by Khalid Mohieldin
Individuals incarcerated in Pennsylvania have been uniquely vulnerable to COVID-19. Social distancing is nearly impossible to enforce when most individuals who are incarcerated live in dormitory-style cells. Correctional facilities have reported shortages of masks, hand soap, and cleaning supplies. Pennsylvania has also slowed its commutation and release processes, keeping more individuals in prisons and risking further spread. Thus, COVID-19 vaccinations hold special importance for all individuals who are incarcerated, regardless of age or health status, as vaccinations are the few public health programs that can be easily and equitably administered within cell walls.
Unfortunately, yet again, individuals who are incarcerated are dealing with the traumas of the pandemic largely on their own. Philadelphia and Pennsylvania’s respective governments have introduced separate frameworks for vaccine distribution, with both placing prison staff and individuals who are incarcerated in phase 1B. Both Philadelphia and Pennsylvania’s vaccine distribution plans rely heavily on “disadvantage indexes,” which, as Assistant Professor of Medical Ethics & Health Policy at the University of Pennsylvania Dr. Harald Schmidt explains, are “the sequence of priority groups, [or] which population is offered vaccines before which other one.” Dr. Schmidt co-authored a study in December 2020 outlining the racial and economic disparities that make certain groups more vulnerable to COVID-19 than others, and detailed how these indexes can be instrumental in outlining equitable vaccine policy. He notes that individuals who are incarcerated are frequently listed as priority populations within these indexes, as prison populations are at a higher risk of contracting and dying from COVID-19. That’s certainly the case in Pennsylvania; as of Feb. 3, there have been more than 13,000 confirmed cases of COVID-19 and 100 deaths within Pennsylvania prisons, a transmission rate that’s three times higher than in the state as a whole.
Despite widespread academic and political understanding of COVID-19’s disordinate impact on prisons, political recklessness and incompetence have made Pennsylvania’s prisons woefully unprepared to equitably administer the vaccine, and it’s unlikely that things will change anytime soon.
Pennsylvania faces numerous obstacles in getting individuals who are incarcerated COVID-19 vaccines, not the least of which includes convincing those incarcerated to actually accept them. Numerous state agencies and county correctional facilities have reported widespread reluctance among incarcerated populations to get the vaccine. While no similar studies have been coordinated in Pennsylvania, one survey conducted in Massachusetts of more than 400 individuals who are incarcerated found that nearly 60% would refuse an FDA-approved vaccine.
Part of this vaccine hesitancy is unique towards recently approved COVID-19 vaccines, according to Dr. Schmidt. Many of these vaccines were funded in part by a public-private partnership with the U.S. government nicknamed “Operation Warp Speed.” Dr. Schmidt argues that “if you call something ‘Operation Warp Speed,’ you’ve decided not to call it ‘Operation Super-Safe Vaccine.’ So if you’re already on edge about trusting a health service system or the government, and then you hear that they’re trying to do something faster than anybody’s done before, that is all not helping.”
But, moreso, broader vaccine reluctance is the product of centuries of medical neglect within incarcerated communities. Generally, U.S. prisons are disproportionately made up of populations that are often hesitant to participate in public health programs, such as sex workers and Black Americans. As Dr. Schmidt explains, “regrettably, it’s a very long history that goes back to the conditions of our nation. One, certainly, is research based: the Tuskegee studies cast an incredibly long shadow that’s been completely untenable in many African American communities.”
Racism in medicine becomes even more amplified when looking at incarcerated populations specifically. For example, from the late 1950s to the early 1970s, the University of Pennsylvania conducted numerous experiments on individuals incarcerated in Philadelphia’s Holmesburg Prison, including studies that inoculated them with herpes, wart virus, and vaccinia, and exposed them to highly toxic and carcinogenic substances.
