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By Hannah Critchfield
A future COVID-19 vaccine is coming to North Carolina’s prisons – and staff will be first in line to get it. But that prioritization is contentious.
Under the state’s tentative plan, prison staff and high-risk incarcerated people will be first to get shots. Thousands of remaining inmates, the majority of the prison population, will wait.
North Carolina’s priorities for prisons mirror the federal-level vaccine plan. Last week, the Associated Press reported that the federal Bureau of Prisons, which oversees North Carolina’s sole facility, Butner Correctional Complex, will be among the first government agencies to receive the coronavirus vaccine.
The first allotments of this vaccine will go to federal prison staff, even though inmates have an infection rate three times that of correctional officers. In North Carolina, one Butner federal prison staffer and 27 prisoners have died of the virus.
The BOP did not respond to interview requests.
The North Carolina Governor’s office also did not respond to multiple requests for comment about the state’s prioritization for prisons.
When asked by NC Health News at a press conference on Thursday, state Health and Human Services Secretary Mandy Cohen, declined to answer why the state had determined all staff should be offered the vaccine ahead of all prisoners.
She also declined to clarify who would initially be prioritized should there not be enough vaccine doses for both staff and vulnerable inmates.
“We think about all of those adults across North Carolina that have two or more chronic conditions, we also know that there are certain settings where those adults are, that are more risky,” she said in response to the question. ”We want to send [vaccines] not just to target the adults with two or more chronic conditions, but also to those settings.
“A prison is a congregate setting, a homeless shelter could be a congregate setting, and others. And we certainly do want to go to those settings,” she continued. “We are relying on that expertise from the independent panel to go with health care workers, long-term care and staff and then to adults with two or more chronic conditions, while we also target them to settings we know are higher risk.”
Prioritizing prisons and jails
As cases spike in North Carolina, outbreaks in prisons across the state are getting worse.
People held in these congregate facilities are in close quarters and have little control over their ability to social distance. Prisons have been compared to petri dishes, wildfires, ticking time bombs, tombs, and hotbeds for the virus due to the rapid spread among people inside.
In November alone, five state prisoners died — 19 percent of the total for state prisoner COVID deaths. A federal prisoner housed at Butner also died last month.
Death rate in state prison system: 84 per 100,000
(26 deaths out of a population of 30,925)
Death rate in NC’s federal prison in Butner: 723 per 100,000
(27 deaths out of a population of 3,734)
Death rate in NC’s general population: 53 per 100,000
(5,605 deaths out of a population of 10,488,084)
Two weeks ago, the Department of Public Safety, which oversees state facilities, announced it was temporarily closing three prisons due to a lack of hospital bed capacity and staff shortages due to virus spread.
Last week, DPS Commissioner of Prisons Todd Ishee told state senators that about 300 staffers were out of work with COVID-19; there are about 11,000 corrections officers in the state prison system. About one-in-five state prisoners have tested positive since the pandemic began.
“Our folks who have worked in the prisons from the beginning, they’re used to danger,” said Ardis Watkins, executive director of the State Employees Association of North Carolina, which represents state correctional officers. “But one officer recently told me, ‘To die at the hands of violence in the prison, that’d be one thing. But to take something home to my family because I went to work is the line I can’t cross.’”
Because of the high prison infection rates, experts and advocates have argued that incarcerated people and correctional officers should be a top priority for receiving the new COVID-19 vaccine.
The order of preference
States have been tasked with distributing an approved COVID-19 vaccine to their residents. The Food and Drug Administration is reviewing the first vaccine this week, and shipments of it could begin going out hours after getting approval.
A limited supply of 84,800 doses produced by Pfizer will be available to the state at first, a number determined based on North Carolina’s population. Hospitals could receive these as early as next week, and shipments should come to the state weekly afterward, according to statements Cohen made at a Dec. 3 press conference.
Coronavirus vaccines in North Carolina will first go to doctors, nurses, and other health care first responders, including those who work in long-term care settings, in “Phase 1a.”
Prisons enter the scene during the next round of distribution.
During this stage, Phase 1b, all residents in long-term care facilities will get immunized.
Inmates over the age of 65, or who have at least two chronic health conditions, will receive the vaccine. The rest of the incarcerated population has to wait.
Under the proposed plan all correctional staff will be offered the vaccine during this phase on a voluntary basis..
“Given that many people in congregate settings may decide against being vaccinated in early phases, North Carolina will also prioritize staff in congregate or crowded settings (jails, prison, homeless shelters) to increase protections for those high-risk individuals,” the proposed plan reads.
A DHHS spokesperson declined to clarify whether high-risk prisoners or staff members would be prioritized should there not be enough initial doses to vaccinate both groups.
“Correction staff and high-risk offenders will be offered the vaccine at a time as close together as is operationally feasible,” said Kelly Haight Conner, communications manager for DHHS.
All other inmates will receive the vaccination in the following round, Phase 2, as manufacturers make more doses available.
Many inmates ‘high risk’
It’s unclear, under these criteria, how many prisoners will be designated “first priority.”
Inmates are more likely to have chronic health conditions such as diabetes, asthma and heart problems than the general public. Also, the U.S. prison population is aging, due to mandatory sentencing laws enacted over the last few decades.
Over 1,000 people in North Carolina prisons are over the age of 65, according to court filings provided by DPS in an ongoing lawsuit over pandemic prison conditions.
Approximately 14,000 state prisoners have at least one preexisting condition recognized by the CDC, those same filings report.
Even assuming all of these are separate individuals, and every person with a preexisting condition also has a second qualifying preexisting condition — a little over half of North Carolina’s 30,925 state prisoners will not be included in an initial round of vaccinations.
Added to this list are people in jails, who often have not yet been convicted of a crime and tend to be younger than individuals in prison, making them less likely to meet vaccination criteria.
A DPS spokesperson declined to provide a number or estimate for eligible state prisoners.
“We will continue working with NCDHHS to make sure Prisons is ready to administer the vaccine to the approved categories of staff and offenders, when it becomes available,” DPS spokesperson John Bull said by email.
The state’s distribution order is based on the National Academy of Science and Medicine’s Framework for Equitable Distribution of Vaccines, according to DHHS spokesperson Haight Conner.
This plan’s schedule for correctional facilities differs from North Carolina’s in one crucial way — it emphasizes vaccinating high-risk people and older adults in prisons and jails in Phase 1b. The plan makes no mention of offering the vaccine to staff who work in these settings until Phase 2.
“Phase 2 includes people in prisons, jails, detention centers, and similar facilities, and staff who work in those settings, with the expectation that they have limited opportunity to follow public health measures such as maintaining physical distance, putting them at significant risk of acquiring and transmitting COVID-19,” the framework reads.
Prisoners incarcerated at Butner, a facility run by the federal Bureau of Prisons, will have to rely on the federal government’s schedule for their vaccinations. Initial provisions of the vaccine “will be reserved for staff,” according to internal agency documents obtained by the AP.
Linked to the community
By nature of the job, correctional officers must come in and out of detention facilities and return to the outside community every day. They’ve been cited as the source of the initial spread of COVID-19 into prisons and jails and linked to spread from a facility into the larger community.
“If you’re trying to slow community spread, it makes sense to focus more on folks who interact with the community,” said SEANC’s Watkins. “If you’re gonna slow the spread in the prison itself, it has to be everybody.”
She noted that prisons “constantly” have people coming in from jails, and they could be infected.
“It’s still going to be a difficult place to contain the virus after staff are vaccinated, no question,” Watkins said.
Lauren Brinkley-Rubinstein, a public health researcher who studies prisons at the University of North Carolina School of Medicine, said the current vaccine distribution plan could have unintended consequences.
If inmates are initially skeptical of the vaccine, and then they’re forced to wait for weeks or even months after staff to get it, they might be even more suspicious of it once their turn comes.
“Because you could be like, ‘Well, that’s not the same thing that that guy got, why am I getting it three months down the road?’” she said. “If you create, unintentionally, an environment where you’re prioritizing certain people to get a vaccine that is protective against potentially lethal diseases, and people see themselves as not being prioritized, that may have collateral consequences.”
Fifty-eight percent of Americans said they would be willing to take an approved vaccine, according to a new Gallup poll released last month, up from just 50 percent in September.
Skepticism about a rushed vaccine remains, particularly within communities of color, who have historically borne the negative consequences of government-backed medical research and are disproportionately represented in North Carolina’s incarcerated population.
“It is counterintuitive to the way that the state has responded to incarcerated people throughout this pandemic to think that all of a sudden they’ve developed consciences about the need to prioritize their health,” said Dawn Blagrove, executive director of Emancipate NC, reflecting some of that skepticism. Her organization seeks to end mass incarceration in the state.
“During the last eight months, we’re seeing that incarcerated people, correctional staff, people who are older, and health workers are at the bottom. And now all of a sudden they’re a priority, and we’re going to give them the vaccination first?” she asked, expressing worry that once again, prisoners might be used as guinea pigs.
Researchers who developed the COVID-19 vaccines have said they’re gone through the traditional testing stages and approval processes required for every vaccination; it’s just the speed of this work that has been significantly accelerated.
“All of the same steps that always need to happen have been followed,” Dr. Cynthia Gay, a researcher who’s leading a Moderna vaccine study at UNC, previously told NC Health News.
Given what’s at stake, Brinkley-Rubinstein said the state should be doing everything they can to ensure as many prisoners are open to taking an approved vaccine as possible.
“I again think all staff and prisoners should be vaccinated together,” she said.