Prioritizing people who live and work in prisons for COVID-19 vaccines will help end devastating outbreaks of the virus both inside and outside of prison walls. But making the doses available is only half of the battle—people still have to make the choice to be vaccinated.

Getting widespread acceptance of the COVID-19 vaccine among people in custody and corrections workers presents unique challenges. Even outside of prison, polls find that around 20 percent of Americans say they would refuse COVID-19 vaccines. Inside prisons, medical personnel also have to overcome well-founded fears stemming from a dark history of medical abuses and the lived experience of incarcerated people.

The long shadow of exploitation contributes to medical mistrust

One of the most notorious examples of medical exploitation in prisons comes from the now-shuttered Holmesburg Prison in Philadelphia. From 1951-1974, University of Pennsylvania medical professor Albert Kligman conducted a series of unethical experiments on incarcerated people at Holmesburg, enticing them with cash payments but disclosing little about the hazards of participating. The worst of these experiments exposed them to the toxic chemical in Agent Orange. These abuses led to strict protections around prison experiments that are in effect today, but have cast a long shadow over prison medical care.

“The effects of that are in the culture, and it’s passed down,” says Nicholas Scharff, a physician who treated patients in Pennsylvania’s Graterford prison and a former chief of clinical services for the state Department of Corrections. Whenever he saw new patients, "there was a level of mistrust that needed to be overcome."

This mistrust is compounded by the experience of receiving substandard and infrequent medical care in prison. The majority of incarcerated people the Prison Society surveyed in Pennsylvania state prisons last fall said they were dissatisfied with their ability to access medical care. While serious side effects of the COVID vaccines are very rare, Lauren Brinkley-Rubinstein, assistant professor of social medicine at the University of North Carolina-Chapel Hill and co-founder of the COVID Prison Project, says that many people in prison may wonder "Do [the prisons] have the ability to take care of me if something goes wrong?”

The DOC reports encouraging progress

Despite all the reasons incarcerated people may be wary of getting a COVID shot, there are encouraging signs that their doubts can be overcome. “We've seen pretty high uptake among people who are incarcerated in the places where there’s been pretty robust vaccine deployment,” Brinkley-Rubinstein says.

That includes the three Pennsylvania State Correctional Institutions (SCIs) that have begun administering vaccines to all people in custody and staff. These prisons (SCI Laurel Highlands, SCI Muncy, and SCI Waymart) have started ahead of the rest because they have high numbers of sick and elderly people. According to data the Department of Corrections shared with the Prison Society, the acceptance rates among people offered the first dose of the COVID-19 vaccine ranged from 73% to 82% in these three prisons.

The DOC did not share how many staff had received shots, but Brinkley-Rubinstein says that in other prisons staff have tended to accept the COVID-19 vaccine at lower rates than incarcerated people. She says that trend is “concerning, given that they're often the ones that have community exposure and bring that back back into the jail or prison setting."

Overcoming misinformation and mistrust

Even among incarcerated people, the promising reports on vaccination rates are based on limited data and don’t diminish the challenge that remains to get enough vaccinated to achieve widespread immunity in prisons.

Mistrust creates fertile ground for misinformation. But dialogue and education about the vaccine in prisons can combat myths and conspiracy theories, Brinkley-Rubinstein says. The Pennsylvania Department of Corrections says it is sending prison medical staff to meet with people who decline vaccinations to help assuage their fears, and that it expects the acceptance rates it reported to grow as the process plays out. It’s also deploying education and communications around the vaccine to combat misinformation.

Scharff, the former prison doctor, says medical staff should engage with incarcerated people about their concerns even when they seem outlandish. "You still wind up giving them advice that they may not have asked for,” he says. “But I think even that goes down better if people feel you have really listened to their point of view, so that you understand the questions that you're answering and the fears you’re addressing."  Pressuring people to get vaccinated, on the other hand, would likely backfire and breed more distrust, Scharff says.

We applaud the department on its progress so far, and urge the prisons to keep up this important work when vaccines become available in all DOC facilities.

We once again call on all state and county officials to offer COVID-19 vaccinations to all people in custody and staff as soon as they become available. In addition, we continue to urge them to:

• Implement weekly, rapid testing of all staff that come into contact with people in custody until they are vaccinated;    
• Expand efforts to safely reduce the number of people in custody;
• Require that every county publicly report prison testing results and virus-related deaths in custody;
• Test and quarantine every new person entering custody; and
• Eliminate the medical co-pay for accessing health care while in custody.

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