Vaccination in prisons requires credible messengers
‘There is no way I think we’ll get the same treatment elites to get.’
By Pam Bailey
Prisons have become cauldrons of coronavirus infection, with confirmed cases four times higher than in the general population and mortality twice as high overall. (Deaths are as much as seven times higher in some state prisons.) And although politicians debate whether incarcerated people are “worthy” of saving, the pandemic cannot be brought into control without bringing those numbers down. In fact, the Prison Policy Initiative reports that during the summer of 2020, over half a million cases of COVID-19 — or 13% of all cases — could be attributed to the passage of the virus into, through and out of crowded prisons and jails.
Punishment used as COVID control
Administrations of prisons and jails have responded by extending institutional “lockdowns” — similar to solitary confinement, but with a cellmate. “They’re using COVID as an excuse to prolong the time we’re closed into our cells,” writes Delonta Williams, currently incarcerated at USP Pollock in Louisiana. “It’s not really about keeping us safe; it’s not like we’re seeing special attention to hygiene and health care.”
He’s right. As reported by Prison Legal News, “Prisoners in all facilities have struggled with lack of personal protective equipment, inadequate cleaning supplies and hand sanitizer, and the inability of depleted medical staffs to respond in a timely fashion to sick calls or provide even simple medications to ease the suffering. Most outside medical visits have been canceled, which means that seriously ill individuals with medical appointments with outside specialists are not transported to receive treatment.”
Colie Long, now confined to the D.C. Correctional Treatment Center, comments, “I haven’t seen sunlight for literally a year. I bet just about everyone here has caught the virus already. You’d think they could find a way now let us go outside for just a little bit.”
Feeding the spread of COVID in jails and prisons is the fact that inmates’ health and the care they receive behind bars has long been notoriously poor. The Bureau of Justice Statistics, for example, estimates that 40% of persons in state and federal prisons and jails are living with a chronic health condition, with high blood pressure the most common.
Add on to that the fact that people of color — who also are more at risk of COVID-19 — are disproportionately represented in prisons and jails. Although the disparity is decreasing, Pew Research documents that Black Americans remain far more likely than their Hispanic and white counterparts to be incarcerated.
‘If they really cared about us, why haven’t they been investing in better health care for us all along?’
It is this nexus of dynamics that could complicate rollout of the vaccines as they make their way into prisons and jails. So far, nine states have included incarcerated people in phase 1 of the vaccine rollout. As for the federal Bureau of Prisons, which houses Williams (since D.C. does not have its own prison), it boasts that it “has achieved a milestone in the distribution and administration of the COVID-19 vaccine.” As of February 19, it says, the bureau exceeded 50,000 total doses administered, with 8,753 inmates and 11,233 staff members fully inoculated.
However, that is only about 6% of the total federal prison population, and to make any further progress, a lot more than supply and a mode of distribution are needed. There is a pervasive lack of trust among inmates in both the “medical system” and prison administrations specifically that will require a focus on audience-sensitive education and motivational messaging to overcome. The Marshall Project surveyed 136 incarcerated people in state and federal prisons in January and February to assess attitudes toward vaccination. Most respondents said they’d get vaccinated, if their questions were answered, if their friends and family said it was safe, or after guards received their immunizations first. And there’s a lot behind those “ifs.”
“Many respondents harbor a deep distrust of medical staff. Misinformation abounds, and officials have moved slowly to explain the vaccine’s benefits and risks,” says the Marshall Project report.
Communication with a handful of men held in facilities across the country suggests there is a prevalent belief that inmates are being given a lesser-quality variant of the vaccines. A case in point is Donzell McCauley, serving life without parole in Kentucky’s Big Sandy U.S. penitentiary.
“The medical staff came around asking if the inmates wanted to be vaccinated; I believe they were targeting prisoners 50 years old and older, but they didn’t say. You’re probably shaking your head as you read this, but I declined,” he wrote in a letter. “I had questions and I received a bunch of surface answers or no answers at all. For instance, when I asked if this was gonna be the Pfizer or Moderna vaccine, the COs were so vague it led me to believe it was some generic version. If the medical staff can’t tell me what variant they’re injecting in me, then what sense does it make for me to take it? I agree that the inoculation of prisoners makes sense because it spreads so rapidly through the prisons and the guards are working in close quarters with inmates and other staff and run the risk of infecting others. But it’s just not right to inoculate the prison staff with a valid vaccine and give the inmate population a generic, unproven version.”
At first blush, McCauley’s suspicious may seem ridiculous. But that same skepticism is rampant among Black Americans in the general population as well. Consider that 40 percent of COVID deaths in Mississippi are among Black people but they account for only 22 percent of vaccinations, according to the Kaiser Family Foundation. And in New York City, higher-income whiter neighborhoods have far higher vaccination rates than poorer communities much harder hit by the pandemic.
In part, that disparity is based on a problematic track record that goes back to medical experimentation on slaves. And then there is the government project in the mid-1900s, when Black men in Tuskegee, Alabama, were deliberately not treated for syphilis so researchers could observe how the disease progressed. Likewise, many Black people point to the case of Henrietta Lack, whose cancer cells were taken for research without her knowledge.
“Plus, we’re treated like throw-aways anyway in prison,” says Long, who is Black and would say no if offered the vaccine. “There is no way I think that us ‘dregs’ will get the same treatment the elites get. If they really cared about Blacks, especially those of us in prison, why haven’t they been investing in better health care for us all along? Then we wouldn’t be at higher risk to begin with.”
Peter Hotez, a vaccine expert at Baylor College of Medicine in Texas, warns of the consequences of this lack of emphasis on education along with vaccine distribution: “One of the key strategies of anti-vaccination movement in recent years has been to target specific groups. They have been exploiting existing problems of mistrust to create a vaccine hesitancy that either didn’t really exist before or was less pronounced than now. And that’s having an impact on coronavirus vaccination programs, and very little has been done to address it so far.”
Building trust in an environment of abuse and power
So, what can be done? One critical imperative is to prioritize outreach by “credible messengers” as much as the logistics of supply and distribution. To date, the emphasis has been more on getting more vaccine across the country and, in the general population, into more types of administration sites, like pharmacies and mobile units. Fortunately, the Biden administration now is also talking about a “massive campaign to educate people” about the safety and efficacy of the vaccines. That campaign should not only include Black leaders but also “peer influencers” — in communities as well as in prisons.
For example, Beatrice Evans, president of the Triangle View Apartments tenant association in D.C., knocked on every door in her 100-unit apartment complex to encourage them to get a vaccine and help them figure out how. And Frankie Hargrove, recently released from prison after 34 years, said he overcame his hesitancy after his personal physician said he had gotten the vaccine.
The same tactics must be deployed in prisons. Inmates who have chosen to be vaccinated could be relieved of the imposed lockdown confinement to speak to their peers. And at the very least, personnel administering the shots should be aware of which vaccines they are administering and trained and incentivized to provide information as well as “jabs.” The health of people behind bars is a moral imperative as well as a contributor to the nation’s health overall.