Should prisoners be first, or last in line for COVID vaccine?

Washington, D.C. Newsroom, Dec 3, 2020 / 17:00 pm

As public officials debate whether prison populations should be among the first or last to receive a COVID vaccine, ethicists say that incarceration should not be the deciding factor.

"Wherever this person is-if they have comorbidities or if they have higher risk for contracting the disease or experiencing complications or death-then they should receive the vaccine sooner," Jozef Zalot, staff ethicist at the National Catholic Bioethics Center, told CNA.

Since the COVID-19 pandemic began, certain populations have borne the brunt of virus deaths, and become the subjects of discussions about who should receive a vaccine first.

While residents of long-term care facilities accounted for 7% of COVID cases in the U.S., they reportedly make up 40% of deaths from the virus. More than 100,000 residents of long-term care facilities have died of the virus so far.

Prisons have reportedly suffered many virus outbreaks as well, although the data at hand do not show as high of a fatality rate among this population.

According to The Marshall Project, by Nov. 17 there have been nearly 200,000 positive COVID cases in prisons; there were at least 1,454 COVID-related deaths reported among prisoners, and at least 98 deaths reported among prison staff.

Now that pharmaceutical companies have developed at least two COVID vaccines and submitted requests for emergency use authorization from the U.S. Food and Drug Administration (FDA), public health officials are discussing which populations should receive a vaccine first.

Although the first vaccines are expected to be distributed and administered this month-a CDC advisory board expects a total of 40 million doses available by Dec. 31-doses will be limited, especially in the initial weeks and months of distribution.

On Tuesday, an advisory board for immunization of the U.S. Centers for Disease Control (CDC) recommended that "phase 1A" of vaccine distribution-listing the populations among the very first to receive it-should include health care workers and residents of long-term care facilities.

Recently, the Colorado Department of Public Health & Environment recommended a phased roll-out of a COVID vaccine with health care workers and long-term care residents among the first to receive a vaccine.

A draft plan reported by the Colorado Sun showed the agency recommending that next in line for a vaccine should be people in "congregate settings"-living in close quarters. This group would include adults living in group homes, students living in college housing, and adults in homeless shelters and prisons.

Only after this phase would "higher-risk individuals"-senior citizens over the age of 65, or adults with a compromising condition such as diabetes, serious heart disease, or chronic lung disease-be prioritized for a vaccine in "Phase 2B."

However, Colorado Gov. Jared Polis has since said that prisoners would not automatically be prioritized for a vaccine before other citizens, saying "[t]here's no way it's going to go to prisoners before it goes to people who haven't committed any crime. That's obvious."

Several ethicists told CNA that the most urgent targets for a COVID vaccine should be those in most need of it-those at highest risk of dying from the virus, whether or not they reside or work in a prison.

According to the CDC, people ages 65-74 have COVID-19 death rates that are 90 times higher than 18-29 year-olds; while those 75-84 years old are 220 times more likely to die from the virus than 18-29 year-olds.

"So obviously, there's something associated with age," Zalot told CNA. "Comorbidities," he said, "also play a big role" in virus fatalities.

"So it would seem then, that when a vaccine comes out," he added, those first in line should be "those with underlying health conditions" as well as "those who are elderly" and "the health care workers, because they're the ones who are dealing with these people."

As nursing homes are mostly filled with the elderly living in close quarters, it does make sense to vaccinate those populations first, Fr. Tad Pacholczyk, staff ethicist at NCBC, told CNA.

Prisons, on the other hand, house many younger or middle-aged inmates, he said, but elderly inmates or those with underlying health conditions should also get a vaccine quickly.

"Prisoners, simply because they committed crimes, do not renounce access to basic health care," Pacholczyk told CNA. While they may suffer restrictions on movement, they cannot be denied "other basic goods, like food, water, medicine, health care."

If a prison population was disproportionately at high risk of the virus, he said, they should get a vaccine quickly.

"If one had a penal institution where virtually all of those who were incarcerated happened to be elderly, say above 75 years of age, then they could reasonably be prioritized, along with those in nursing homes, to receive early doses of limited vaccine supplies," Fr. Pacholczyk said.

Dr. Charles Camosy, a theology professor at Fordham University, told CNA that Catholics do need to pay attention to and serve those in prison-but they may or may not be among the most vulnerable people for the virus.

"As Christians we are obviously called to have special priority for prisoners," Camosy said, "and to see the face of Christ in them."

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However, "there are many different vulnerable populations bearing the face of Christ during the pandemic," he added, "and our duty, as inspired by Catholic Social Teaching, is to focus on the most vulnerable."

Elderly and sick prisoners "should not be refused vaccines because they are prisoners," he said. "But young and relatively healthy prisoners have such little chance of having bad outcomes that we should prioritize those who are elderly and sick (outside of nursing homes) ahead of them."