Vaccines will begin arriving in North Carolina’s state prisons this month.
Some staff members are already beginning to receive doses, while incarcerated people in the same age demographic wait.
As the number of new novel coronavirus cases shattered records last week, topping over 10,000 new cases on each of several days, North Carolina is beginning to enter Phase 1b of its vaccination plan.
Frontline health care workers and people who live and work in long-term care settings, such as nursing homes, have been given the opportunity to get vaccinated. This includes health care staff who work in prisons and jails. State prison health care workers began receiving the vaccine on Jan. 4, according to an internal Department of Public Safety document obtained by North Carolina Health News.
Last month, the state health department released an updated plan that mirrors new Centers for Disease Control and Prevention guidance for determining who should get initial doses of the COVID-19 vaccine.
Under this schedule, the first group of people in Phase 1b to be offered the vaccine are individuals who are 75 and older “regardless of medical condition or living situation.”
This includes both staff and inmates.
People who are 75 or older have had significantly higher rates of infection, hospitalization and death from the novel coronavirus, even when compared to individuals between 65 and 74 years old, according to the CDC’s Advisory Committee on Immunization Practices, which developed these recommendations.
Approximately 165 state prisoners are in this age group, said Tim Moose, chief deputy secretary of the Division of Adult Correction and Juvenile Justice at DPS, at a press conference last week.
A small number of correctional staff who are 75 and older are beginning to receive the vaccine from their local health providers, said Todd Ishee, commissioner of prisons at DPS, who spoke at the conference.
The prison agency, which will oversee administering doses to inmates in its custody, has yet to receive the vaccine -- meaning incarcerated people in this age group will have to wait. Ishee said DPS expects to receive doses later this month from the Department of Health and Human Services.
The Plan Thus Far
Younger staff, who will receive the vaccine next in upcoming groups of Phase 1b, are expected to receive doses by mid-to-late January or early February, according to Ishee. Remaining inmates, who comprise the vast majority of the prison population and are scheduled for a later phase, will also be offered the vaccine in this rough time frame.
“That's a pretty fluid guesstimate,” he said. “It's subject to change based on the availability through the federal government and guidance from our local state health department.”
Prisoners 75 or older are supposed to be prioritized above the general staff and prison populations. They will likely be offered the vaccine around the same time as lower-priority inmates, according to DPS chief medical officer Dr. Les Campbell.
“At least by then, it could be sooner depending on what we get for vaccine,” he said during the press conference. “But that’s correct.”
Prison officials said they were uncertain which type of vaccine -- Pfizer or Moderna -- they will receive for inmates and staff. That could affect timing.
“We want to stress that we currently do not have a firm schedule of dates and locations,” said John Bull, DPS spokesperson. The agency has designated four locations, one for each “prison region,” for receiving and storing the vaccine, according to internal DPS documents.
Prison health care staff will administer the coronavirus vaccine to inmates once the agency does receive doses, said Bull. The prison system is working with DHHS, local health departments, and the National Guard, who will send strike teams to coordinate the effort.
First To Staff, Then To Inmates
Under the plan, most of North Carolina’s state prisoners -- 29,080 of 29,245 total incarcerated in a state-run facility -- will not receive the vaccine until after it has been offered to correctional staff.
Corrections officers are considered frontline essential workers by the CDC. Staffers who are 50 or older will come first, in group 2 of Phase 1b. The remainder of officers will receive doses next, in group 3.
In Phase 2, incarcerated people re-enter the scene. People who are 65 to 74, including inmates, will be given the chance to take the vaccine first, followed by those who are 16 to 64 with a serious medical condition in the next group. Finally, “anyone who is incarcerated” and has not already been vaccinated will be offered the shots, according to the state plan.
Prison officials said this schedule was set by DHHS, following CDC guidance to determine their vaccine distribution plan. DHHS spokesperson Catie Armstrong said the health agency “continues to communicate with DPS to provide guidance and ensure that vaccine rollout and administration goes smoothly.”
