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Tanzina Vega: More and more people across the country are getting vaccinated every day as states continue to expand eligibility requirements, but vaccine distribution for incarcerated Americans still lags behind the general population. That's despite the fact that prisons and jails have been hotbeds of outbreaks during the pandemic. So far there have been more than 390,000 COVID-19 cases among incarcerated people in the United States, largely because of insufficient medical care and people being unable to socially distance while living in such tight quarters.

That's according to data from the Marshall Project. Two recent rulings aim to change this. On Monday, a New York State Supreme Court Justice issued a ruling requiring New York to immediately begin offering vaccines to all incarcerated people. That ruling echoes a similar one made last month in Oregon. I'm Tanzina Vega, and a look at the uneven vaccine rollout for incarcerated people nationwide is where we begin today on The Takeaway. Nicole Lewis is a staff writer for the Marshall Project focusing on felony disenfranchisement. Nicole, welcome to the show.

Nicole Lewis: Thanks for having me on.

Tanzina Vega: Lauren Brinkley-Rubinstein is an assistant professor of social medicine at university of UNC Chapel Hill and head of the COVID-19 Prison Project. Lauren, welcome back to the show.

Lauren Brinkley-Rubinstein: Thanks for having me.

Tanzina: I'll start with you Lauren. Before we even talk about vaccines, what are we looking at when it comes to case numbers and deaths in prisons and jails nationwide most recently?

Lauren: We continue to see a rise in cases disproportionate to the general population. There have been about 400,000 cases nationwide. About 20% of the population of incarcerated people have had COVID, over 2,500 deaths. One of the real problems though, is as we can start to focus on vaccination, we're seeing less and less data and so it's hard to tell in recent weeks what cases look like, because states are becoming more opaque relevant to what's happening behind the walls.

Tanzina: Nicole, we're talking about vaccine rollout here, but it seems like this population has not been a priority, or it's been varied from state to state.

Nicole: Yes, that's right. There are several states that put incarcerated people in phase one, kicked off in January. Massachusetts, New Jersey, for example, but then there are several states for which we still actually don't know where incarcerated people are going to fall. Folks in Florida have no information about when they'll be vaccinated. Large systems like Texas only just started vaccinating people a few weeks ago, and so this is just very mixed across the country and still very unclear.

Tanzina: Nicole, we mentioned at the top that New York State just issued a ruling where vaccines should be offered to its entire incarcerated population, that includes jails and prisons. How long is that going to take?

Nicole: It can really depend. New York is looking at about 50,000 people incarcerated here. It's not a huge number, but not a small number either and so it's really important to remember that vaccine allocation, where these vaccines go, is determined by the state. If they weren't figured into the plan weeks ago, months ago, that those vaccines may not be available, may not be ready to be directly shipped into the prisons. Prisons are also spread out across the state, so it could take some time before we are able to see a robust vaccination campaign behind bars, but it is decidedly good news.

Tanzina: Lauren, I was listening to a report today on a sister program here on public radio, and they were talking about homeless populations being vaccinated. They're seeing much success with the Johnson & Johnson vaccine because it's a one-shot only, it doesn't require two shots, and it also can be stored. It requires less rigorous storage requirements. In other words, you can put it in a refrigerator, not something like Moderna or Pfizer that require very specific storage temperatures. When we talk about what type of vaccine could be used for incarcerated populations, is that what they're considering or do we not know yet?

Lauren: It's pretty variable across the country. Many of the states that started early vaccination did use Pfizer and Moderna and figured out how to do that, mostly in partnership with departments of public health locally or at the state level. We have seen some states start to use the Johnson & Johnson vaccine. I think all three are on the table. As you've mentioned, the Johnson & Johnson vaccine is really great because it just requires one shot, not two. That's really important in the context of high turnover carceral spaces, such as jails. I think we're seeing it all on the table, but Johnson & Johnson does help us overcome some of the barriers that are inherent to jails and prisons.

Tanzina: Lauren, what about when it comes to testing? Is there any type of rigorous testing happening in incarceration for incarcerated people and particularly in places like jails, where as you said, the turnover rate is quite high?

Lauren: As with everything we're seeing a lot of variability across the country. We have some jails in this country that are highly resourced and some that lack resources and have virtually no testing on board. We have seen more testing happen recently than happened, say, a year ago at the beginning of the pandemic. We've also seen uptake of surveillance methods using rapid antigen test. We've seen more testing than in the past, still not enough adequate testing, but we've seen some targeted populations such as transfers from facility to facility or new intakes or on release, so we're seeing some testing plans see light, but definitely not as much as we would have wanted.

