In Massachusetts, Inmates Will Be Among First to Get Vaccines

Tens of thousands of prison inmates in Massachusetts will be among the first to be offered coronavirus vaccines, before home health aides, seniors and medically vulnerable residents of the state.

The inmates, along with people who live in homeless shelters and other congregate settings, will be vaccinated by the end of February, after health care workers, emergency medical workers and residents of long-term care facilities receive the shots.

The state’s high prioritization of inmates is unusual. A dozen states have listed prisoners among those set to receive vaccines in the first round of inoculations, but none ranks inmates so highly. Federal health officials have recommended that corrections officers and staff at state facilities receive high priority but have said nothing about inmates. The federal prison system has said it will vaccinate officers and staff first.

(On Wednesday, researchers at seven universities urged the Centers for Disease Control and Prevention to prioritize the vaccination of people in prison and recommend that vaccines be administered to inmates at the same time that correctional officers and staff receive them.)

“This is all because there is limited supply,” said Jennifer Kates, senior vice president and director of global health and H.I.V. policy at the Kaiser Family Foundation. “Tough decisions have to be made.”

Some of the largest coronavirus outbreaks in the country have taken place in the nation’s prisons. At least 400,000 cases have been reported among inmates, and at least 1,800 deaths have been reported among inmates and staff, according to a database maintained by The New York Times.

There are more than two million incarcerated people in the United States. An estimated 20 percent have been infected with the coronavirus. Inmates are four times more likely to be infected than the general population, and twice as likely to die of Covid-19.

While the stereotype of prisoners is that they are young, more than one in 10 nationwide is over age 55 and therefore more vulnerable to the virus, according to Lauren Brinkley-Rubinstein, co-founder of the Covid Prison Project, which tracks cases among incarcerated people nationwide.

Inmates also have higher rates of chronic medical conditions, like diabetes and hypertension, that increase the risk of severe disease if they become infected. Many suffer from mental illness.

Prison infections can lead to outbreaks in the community. One in seven infections in Chicago, for example, was linked to people going in and out of the Cook County Jail, according to a recent study in the journal Health Affairs. The jail is “one of the largest known nodes of SARS-CoV-2 spread in the United States,” the researchers said.

Yet there has been no comprehensive plan to roll out the vaccine for inmates. Even in those states prioritizing prisoners for early vaccination, details are often vague. Some states have simply decided that when older adults and medically vulnerable residents are vaccinated, inmates in those categories will be included — but not other prisoners.

The decision in Massachusetts to prioritize prisoners was driven by a commitment to equitable access amid a pandemic that has taken a disproportionate toll on people of color, who are also overrepresented behind bars, said Dr. Simone Wildes, an infectious disease specialist and a member of the state’s Covid-19 vaccine advisory group.

“We used equity as a core principle in our recommendations,” Dr. Wildes said. “We have had a lot of cases of Covid in the prisons, and we wanted to make sure those at highest risk were getting the vaccine first.”

Black and Hispanic people account for just over half of the prison and jail populations in Massachusetts, although they represent fewer than 20 percent of the state’s population, according to the Prison Policy Initiative, an advocacy organization.

Allocating scarce medical resources to people in prison can be controversial, and the Massachusetts advisory committee had some “very robust discussions,” Dr. Wildes said. But criticism so far has been muted.

Nearly 4,000 infections have already been reported among inmates and corrections officers in Massachusetts, and the number of incarcerated people testing positive has been steadily increasing since November.

In recent weeks, an outbreak at the Massachusetts Correctional Institution in Concord infected 47 employees and 161 inmates, about one-quarter of the prison’s population. Outbreaks of similar size occurred among inmates at M.C.I.-Norfolk and M.C.I.-Shirley in November, and several county jails have also reported large outbreaks recently.

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At least three inmates died of Covid-19 in December alone, but many deaths may go unreported. For example, Milton Rice, 76, was granted medical parole from the Norfolk prison but died of Covid-19 at a nearby hospital one day later, on Nov. 25, according to his lawyers.

While advocates have applauded the state’s decision to allocate vaccines to inmates, they said they hoped it would not detract from the need to take other urgent steps, including early releases to reduce crowding and increased testing to identify cases.

Many institutions are testing only inmates who display obvious symptoms of coronavirus infection. But since solitary confinement and lockdowns are used to contain the virus, many inmates are reluctant to report symptoms, said Monik Jimenez, an epidemiologist at the Harvard T.H. Chan School of Public Health who is studying prison conditions.

“It’s kind of like the Wild Wild West of testing — they pick and choose what they do,” she said. “When you don’t have comprehensive testing, you know you’re only seeing the tip of the iceberg.”

Carol Rose, executive director of the A.C.L.U. of Massachusetts, said, “Prisons and jails are just petri dishes for the coronavirus.” She added, “We need to reduce incarceration levels and release people who aren’t a danger to society, so more people are alive to receive the vaccine when it becomes available.”

But in Massachusetts, as in other parts of the country, efforts to reduce the number of people behind bars — largely by releasing people held in pretrial detention — have slowed. And the numbers have crept back up: As of Dec. 7, there were 4,306 inmates being held in pretrial detention in Massachusetts, exceeding the 4,194 who were being held in early April.

Though the state has a process for granting medical parole, many inmates who have chronic illnesses that would put them at risk for severe Covid-19 don’t qualify.

“You have to be terminally ill, within 18 months of dying, or permanently incapacitated,” said Elizabeth Matos, executive director of Prisoners’ Legal Services of Massachusetts, an organization that defends prisoners’ rights and advocates the least restrictive imprisonment.

The organization is representing a 78-year-old inmate who was denied medical parole this past spring, even though he has heart disease and chronic lung disease and is dependent on supplemental oxygen.

There is no guarantee that offering the vaccine to prisoners will end the epidemic behind walls, several experts noted.

Simply getting the doses to prisoners will be difficult. Prisons don’t have the ultracold refrigerators required to store the Pfizer-BioNTech vaccine, and are often located in remote areas. And tracking patients to ensure they receive both doses will also be challenging — inmates cycle in and out of jails, and prisoners are frequently transferred.

Distrust of the medical system is rampant, and doctors who work in the state’s prisons anticipate deep skepticism about the vaccine, among both inmates and correctional officers.

“I’m expecting a lot of resistance,” said Dr. Alysse Wurcel, an infectious disease specialist at Tufts Medical Center in Boston.

“There’s just a lot of distrust,” added Dr. Wurcel, who is also a Covid-19 consultant to the Massachusetts Sheriffs’ Association. “If you don’t trust the medical care you’re getting in the facility, how are you going to trust the needle in your arm?”

Leslie Credle, 54, who spent four years in prison and now runs Justice for Housing, a group that fights discrimination against former inmates, says some who are still incarcerated have told her they don’t trust the state Department of Corrections to administer the doses.

“‘They’ll take it home to their wives, and we’ll get water’ — that’s what one person told me,” Ms. Credle said. “If I were still in there, I wouldn’t take it myself.”

She fears vaccinations will put an end to efforts to depopulate the state’s prisons and jails.

“They keep going back and forth, saying they’re going to release, and then they don’t,” Ms. Credle said. “Now the vaccine has come out, they’re not going to release people.”