Last month, a team from Wellpath, a private company that provides health care at jails and prisons, delivered COVID-19 vaccines to more than 1,000 incarcerated people.
At this particular facility (which the company wouldn’t name), the last mile of the COVID-19 vaccine supply chain is between the pharmacy building and the housing units, where inmates live.
But a lot can happen in that final mile to slow vaccinations, according to Chief Nursing Officer Heather Norman, who traveled with the Wellpath team to administer vaccinations.
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“I thought it would be a simple process for [a health care administrator] to do,” Norman told FreightWaves. “Actually, a lot can go wrong.”
The shipping dock that receives vaccines for this facility is a mile from the pharmacy, where the shots are prepared. The pharmacy is a mile from the building where patients live. Staff have to go through a security screening before entering every building, a time-consuming process.
During Norman’s visit, her team prepped the vaccines and was on the way to the housing unit when they realized that they had forgotten to report the lot number. That meant a trip back to the loading dock and another round of security screening.
Later, at the same facility, the problem was port-a-potties. A large winter storm had disrupted the plumbing, so the prison brought in some port-a-potties.
“They were picking port-a-potties up, so they shut down movement. That put our ability to deliver vaccines on hold. They had to lock down all the inmates to do a count,” Norman said. “We had to stop everything we were doing in nursing so that they could count all the prisoners.”
The remote location of many jails and prisons, extra security measures and the unpredictability of a prison setting have complicated the vaccine supply chain for incarcerated people. In addition, correctional facilities have to communicate constantly with public health officials to coordinate vaccinations for new arrivals or people who are released.
Despite the challenges, some jails and prisons are vaccinating significant portions of their population quickly. However, crowded conditions allow the virus to spread easily and unvaccinated people still face major health risks.
Jails and prisons have been a major hot spot for COVID-19 outbreaks. A recent analysis by the COVID Data Dispatch found that jails and prisons were the most common setting for superspreader events. The New York Times estimates that well over 600,000 people were infected in correctional facilities and more than 2,700 incarcerated people and correctional officers have died from COVID-19.
Given the severity of coronavirus outbreaks in prisons, many public health experts have recommended putting prisoners at the front of the line for vaccines. Most states and federal corrections systems are currently giving vaccines to inmates. Eight states are not and another eight aren’t reporting their plans, according to the COVID Prison Project.
So far, more than 87,000 prisoners and 64,000 correctional officers have received at least one dose of a COVID-19 vaccine, according to a tally by UCLA’s COVID Behind Bars project.
The Federal Bureau of Prisons has fully vaccinated about 45% of its staff, who were offered shots first, and nearly 13% of all inmates. That’s not a high enough number to provide widespread protection for inmates, and some prisons still haven’t received any vaccine doses. But it would be hard for the BOP to move faster.
The federal government’s vaccine program determines how many doses the BOP gets, a spokesperson wrote in an email. According to BOP documents, those doses are distributed to facilities based on disease risk and vaccine availability. The highest-risk patients receive the vaccine first if doses are in short supply.
The agency has administered about 97% of the vaccines it has received. That’s much more efficient than even the most successful states. North Dakota has administered nearly 89% of its doses, and the national average is about 77%, according to Bloomberg’s vaccine tracker.
While the BOP received allocations of vaccines directly from the federal government, other federal entities did not. County health departments are allocating vaccine doses to Immigration and Customs Enforcement detention centers, which held about 33,000 people on an average day last year. So far, a limited number of ICE detainees have started to receive vaccines, according to an ICE spokesperson.
Part of the BOP’s efficiency is due to careful planning. In December, a group of health care corrections researchers from Yale, Columbia and the University of North Carolina recommended creating vaccine distribution plans specific to corrections systems. As an independent jurisdiction, the BOP was able to create a detailed guide.
The Moderna doses are shipped directly to each BOP facility by McKesson. Those doses must be used within 30 days.
Doses of the Pfizer vaccine for the agency are first shipped to hub sites. Prison staff from spoke sites — facilities within 175 miles of the hub — pick up the doses as soon as possible and immediately bring them back. They have to use them within five days.
Most jails and prisons don’t have ultra-cold freezers to store vaccines for long periods of time. That means a countdown starts as soon as shots arrive, and health care workers must administer them quickly.
