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North Carolina changed its COVID-19 vaccination distribution plans for a second time Thursday, reshuffling who is prioritized for a shot and when.
For a second time, most people in prison were pushed down the list, a decision that seems to be in line with guidelines from the national Centers for Disease Control and Prevention but is at odds with recommendations from other federal bodies and public health experts who study disease spread through prisons.
Leaders at the Department of Public Safety, which oversees the state’s prisons, say they are hampered in their ability to plan how they will distribute the vaccine to their staff and to people in prison when the state keeps changing its vaccination plan.
The unpredictability of the supply chain from the federal government to state allocations isn’t helping DPS to plan either.
“We don’t have what you would call a vaccination plan, per se, because we can’t plan for what we can’t predict,” Tim Moose, DPS’ chief deputy secretary who oversees adult and juvenile prisons, said during a Thursday press conference.
“Instead, we have the framework, a structure that’s lean and flexible. When we know beyond a doubt that we’ll have a number of vaccine doses available on a day, we can then make the actual plan based on the priorities established with our public health partners.”
The state Department of Health and Human Services did not grant DPS any vaccine doses this week, and neither agency could say when, what type or how much vaccine would be given to the prisons.
The framework, which DPS shared with Carolina Public Press after a press conference on Jan. 7, is 1 1/2 pages long and is now largely outdated by DHHS’ new priorities. CPP has asked DPS for details not covered in the document, such as how many vaccines it can store, of which type, at any of its four staging locations.
And yet, North Carolina may be one of the more prepared states in the nation for distributing vaccines behind bars.
Organizations like the COVID-19 Behind Bars Data Project, COVID Prison Project and Prison Policy Initiative, which have been tracking prison and jail responses to COVID-19 around the country, are all just now starting to gather data on vaccine distributions and plans.
Information collected by the COVID Prison Project shows that 14 states beat North Carolina at beginning to give people in prison the vaccine, but even so, none of those organizations have seen plans for how prison systems plan to carry out the vaccine distributions behind bars.
“If the state’s plan for vaccinating nonincarcerated people was this short on detail, I have no doubt that the public would be asking for more information,” said Wanda Bertram, communications specialist for the Prison Policy Initiative. “Unfortunately, there is not a lot of attention paid to people in prisons and jails, so this is actually one of the more detailed plans that we have seen so far.”
DPS staff shed some more light on their plans during Thursday’s press conference.
DPS will use four prisons — Alexander Correctional Institution in Taylorsville, Central Prison in Raleigh, Maury Correctional Institution in Hookerton and Scotland Correctional Institution in Laurinburg — each in a different quadrant of the state, as staging areas for vaccine storage and distribution.
The department signed up for vaccine allocations from DHHS, and when DHHS decides how many doses and which type of vaccine DPS should get, the manufacturers will send the doses directly to one of those prisons. From there, six-member “strike teams” of nurses and support staff will travel to other prisons and inject staff members or prisoners who are both eligible for and willing to get the vaccine.
A question of willingness
Taking the vaccine is voluntary for both prison staff and incarcerated people, Moose said. That complicates the logistics.
While DPS knows how many staff members and prisoners are eligible for the vaccine in each of the rollout stages and what prisons they are at, DPS does not know how many people will opt in to getting the vaccine.
“We’ve conducted surveys of staff and offenders to gauge their willingness to be vaccinated,” Moose said. “Participation rates change daily and sometimes by the hour as people make up their minds or change their minds.”
That means that DPS does not know how many vaccine doses it needs for the whole system, let alone by prison, Moose said.
In all, DPS incarcerates roughly 30,000 people and has another 14,000 prison staff members.
The state’s new rules brought people ages 65-74 into the next group who will get the vaccine, while pushing back younger prison staff, people with high-risk medical conditions and all other people who are incarcerated.
DPS’ most recent data, which is from Nov. 30, shows that DPS housed people 65 or older in basically every prison across the state, for a total of 1,170 prisoners.
Moose said 839 staff members and prisoners have requested to be vaccinated, but that is only based on DHHS’ old guidelines for who would be eligible for vaccinations this week, a much smaller group of medical staff and people who are at least 75 years old.
DPS has mounted an education campaign to encourage staff members and people in prison to get vaccinated and is considering a package of incentives for prisoners to convince them to opt in, too. Moose said the incentives will likely be announced next week.
The importance of vaccination behind bars
So far, 39 people in North Carolina state prisons have died from COVID-19, while over 8,200 have gotten sick. At least 1,560 staff members had fallen ill, and five had died as of mid-December.
Under North Carolina’s current plan, all people in the state 65 or older should get the vaccine in the coming weeks. Then, it’s front-line essential workers, which includes correctional officers.
After that, it’s people with high-risk medical conditions, which could make a COVID-19 infection worse. DPS has 14,000 of those people in its custody, according to legal filings in NAACP v. Cooper, wherein the plaintiffs are alleging prison conditions are unconstitutional during the pandemic.
In the next stage, everyone in prison, regardless of health or age, will get vaccinated.
But groups that have expertise in prison health care, like AMEND, recommend that all people in prison should get vaccinated at the same time, if not before, prison staff.
Vaccinating people in prison will slow down the rate of viral spread in the prisons and will limit the number of people who die from the virus, according to Aaron Littman, deputy director for the COVID-19 Behind Bars Data Project at UCLA Law, which monitors COVID outbreaks and deaths behind bars around the country.
Though the data shows that older people in prison die of COVID-19 at higher rates, just like outside, vaccinating only people over 65 then waiting for everyone else “won’t stem the deaths behind bars,” Littman said.
“Incarcerated people across ages are quite disproportionately likely to have serious comorbidities that make them more susceptible to serious illness and death,” Littman said.
The data in North Carolina bears this out. Though DPS has touted that its case-fatality rate, or the number of people who die from COVID-19 per the number who test positive for the virus, is lower than that of North Carolina as a whole, it’s not an accurate comparison.
Prisons also have a much younger population than the general populace, according to Kathryn Nowotny, a sociology professor at the University of Miami and co-founder of the COVID Prison Project.
When Nowotny accounted for the age difference, where younger people tend to die from COVID-19 at lower rates, the number of deaths in North Carolina prisons exceeded what would be expected among the general population.
Along with being some of the most medically vulnerable groups in the country, people in prison also have little control over viral introduction into their prisons. Once it’s in, prisons are an incubator for the virus, Littman said, and the conditions allow the virus to spread rapidly.
“Prisoners are among the people most likely in the country to spread the infection if infected because they don’t have any choice about how many people they come into contact with and they live in densely packed settings,” Littman said.