The N.C. Department of Public Safety is slated to get its first allocation of COVID-19 vaccinations for inmates and correctional officers ages a75 and older this week.
But, as of late last week, the department did not yet know how many doses or which vaccine it would receive. Which state partners will be available to help distribute the vaccine — be it N.C. Emergency Management or the National Guard — was also unclear, according to Tim Moose, the chief deputy secretary for Adult Correction & Juvenile Justice.
Individuals 75 and older are the next vaccination priority group after front-line health care workers under the state’s vaccination plan.
Since March, 36 people in North Carolina state prisons have died from COVID-19, more than 7,700 people have been infected in the state’s prisons, and a judge has ruled that prison conditions during the pandemic were likely unconstitutional.
The problems are not limited to behind the walls. At least five prison staff members have also died, more have brought the virus home with them, and national research has shown communities around prisons tend to have more COVID-19 cases than elsewhere, meaning that prisons act as reservoirs for the virus, placing everyone’s public health at greater risk.
“I want to stress that we currently do not have a firm schedule of dates and times and locations as there are many unknowns in the vaccine distribution at this point,” Moose said.
But DPS has a plan, Moose said, that should allow for a quick distribution of vaccines once the agency gets it.
Like hospitals and health departments, DPS has to request vaccine doses from the Department of Health and Human Services, which controls distribution in the state. According to a DHHS spokesperson, vaccines are allocated a week after they are requested, so DPS should get vaccines this week.
Prison health care staff members have been getting vaccinated at county health departments since last Tuesday. DPS has not explained why it was not coordinating with those same health departments to vaccinate inmates or prison staff.
This first round of vaccine distribution by the prison system itself will be relatively small. Moose said a few correctional officers are 75 or older, and about 165 people in prison are in the same age range.
Data on the DPS website shows that, as of Nov. 30, the 165 inmates who are eligible to get the vaccine in the next stage of distribution are spread out across 38 prisons in all corners of the state. Several of those prisons, such as Central Prison in Raleigh, have ongoing COVID-19 outbreaks.
In the next group, front-line essential workers ages 50 and older will get the vaccine, and the final group of phase 1B includes all front-line essential workers. The national Centers for Disease Control and Prevention guidelines include prison staffers who interact with incarcerated people in the definition of essential workers. In total, 14,000 correctional officers work in North Carolina prisons.
The federal government distributes the vaccine to states, which then distributes to hospitals, county health departments and other agencies like DPS. Since the number of vaccine doses from the federal government is known only a couple of weeks in advance and there may be a delay between sending out the vaccine and when it’s put in people’s arms, there’s no way to know for certain when the next phase will begin.
Change in plans
Under the state’s original vaccine distribution plan, inmates would have received priority over other populations, based on guidelines from the National Academies of Medicine. But when the CDC issued updated recommendations in December, the state’s health department changed its own rollout plan.
Before, people in prison ages 65 and older, along with people who had two or more health conditions that put them at higher risk for serious illness or death if they got COVID-19, would have been vaccinated in the next phase.
But now, those people will have to wait until phase two of the vaccine rollout. Per DPS data, there are an additional 1,000 inmates who are 65-74 years old.
According to public health experts like Lauren Brinkley-Rubinstein, assistant professor of social medicine in the UNC School of Medicine and co-founder of the COVID Prison Project, pushing back the date for vaccinating people in prison is not necessarily the best public health strategy.
“Prioritization should be solely based on the epidemiology of the disease and who would benefit from a decreased risk of severity of disease and death,” Brinkley-Rubinstein said. “And if we look at that alone, it doesn’t make any sense to prioritize staff before incarcerated people.”
An additional 14,000 inmates have at least one CDC risk factor, according to DPS data revealed in a lawsuit whereby a coalition of civil rights groups is suing the state over alleged unconstitutional conditions during the COVID-19 pandemic.
Now, those prisoners will have to wait what will likely be additional months before they are given access to the vaccine.
DPS officials said they are following guidance from DHHS and the federal government on who gets the vaccine and when. North Carolina still prioritizes getting the vaccine to prisoners more than the CDC recommendations, just at a lower level than it did before.
If it’s true that staffers are a primary way the virus is moving into prisons and back into communities, and if the vaccine lowers transmission, it makes sense to vaccinate staff, Brinkley-Rubinstein said. It is a safe bet that the vaccine lowers transmission, she said, but the vaccine was tested during clinical trials for reducing infection severity and death, not transmissibility.
Vaccinating people in prison can also help ease the burden on health care systems, according to Dr. Mark McClellan, director of the Duke-Margolis Center for Health Policy and a former commissioner of the U.S. Food and Drug Administration.
“Some states have prioritized prison workers over prisoners, but if you really want to prevent the opportunity for spread from places like that back into the community and if you really want to get the burden on health care down, vaccinating in prisons early is an effective strategy,” McClellan said.
The vaccination is currently voluntary for DPS staff and inmates, following DHHS recommendations, Moose said.
The prisons are using an educational campaign to encourage as many staffers and inmates to take the vaccine as possible. The department is reserving the right to move to mandatory vaccinations.