Syringes used to administer the COVID-19 vaccine. Clare Grant / Carolina Public Press

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As state officials open up COVID-19 vaccine eligibility for more and more individuals, North Carolina’s prison system is gearing up for a push to vaccinate more than 30,000 incarcerated people and prison staff. 

In a state legislative hearing before the joint House and Senate Justice and Public Safety Committee on March 9, Commissioner of Prisons Todd Ishee said prisons would receive weekly vaccine allocations to allow every person in the prison system to be vaccinated. 

In the state’s original plan, both staff and inmates were prioritized in the first vaccination group, just after front-line health care workers, but the state twice changed the vaccine rollout, delaying shots for the entire prison population. 

Now, as the state opens vaccinations up to Group 4, which includes adults at high risk for exposure or risk of severe illness and individuals in congregate living settings, everyone in the prison system is eligible to be vaccinated. 

“Prisons anticipate the allocation of 3,000 first doses and 3,000 second doses of Moderna virus weekly, starting in two weeks, until the staff and offenders who wish to be vaccinated are fully vaccinated,” prisons spokesperson Brad Deen wrote to Carolina Public Press. These allocations are set to begin the week of April 5, though the Department of Public Safety, which oversees the prisons, has already started vaccinating staff and inmates.

Prison staff members have been getting vaccinated since early January, largely through an interpretation of a provision that counted them as health care workers.

Incarcerated people ages 65 and older became eligible for vaccination in late January. According to DPS, 70% of prison inmates 65-74 years old participated in the vaccine program, and 91% of inmates 75 and older participated. It is not clear if the level of interest will be the same for the majority of the prison population, which is much younger. 

Approximately 5,500 prison staff members and nearly 3,000 incarcerated people have been at least partially vaccinated as of March 9, according to DPS data. Another 8,070 staff members and 25,600 incarcerated people remain unvaccinated.

DPS has not yet updated the data because it is “working on reconciliation of data entered into (the Coronavirus Vaccine Management System),” which is used by the Department of Health and Human Services to track who has been vaccinated, according to another DPS spokesperson, John Bull

Some prisons operating as ‘distribution hubs’

DPS operates 55 prisons across North Carolina. In order to distribute the vaccines, the state designated Alexander Correctional Institute, Central Prison, Maury Correctional Institute and Scotland Correctional Institute as “distribution hubs” to receive doses.

From there, teams of nurses and prison staff deliver vaccines to other prisons. According to Deen, prisons distributed 3,000 vaccines in 2 1/2 days last week using this method. 

In the current week’s allocation, only three of the four correctional facilities were initially receiving doses.

“There was an error in the ‘acceptance’ phase once 1,000 doses of vaccine had been allocated by DHHS for Central Prison,” Bull said. “We worked with DHHS earlier this week, and Prisons has already received 800 doses of vaccine for the week for the Central Prison vaccination hub.”

The error in question was DPS’ failure to respond on time to a weekly survey about whether or not they wanted doses, according to Catie Armstrong, a press assistant for DHHS.

“This week, we did not receive a response to accept their allocation for Central Prison Complex – however, NCDHHS worked with other providers who were willing to transfer vaccine to DPS allowing them to receive 800 doses for Central Prison,” Armstrong wrote in an email to CPP.

Even when doses are ordered and received, vaccinating a high-turnover population has several challenges. Roughly 1,700 people were released from prison each month since March 2020, when the pandemic began. In a typical month, approximately 1,300 new people enter the prison system.

Since the Moderna vaccine requires two doses about a month apart, some people will be released before they receive second doses.

In those cases, DPS coordinates with local health departments to get those people second doses, according to Deen.

It is much easier to vaccinate people while they are still incarcerated than to do so after release, according to Evan Ashkin, a doctor of family medicine at UNC Chapel Hill and the founder of the Formerly Incarcerated Transition program, which connects people leaving prisons to medical services. 

“Additionally, it would protect them likely from spreading COVID upon release when they may return to a setting already disproportionately impacted by COVID,” Ashkin wrote in an email to CPP. 

Full vaccination also protects the formerly incarcerated from higher-risk settings where social distancing is a challenge, like a transitional house or staying with someone on a couch, Ashkin said. 

Not a mandatory move

Although there are benefits of vaccination to both incarcerated individuals and the prison system, vaccines are voluntary. 

Internal DPS surveys of prison staff initially showed fewer than 20% of prison staff members were willing to get vaccinated in January, but that number more than doubled in subsequent surveys and continued to increase. DPS discontinued those surveys, according to Deen. 

Even if a staff member or inmate declines the vaccine, it remains available should those people change their minds. DPS is encouraging vaccine participation through educational materials and an incentives package for inmates, which includes five days off the prison sentence if eligible for release, phone calls and more visitation. 

“I think that until we get enough people vaccinated, we’re going to have to continue to modify all of our activities, the closures that we see, all those kinds of steps we’re taking are going to continue to be in place until we get a sufficient number of people vaccinated to where we’ve really blunted this virus,” Dr. Arthur “Les” Campbell, the prison system’s medical director, said in a DPS video encouraging prison staff to get vaccinated

A long road

Despite a downward trend in COVID-19 cases in state prisons, the pandemic and its consequences are not going away anytime soon, according to Julie Ward, a registered nurse and Ph.D. candidate in health and public policy at Johns Hopkins University. 

“For a year now, we’ve had to think of the COVID-19 pandemic as a temporary crisis, but we all know that COVID-19 is not going to go away magically,” Ward said. “So, as we slowly start to gain the tools like vaccines that we need to bring the pandemic under control, we need to start to shift our thinking toward maintenance and prevention.” 

For Ward, that means thinking of the COVID-19 response as an ongoing effort similar to that of other infectious diseases or preventable chronic conditions, especially since the disease has hit incarcerated people and prison staff harder than the rest of the population. 

“We found that compared to the rest of the U.S. population, cases were 3.2 times more prevalent among prison staff and 4.6 times more prevalent among prison residents who then die from COVID-19 at three times higher rates than other same-age populations,” Ward said, referring to studies she led and contributed to that examined COVID-19’s impact behind bars. 

People may also need boosters to keep up immunity against the virus that causes COVID-19, especially with the proliferation of variants, according to Aaron Littman, deputy director of the COVID-19 Behind Bars Data Project at the UCLA School of Law.

Between the possible need for boosters and the constant churn of the prison population, prisons are looking at a long-term need to keep up vaccinations.  

“It won’t be possible to just have everyone vaccinated once in a period of a few weeks and then sort of stop,” Littman said. 

If prisons stop vaccinating people or decline to offer boosters, should they become available, it could open the state up to more litigation, according to Littman. 

Gov. Roy Cooper, DPS and the Parole Commission settled a lawsuit over prison conditions during the COVID-19 pandemic on Feb. 25 and agreed to the early release of 3,500 people and continued measures for protecting incarcerated people from the spread of COVID-19. 

Jordan Wilkie

Jordan Wilkie is a Report for America corps member and is the lead contributing reporter covering election integrity, open government, and civil liberties for Carolina Public Press. Email jwilkie@carolinapublicpress.org to contact him.