Tanzina: Nicole, you've done a lot of reporting around this issue. One of the things you've reported on was you surveyed incarcerated people earlier this month to get a sense of how they were feeling about getting the vaccine. What stood out to you in their responses?

Nicole: That's right. I'd say the biggest thing we found was that this year behind bars during a pandemic, where most prisons have been in lockdown, people haven't been able to see their families, has been so hard on incarcerated people that it is creating some interest and encouraging people to get vaccinated. Many people were saying that they see this shot as a potential way of getting off of lockdown and having some return to normalcy. That's a really important and interesting finding.

Tanzina: On the flip side of that, Nicole, you also did reporting on vaccine hesitancy, except this time we're talking about corrections officers. The people who are working in the facilities. Tell us about what you found there.

Nicole: That's right. On this side we found widespread hesitancy, refusal in some cases to get vaccinated. The reasons for that were really quite varied. On one side we definitely had groups of people who believed in conspiracy theories about the vaccine, about what it might do to them. There's limited information. I think it was really important for some of the sources that we spoke to, to point out that correctional officers are not alone in this. Police officers, some nurses have refused the vaccine at higher rates, confusing public health officials.

These folks are on the front lines. In many cases, corrections officers have a little education, tend to lean right. We've seen national polls have shown us that Republicans, people with lower education tended to be more hesitant. There's just a number of reasons for why this is happening. I'd say my biggest concern there, the thing that really stands out to me is that in some cases it was interfering with incarcerated people's decision making around whether or not they should get vaccinated.

This is a community of people who don't have really much or any connection to the outside world. They can't do research on their own and so what corrections officers are telling them becomes incredibly important.

Tanzina: Also, Lauren, I'm wondering your thoughts, doesn't that also present a interesting scenario where the corrections officers who leave the facility and come home and go home and come back. If they choose not to be vaccinated, couldn't they also pose a risk to the incarcerated population?

Lauren: That's right. We've seen that staff in particular have exposure in their communities or exposure in the jail or prison setting, and then they bring that back home or they bring that back to work. When folks decide to not get vaccinated and they are exposed to these high risk settings, they are putting communities at risk. They're putting incarcerated folks at risk. As Nicole said, when you're an incarcerated person who has no agency, many times [unintelligible 00:09:29] your decision-making, it might make you less likely to take the vaccine when you're offered it.

It also puts you at risk. I'm thinking a lot about variants too, as these new variants come on board that are much more contagious in the setting of prisons and jails. They've been hotbeds as you noted, really the epicenter of the pandemic, but in the context of these variants, it becomes even more dangerous. It really underscores the importance of staff uptake of vaccines when they're made available.

Tanzina: Nicole, has this issue-- I mean, it seems like so many things around the pandemic have been politicized. Has the vaccination of incarcerated communities become a political issue as well in your reporting?

Nicole: Absolutely. In several states we saw that incarcerated people were prioritized. Then in some cases the state legislature, oftentimes led by a group of Republicans, really pushed back. Passed legislation, introduced resolutions to deprioritize these folks. There's been a ton of backlash on social media and online. I can't tell you about the number of local radio shows that I hear where people are framing this issue as, "Murderers and rapists are going to get vaccinated before your grandmother." It's just such a huge distortion to think about where, as Lauren said, the importance of vaccinating people who are incarcerated as a way to protect the whole community. It's just sort of politically fraught across the country.

Tanzina: Lauren, as we bring the segment to an end here, I'm wondering if there's something specific that you would like to see, whether it's states, which right now have a patchwork of different policies for vaccinating incarcerated populations, or from the federal government, that you think would help incarcerated people get access to vaccines in the coming weeks?

Lauren: Sure. I mean, a giant piece of legislation, the American Recovery Act, was passed a couple of weeks ago. It mentioned specifically congregate living facilities. I think it mentions jails and prisons once. I really think there's a space for the federal government to make a call that some of this money that's going to go to states to help pay for prevention activities, such as testing or vaccines, really be carved out for prisons and jails, to develop interventions that increase awareness or information, education relevant to vaccines, how COVID works, how the vaccines work.

I also think there's something there around the mandating of data transparency. The only reason why we know so much about COVID is because all of the prison systems in this country launched public dashboards. We were able to, in some ways, keep them accountable because we had information that we wouldn't have otherwise had. I think that same needs to go for vaccines and vaccine deployment, and some of that money can be tied to, that's given to the states from the federal government, can be tied to data transparency. I think that's pretty important and something that's kind of missing at the federal level currently.

Tanzina: Lauren Brinkley-Rubinstein is an assistant professor of social medicine at UNC Chapel Hill and head of the COVID-19 prison project. Nicole Lewis is a staff writer for the Marshall Project. Thanks to you both.

Lauren: Thank you.

Nicole: Thank you.

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