5 Prisoners Has Had COVID