Webinar Examines Vaccination Priorities for Incarcerated Populations
The United States has the greatest number of incarcerated people in the world, with disproportionally high numbers of people of color behind bars. It shouldn’t be surprising then that rates of COVID-19, already high in the U.S., are even higher in jails and prisons. So far, however, the availability of vaccinations for incarcerated populations has lagged.
A recent webinar examined barriers to vaccinating people in jails and prisons, from logistics to politics, and beyond. The discussion was organized by the Global Health Justice and Governance (GHJG) program at Columbia Mailman School. Chelsea Clinton, MPH ‘10, adjunct professor of Health Policy and Management, moderated. (Watch the video below.)
Terry McGovern, chair of Population and Family Health and director of GHJG, gave opening remarks. She noted that 40 of the 50 largest clustered outbreaks of COVID-19 in the United States so far have happened in jails and prisons, where case rates have been more than five times higher than those seen in the general population. Yet vaccines are often unavailable where they are needed most, with policies varying from state to state.
Among four states with the highest rates of COVID-19 in correctional facilities, California is the only one that is simultaneously vaccinating staff and residents. One advantage of this approach is the efficiency of covering both groups at once, noted Grace Lee, professor of pediatrics at Stanford University School of Medicine and vice-chair of the U.S. Advisory Committee on Immunization Practices. By contrast, Michigan is offering vaccines to staff but not to residents. Florida and Texas ignore both groups in their vaccination plans.
In contrast to much of the country, New York City has done a commendable job in lowering the risk of COVID-19 for its incarcerated populations. Patricia Yang, MPH ’85 DrPH ‘05, senior vice president for Correctional Health Services at NYC Health + Hospitals, leads this effort. Incarcerated individuals are regularly tested and housed separately based on infection risk. They are offered assistance on release, including to locate housing. New York City also offers compassionate release, based on COVID risk. So far, about half of those jailed are now eligible for vaccines under the current state guidelines, although Yang advocates for accelerating their availability. “We’re very hopeful that we will soon get that approval,” she said.
Attitudes and politics around mass incarceration often get in the way of managing the pandemic in carceral settings. Bruce Western, a professor of sociology and co-director of the Columbia Justice Lab, said U.S. prisons are punitive and “primarily are not built for the welfare of the people housed” in them. They are often overcrowded, poorly ventilated, and exist outside public scrutiny. Solutions include diversion to prevent people from getting locked up and compassionate release once they are behind bars. Too often, however, compassionate release is restricted to those within six months of death. Especially during the pandemic, the criteria should be broadened to include medical vulnerability, he argued.
The spread of COVID-19 in jails and prisons is not an isolated phenomenon, and one of the biggest challenges is the movement of people to and from communities on the outside. Robert Fullilove, a professor of Sociomedical Sciences and instructor with the Bard Prison Initiative, explained that outbreaks are likely to spill over into communities of color where many incarcerated individuals live. On any given day, 700,000 Americans are in jail, and over the course of a week, more than half of them circulate into the community, as do corrections staff. “That circulation is part of what makes COVID-19 so deadly,” he said.
Governors afraid of seeming soft on crime are loath to make the vaccine available to vulnerable populations portrayed as deserving of punishment. However, if the public understands how a pandemic in jails and prisons easily spreads to surrounding communities, they might come to rethink the value of mass incarceration, more broadly. Fullilove: “Now that we see that there are public health consequences to what we do in the name of social control, it would be interesting to see ... whether we start thinking about the wisdom of redirecting money [spent] on police to housing and mental health and [alleviating] poverty, which is at the core of so much of crime that is committed.”