“It’s hard when we’re working on such a tight timeline. We have just a week … so this is time sensitive for us,” Norman said. “We have to expect the unexpected, but you can’t plan for the things that happen in our line of work.”
In addition, the remote location of many jails and prisons can complicate delivery, Wellpath Director of Procurement Susan Patrick Harris told FreightWaves.
“I tell our suppliers every day. We’re not located at 123 Main Street. We’re at 123 cornfield,” she said.
At facilities served by Wellpath, the first step of the vaccination process is education, Norman said. Jails and prisons may hold town hall meetings to talk about efficacy or side effects. Then, health care workers take a poll to see how many people are interested in getting the vaccine.
“We educated our patients from day one,” she said. “They are very knowledgeable. I was really impressed when we went out to the housing units at how knowledgeable our patients are about COVID-19.”
In general, Norman said the acceptance rate among incarcerated people has been very high. At first, it was higher than acceptance by Wellpath employees.
That matches up with a survey from the The Marshall Project, which found widespread interest in the vaccine among people in prisons. The Marshall Project also reported that correctional officers are generally more hesitant to get the vaccine.
After the port-a-potties were safely removed from the facility Norman visited, the process of administering shots was relatively routine. The only major difference compared with a regular health care setting was the level of security.
“Security requires a corrections team to be with the nurses,” she said. “For each nurse that we send … we’ll have one or two corrections officers.”
Over the course of a week, Norman’s team continued to administer vaccines. However, that prison’s population could easily change over the next month, when the initial recipients will need a second dose. New people come into the prison, and others are released or transferred, adding another challenge.
In a February op-ed published in The Appeal, a group of corrections health care researchers pointed out that jails only hold people an average of 25 days, less than Moderna’s four-week gap between shots.
“Implementation plans will need to account for follow-up shots in the community for individuals who are released prior to receiving the second dose,” researchers Emily Wang, Lauren Brinkley-Rubinstein and Lisa Puglisi wrote in The Appeal.
“Historically, this has been done for other infectious diseases that are prevalent in incarcerated populations and can affect community transmission rates, such as hepatitis B, where vaccination is started during incarceration and completed in the community.”
Wellpath has added questions about vaccination status on intake forms, and tries to connect people who are released after one dose to health departments to get their second shot.
“The key to all of this is partnering with our health departments. That’s the only way to make this successful,” Norman said.
That kind of communication is an important part of New Jersey’s efforts to vaccinate inmates, New Jersey Department of Corrections spokesperson Liz Velez wrote in an email.
The Department of Corrections is working with the state’s Department of Health and Parole Board, as well as other community institutions, to make sure people who are released have access to a second dose. Currently, people who are transitioning from prison back to civilian life at halfway houses can come back to a prison to get their second dose.
“This is definitely a work in progress, a first-of-its-kind process with a lot of moving parts,” Velez wrote.
Craig Sherman, who is incarcerated at Northern State Prison in Newark, New Jersey, said he’s been impressed by vaccine rollout so far.
“Surprisingly, they have been doing a good job,” he wrote in an email. “They first came round with a request form asking if anyone would like to get the shot. I have some underlying medical issues, so it was in my best interest to get vaccinated. I filled out the form, and in about a week’s time I was at the gym getting my first shot.”
While the number of incarcerated people receiving vaccines is growing, some public health experts would like to see more.
Wang, Brinkley-Rubinstein and Puglisi, along with Bruce Western of Columbia University, published recommendations for vaccinating incarcerated people in December. They argued that the U.S. could replicate the federal government’s program to vaccinate long-term-care facilities as a way to make the vaccine supply chain more efficient.
“The responsibilities for vaccine distribution and administration should not lie entirely with Departments of Correction or local jails, many of which have staffing shortages and strained health services,” they wrote.
They also recommended including corrections experts in state-level committees planning vaccine distribution.
Other researchers argue that vaccinating inmates simply isn’t enough. In an essay in The New England Journal of Medicine, a group of public health researchers argued that, in addition to providing vaccinations, corrections systems should release people as a way to stop the spread of the virus, a common practice last year.
Meanwhile, Sherman said he’s happy to see more and more prisoners get the vaccine.
“We just got off a 22 hour lock down last week. That was our normal for the past year,” he wrote. “Now they’re starting to open up. … Everyone is ready to get back to some level of normalcy.”