Include prisons in planning

Connecticut rightfully included incarcerated people in a high priority group for the COVID-19 vaccine — now we must include them in distribution planning.

Since the beginning of the CO

VID-19 pandemic, Connecticut prisons and jails have been hit hard by the coronavirus. After recent systemwide testing, 13 percent of incarcerated people tested positive for the virus, and recently, the 10th person died of

COVID-19 within Connecticut’s correctional system.

Gov. Ned Lamont has confirmed that health care workers and residents of nursing homes will be among the first to receive the COVID-19 vaccine in Phase 1a. Importantly, incarcerated individuals will be in Phase 1b, which sets Connecticut apart from many states that have failed to recognize the science behind prioritizing this population for the vaccine. This was the right decision -- consistent both with sound ethical principles of vaccine distribution and with the severe impact of the virus on this group. Good science and good ethics aren’t conflicting here.

But just because incarcerated individuals are rightfully prioritized for the COVID-19 vaccine does not mean they will take it. A survey commissioned by Pew Center of States found that 49 percent of participants would not get vaccinated initially, and these rates are highest among Black and brown communities, which have long been neglected and discriminated against by the health care system at large. Addressing vaccine hesitancy is a necessity within Connecticut’s correctional system, where nearly

70 percent of individuals are Black or Latinx.

One way to maximize CO

VID-19 vaccine uptake in prisons and jails is through a communication strategy aimed at acknowledging past harms caused by health systems, building trust and harnessing community resources. Key to this is having incarcerated individuals and their families at the table to help design vaccine distribution plans from the very beginning. There can be deep mistrust of health services within prisons and jails stemming from the failure of correctional systems to protect the health of those incarcerated, which will not resolve on its own. Empowering and resourcing incarcerated people to act as vaccine experts equipped with resources and knowledge to address valid concerns could increase vaccine uptake, as has been done for other health topics.

Similarly, ensuring vaccine uptake among correctional staff must also be prioritized to manage COVID-19 rates inside prisons and jails. These individuals are part of the carceral ecosystem and spend their time between their communities and work facilities, potentially spreading the virus within both. Black and Latinx individuals are also overrepresented in the correctional staff, and addressing their concerns and hesitancy about the vaccines is critical.

Despite the importance of addressing vaccine hesitancy within our correctional system, Connecticut’s COVID-19 vaccine advisory group does not appear to have an individual explicitly representing currently incarcerated people or even a representative from the Connecticut Department of Corrections. We call on this group to include incarcerated individuals and correctional staff in the planning for the COVID-19 vaccine distribution. This group must also construct and deliver messages focused on vaccine resistance that are appropriate for incarcerated populations and correctional staff. Otherwise, our prisons and jails will continue to be COVID-19 hot spots, and we will never address the disproportionate impact of the virus on Black and brown communities.

To be sure, even with an effective communication strategy that includes currently incarcerated individuals and correctional staff, people will decline the vaccine as they should be allowed to at this point. The choice to decline vaccination must be preserved within our prisons and jails without retaliation from correctional staff or leadership. Mandating vaccination and enforcing harsh, punitive strategies in correctional settings has not been an effective strategy for vaccine uptake previously and will not work now.

Connecticut has a good strategy for vaccine prioritization. But to see it through, we must have the real experts — incarcerated people and correctional officers — take part in messaging and strategies for distribution. Otherwise, COVID-19 will continue to devastate our correctional system, and thus our state as a whole.

Tyler Harvey is the program administrator at the SEICHE Center for Health and Justice at the Yale School of Medicine. Dr. Lisa Puglisi is an assistant professor of medicine at Yale School of Medicine and co-director of the Transitions Clinic Yale-New Haven. Dr. Emily Wang is an associate professor of medicine at Yale School of Medicine and co-director of the Transitions Clinic Yale-New Haven.