In this commentary, Stone Center postdoctoral scholar Jaquelyn Jahn, a social epidemiologist who focuses on health equity, discusses ways to prevent more illness and deaths in jails and prisons.
Since the start of the Covid-19 pandemic, more than 612,000 incarcerated people and staff in U.S. jails and prisons have been infected and at least 2,700 have died. Social distancing is nearly impossible in these settings, and rates of confirmed cases are nearly four times higher than the national average. The failure to prevent so many of these deaths and infections not only speaks to shortcomings in the pandemic response in detention centers but also in the existing structures that have contributed to poor health for incarcerated people for decades.
For the past several years I’ve worked with Deeper Than Water, an activist coalition led by incarcerated and formerly incarcerated people to address toxic water and medical treatment in Massachusetts state prisons. Since the early days of the pandemic, incarcerated activists have brought attention to overcrowding, poor ventilation, inadequate mask distribution, and infrequent Covid-19 testing inside detention facilities.
These problems have mobilized an unprecedented level of public support for reducing the number of people inside jails, prisons, and detention centers. Along with other public health practitioners and researchers, I helped write the American Public Health Association’s policy statement, calling for urgent releases from detention facilities, investment in health-promoting services to facilitate reentry, and community-level public health interventions to prevent incarceration in the first place. Despite an initial trickle of releases in the early months of the pandemic, prisons populations have been largely unchanged.
In the context of very limited releases from detention facilities, widespread Covid-19 vaccination is vital. In January 2021, around 39,000 detained people in the United States received at least one dose of the Covid-19 vaccine. However, this is a small fraction of the nation’s 2.3 million incarcerated people. Only 8 states specifically list incarcerated people in Phase 1 of Covid-19 vaccine distribution and just 15 states prioritize corrections staff in Phase 1.
Even in places where vaccines are being offered to incarcerated people and staff, widespread vaccine hesitancy is felt by many in these settings. Although federal detention centers receive vaccine supply directly through the Bureau of Prisons (as opposed to through state governments) as part of Operation Warp Speed, so far only half of staff offered the vaccine took the first dose. Since the beginning of the pandemic, incarcerated people have consistently voiced concerns around transmission from staff and now must weigh those concerns with distrust of the vaccine and the prison healthcare system. Many incarcerated people, a disproportionately Black population, are cautious after historical and continued medical racism, a legacy of experimentation on prisoners, and recent calls for Covid-19 vaccine trials within prisons. Several incarcerated people I spoke with were worried they were at risk of participating in a vaccination trial without their consent. For some, these broader concerns were compounded by current distrust or dissatisfaction with the healthcare provided in detention facilities.
Healthcare advocates across the country are working to address questions and misinformation about the Covid-19 vaccine for incarcerated populations. Deeper Than Water worked in partnership with groups in Massachusetts, including Black and Pink and Families for Justice As Healing, to generate a factsheet on the Covid-19 vaccine for incarcerated people and held a town hall where people with an incarcerated family member shared their concerns and had questions answered by physicians and epidemiologists.
Many of the concerns raised related to how the vaccine would affect someone with pre-existing chronic diseases, like COPD, diabetes, and auto-immune diseases, and whether there would be adequate medical care available for possible adverse reactions to the vaccine — comments that underscore the extent to which prisons hold some of the nation’s most medically vulnerable people. These are institutions built for punishment, not care, and although they are constitutionally required to provide healthcare, they often make diseases worse. Distrust in this context is, to me, entirely understandable. The pandemic has been yet another example of a political commitment to punishment that too often outweighs any efforts to meet the material and medical needs of society’s most marginalized.
About the Author:
Jaquelyn Jahn, who joined the Stone Center in 2020, researches the consequences of social policies for population health and health equity. Her current projects examine the intergenerational implications of criminal legal contact for health and well-being across the lifecourse, as well as effects of reforms in U.S. health care and criminal justice policy.