“We have had public meetings, reviewed data, and we've reviewed what others have said and really taken that to heart before coming up with this plan,” said Dr. Katherin Poehling, professor of pediatrics and epidemiology at the Wake Forest School of Medicine and a member of the CDC vaccine advisory committee. “It is a very difficult task, and it was not made lightly.”
‘A seesaw of concerns’
Members of the committee that developed the CDC’s recommendations said they designed the plan with the idea of balancing a “seesaw of concerns.”
“We're trying to balance maintaining infrastructure and the economy of the US and reducing the number of deaths and the strain on the hospital,” said Dr. Helen Keipp Talbot, a committee member and professor of infectious diseases at Vanderbilt University Medical Center in Nashville, Tenn. “So step-wise, it’s how do we maintain what we have, and protect people at the same time?”
It’s why health care workers, who are essential in treating patients for COVID-19 or other ailments have come first. Also in that first group are long-term care residents, who have accounted for 40% of all deaths. One group maintains infrastructure, the other is high-risk.
“The idea was people that keep us fed and safe need to be next, in Phase 1b, for multiple reasons: They can't work from home, they put their lives at risk for us to eat every day, and they often live in multi-generational households with multiple comorbid conditions,” Talbot said, in reference to essential frontline workers such as detention officers.
“And then to balance that out, on the other side [of the seesaw] would be the over-75 group, who is next in line for risk after the nursing home patients,” she said.
While some incarcerated people will be included in this over-75 group, the committee left it up to the states to decide if they wanted to make a specific provision for incarcerated people in general.
“We wanted to give information to the states, and let them make the adjustments based on their reality,” Poehling said, noting that in places like North Carolina, where there are outbreaks in correctional facilities, working these areas into the plan is appropriate.
Some states, like Minnesota and New Jersey, have specifically set aside doses for prisoners in Phase 1a.
Talbot said that vaccinating detention staff will begin to quell spread in correctional facilities.
“The idea was if we could get all of the staff vaccinated, that reduces inmates’ risk -- it's really the people who work there who bring COVID into the facility,” she said. “It’s again about balancing their risk and severity. Inmates are in a congregate setting, which increases the risk of spread, but not necessarily the severity.”
Assessing Severity
By prioritizing older people regardless of setting, the distribution plan will ideally target incarcerated people who are in a high-risk age demographic first -- if DPS is able to administer the vaccine to them on schedule.
Still, Dr. Pablo Sánchez, a pediatric infectious diseases specialist at Nationwide Children’s Hospital in Columbus, Ohio, and also a member of the advisory group, said he voted for “elderly people'' to be prioritized in Phase 1b with the understanding that it would mean people 65 or older. He said this would have captured a greater scope of at-risk people, including in carceral facilities.
“We really do need to quickly start prioritizing some of the elderly who are 65 years of age and older, especially those who are not able to quarantine effectively,” he said.
Twenty-one of the 36 state prisoners who have died were 65 or older, according to press releases and death records obtained by NC Health News. Eight of them were 75 or older.
Looking Ahead
It’s still unclear which individual prisons will receive the vaccine first, and how many times strike teams and medical staff administering shots will come to each facility.
DPS has a written framework plan for this process, which NC Health News obtained through a freedom of information request; this plan is subject to change, according to Ishee.
The prison agency has developed educational materials and videos about the safety of the vaccine for inmates, as well as consent forms, according to the framework.
Getting vaccinated is currently optional for both staff and state prisoners. That too could change, he said.
“But we are not there right now,” Ishee said, noting the decision would be made in consultation with the state health department.
“It is voluntary, and we really hope that our staff and our offenders will jump on board and get vaccinated,” he added. “We think that this is critical not only to that to the health and welfare of the prison system -- we're also all contributing members of communities.”
This article first appeared on North Carolina Health News and is republished here under a Creative Commons license. North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina.