Here's why inmates should get vaccinated against COVID-19 before the rest of us

With the impending approval of COVID-19 vaccines, the United States will soon have some difficult choices to make about who gets priority for receiving inoculation. Debate among federal and state health officials about vaccine distribution is heating up, and lobbying efforts are intensifying.

Perhaps the most controversial question of priority concerns inmates in American jails and prisons. Given this country's generally unforgiving attitude toward the incarcerated, putting them toward the head of the vaccine line would not be an easy political choice.

Yet there are compelling reasons to do so.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) issued guidelines on Nov. 23 that recognized the distinctive situation for prisons. It listed correctional officers as essential workers who would be among the segment of the population to get the vaccine in the second wave of Phase 1, immediately following health care workers and residents of long-term care facilities. Those guidelines recognized that, like other essential workers, people who work in jails and prisons are "at increased risk and should be given the opportunity to be vaccinated early on."

In line with the ACIP recommendation, the Federal Bureau of Prisons quickly announced that it will give vaccine priority to its prison staff, according to a report by The Associated Press. The bureau already has started working to secure the vaccine. Wardens and prison staff could receive the vaccine within weeks.

But neither the ACIP guidelines nor the Bureau of Prisons said anything about inmates, even though their living conditions can pose even greater risks than conditions in nursing homes and long-term care facilities. This silence raises what a New York Times report called the "chilling prospect" of "another prison outbreak that kills scores of inmates after the only preventive was reserved for staff."

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State and local governments across the country face similar prospects as they decide the fates of jail inmates and prisoners held in state penitentiaries. They, too, are making choices and announcing plans.

The Marshall Project reports that at least six states have decided that inmates and prisoners will be among the earliest vaccine recipients. North Carolina is one of them, treating people who live in close quarters (including migrant farm camps and homeless shelters) equally.

Elsewhere, resistance is emerging. Colorado Gov. Jared Polis, a Democrat, recently announced his opposition to recommendations that his state should follow North Carolina's example. Referring to the distribution of the COVID-19 vaccine, Polis said, "That won't happen. ... There's no way it's going to go to prisoners before it goes to the people who haven't committed any crime. That's obvious." He assured the state's residents that the public health department will deprioritize prisoners when it finalizes its vaccination plan.

His stance won plaudits from people across the state. As one newspaper explained, the vaccine should go to Coloradans "who simply need a vaccination even more. Some of them are teaching school or running our schools ... while others are keeping various federal, state and local public services functional. Police and firefighters of course provide fundamental services we can't do without. ... Prison inmates, by contrast, contribute little to any of that activity. Their lives are on hold. The rest of us do not depend on them."

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The issue in Colorado and elsewhere is whether vaccine distribution should focus on saving the lives of those most at risk or should be based on the contributions of various segments of the population to the general welfare.

Such choices are by no means easy ones.

But the CDC guidelines rightly articulate the principle that priority should be given to saving the lives of those at highest risk. While those guidelines don't recognize it, people confined in the nation's prisons and jails are certainly in the high-risk category.

In fact, the likelihood of getting COVID-19 in prison is 5.5 times higher than for the general population. As of Thursday, nearly 252,000 prisoners had tested positive for the virus.

Some of the worst outbreaks in the USA have been in prisons, such as at California's San Quentin state facility, where the coronavirus infected 75% of the incarcerated population.

Because incarcerated people have higher rates of underlying conditions than the general population, prisoners are also more likely to experience severe complications or death if they contract the virus. Their COVID-19 mortality rates are higher than in the general population.

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The reasons are not hard to find. Many of America's correctional facilities are antiquated and notoriously overcrowded. In California, for example, more than a third of the state's institutions are operating overcapacity. In New York City, inmates sleep 40 people to a room, making social distancing an implausible form of protection.

Sanitation in jails and prisons is frequently poor. In many facilities, the plumbing regularly fails, ventilation is inadequate and food preparation fails to meet minimum standards of safety.

And given the disproportionate number of persons of color serving time in U.S. jails and prisons, delaying vaccine distribution will exacerbate COVID-19's already disparate racial effects.

Life behind bars is hard enough without a deadly virus on the prowl. When COVID-19 strikes, additional restrictions make it even harder. Family visitation is often suspended, as are visits by lawyers. To prevent the spread of the virus, prison authorities order inmates locked down in their cells. Delay in vaccine distribution means that such restrictions and deprivations will continue.

The Supreme Court has long recognized that "when the State takes a person into its custody and holds him there against his will, the Constitution imposes upon it a corresponding duty to assume some responsibility for his safety and general well-being."

What this means is that we have an obligation to attend to the health needs of those whom we incarcerate and cannot treat them as less deserving of disease prevention measures like the COVID-19 vaccine.

Recognizing this obligation, last month the American Medical Association said that people behind bars "should be prioritized in receiving access to safe, effective COVID-19 vaccines in the initial phases of distribution."

Political leaders in Washington, D.C., and across the country need to muster the political courage necessary to heed that wise and humane recommendation.

Austin Sarat is associate provost and associate dean of the faculty and William Nelson Cromwell Professor Jurisprudence and Political Science at Amherst College. He is the co-editor of "Life Without Parole: America's New Death Penalty?" Follow him on Twitter: @ljstprof

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This article originally appeared on USA TODAY: Here's why inmates should get COVID-19 vaccine before the rest of us