Nursing Homes and Prisons Share Similar COVID Risks, but Don't Share the Same Vaccine Prioritization

Comparing prisons to nursing homes may feel like comparing apples and oranges, but the current COVID-19 pandemic has revealed their disconcerting similarities. Both the settings have been hotbeds for the worst COVID-19 outbreaks in the country (data here & here). Prisons and nursing homes share similar features: they are crowded, congregate living facilities with high rates of staff and population turnover, and neither are environments conducive for adhering to social distancing practices and limiting contact with outside communities. At the same time, both house populations that have a disproportionally high risk for infection and severe complications or death from COVID: the elderly and those with preexisting medical conditions. As a result, 28% of the country’s incarcerated population has tested positive for the virus compared to about 9% of the total US population and nursing home residents have accounted for 34% of deaths.  

Yet when it comes to COVID-19 vaccine distribution, people who are incarcerated face a very different outlook compared to those in nursing homes. Following the current guidance from the CDC recommends that nursing home residents be first to be vaccinated alongside healthcare workers, all 50 states placed them in Phase 1a. By contrast, there are no federal guidelines on which group people who are incarcerated fall into.s With States left in charge of decision making, wide discrepancies in vaccination prioritization between these two groups have emerged. Across the board, States have swiftly vaccinated their nursing homes with high priority: more than 4.5 million residents and staff have received at least one dose of the vaccine. As a result, the impact of this population has been strong and clear:  between late December and early February new cases among nursing home residents decreased by more than 80 percent, nearly double the rate of improvement in the general population. Deaths in nursing homes have decreased by 66%. But for those currently incarcerated who are equally vulnerable, the response has been very different. By October 2020, only four states explicitly placed people who are incarcerated in the first phase of their vaccine distribution plans. While updated CDC guidance0, along with pressure from advocacy groups and a new policy from the American Medical Association has played a role in increasing this number, to date, only 10 states place people who are incarcerated in Phase 1. An additional 18 states explicitly place their prison population in Phase 2 alongside such groups as agricultural workers, U.S. Postal Service workers and public transit workers and eight states have not included them in their plans at all.  The following table, from the Prison Policy Initiative, summarizes vaccination distribution plans for 49 States.

So how does this all play out? Differently, depending on what State you live in.  As of February 22, only 15 states were actively distributing vaccines to prison populations. California sits at the top of the efforts, having vaccinated about 40% of its incarcerated population. In contrast, Colorado has  deprioritized vaccinations in prisons as a result of public backlash for putting them ahead of the elderly and medically vulnerable. Many states have opted to only vaccinate people who are incarcerated who belong to other priority groups, including people older than 65 or those with preexisting health conditions. Further complicating matters, there isn’t a clear picture of the percentage of the incarcerated population that has been vaccinated, as only a handful of States have reported vaccination data. 

The patchwork nature and delayed priority of vaccine distribution to incarcerated populations raises concerns for equitable vaccine distribution. These concerns builds off an interwoven web of inequity at the intersection of health and criminal justice like the disportionate rates of COVID-19 infection and death in communities of color and the hyperincarceration of Black men, and the history of medical exploitation of people who are incarcerated. 

Unsurprisingly, these inequities are being repeated in the current pandemic:  28% of the incarcerated population in state and federal prisons has tested positive for COVID-19 since the start of the outbreak, with those incarcerated being 5.5 times as likely to contract the virus and three times as likely to die from it than the general population. For many, the lack of adequate prevention measures or medical treatment for COVID-19 has become the life sentence they were never served in court, and this consequence is now being prolonged by inaccessibility to the vaccine. 

The stark contrast between the care given to nursing home residents and the negligence shown to people who are incarcerated builds on a long record of incarcerated populations being left out of public health efforts and having their well-being disregarded. The impact of current carceral practices and conditions on viral transmission adds to the growing evidence for the harmful consequences of incarceration to the health of individuals, their families, and communities. This lack of care and attention ultimately serves to underscore the long standing contention about how we view the rights and humanity of incarcerated people.