Furthermore, history isn’t the only regrettable facet of U.S. medical policy. Racism is alive and well in contemporary healthcare, particularly in prisons. In the past few years, Pennsylvania courtrooms have been flooded with lawsuits alleging delay of medical treatment for individuals who are incarcerated. Elsewhere, Black and Brown women incarcerated in Pennsylvania have reported worse health outcomes and higher rates of abuse than those not incarcerated.
Dr. Schmidt sees vaccines as a tool that could potentially reverse some of the embedded distrust in healthcare among incarcerated populations. “The other opportunity that we have here is to not just make this a one-time initiative, but instead make this be part of a longer-time change in the relationship of people who have lost trust in the healthcare system by working with communities and keeping them engaged longer-term,” he said.
Problems with Vaccine Rollout
Unfortunately, it is unclear whether Pennsylvania’s Department of Corrections has publicly introduced any vaccine education programs for individuals who are incarcerated. Furthermore, according to public messages from individuals incarcerated in Pennsylvania prisons, endorsements of the vaccine have only been made in passing by correctional officers, and with little medical nuance behind them.
Even for those willing to take the vaccine, the state’s vaccine distribution plan has been fraught with allegations of “line-jumping.” Just last month, the Perelman School of Medicine at the University of Pennsylvania announced plans to place employees in phase 1B of its vaccine distribution program, defying Philadelphia’s vaccine rollout plan, which places higher-education employees in phase 1C. Throughout the pandemic, the University of Pennsylvania has refused to open testing sites to the general public, and only a few weeks ago allowed subcontracted dining employees to get tested on campus. Other schools across the nation, such as the University of California, Davis, however, have instituted various COVID-19 community outreach programs.
The University of Pennsylvania has essentially been given free rein to toy with Philadelphia’s virus policy, while the city and the state have stumbled through nearly every stage of their vaccination rollout. Pennsylvania Governor Tom Wolf initially touted the state’s vaccine rollout as “phenomenal,” only to later admit that Pennsylvania was packed “in the middle” of states, when in fact Pennsylvania is only 41st in vaccine rollout among U.S. states.
Line-jumping has been consistent with national trends, and much of it revolves around competing ethical ideals of vaccination. Many state officials, including Pennsylvania representative Doyle Heffley, have opposed prioritization of incarcerated populations. Heffley, among others, argue that people who’ve committed serious crimes should not receive the vaccine before members of the general population. In other states, such as Colorado, governments have reversed entire prioritization plans due to the political unpopularity of vaccinating individuals who are incarcerated.
Pennsylvania has also repeatedly shuffled its prioritization scheme, which has only furthered confusion. On Jan. 20, the Wolf administration moved pregnant women and smokers into the first phase of vaccine distribution, ahead of prison guards and individuals who are incarcerated. That move sparked outrage within the state’s prison ranks, who have faced some of the worst conditions of the pandemic. The Pennsylvania State Corrections Officers Association blasted the move, stating, “Our state prison system has been overcome by COVID[-19], but for some reason the Wolf administration has decided to ignore its own corrections officers.”
The distinction between vaccinating guards as opposed to those incarcerated also introduces new, complicated folds to the issue. Already strained by rising case counts, Pennsylvania correctional officers have been asked to come back to work earlier and for more hours, even if they are experiencing symptoms. In many cases, correctional officers are the source of spread within prisons, and without equal protection for guards and incarcerated populations, COVID-19 will continue to rampage through prison walls.
Vaccines as the Last Available Option
In the midst of one of the deadliest epidemics in U.S. history, Pennsylvania’s government has been violently unforgiving towards its prison population. At the same time, the state has allowed institutions like the University of Pennsylvania to stockpile tests and vaccines, making them barely available to their own employees, much less the general public.
Integration of individuals who are incarcerated into more cohesive public health policies is necessary to curb the spread of the virus. Dr. Schmidt tells us that “we shouldn’t penalize people twice, [and] we shouldn’t make other assumptions about [individuals who are incarcerated’s] deservingness because they are in prison.” Unfortunately, it looks as though Pennsylvania already has.
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