Outbreaks of the coronavirus in prisons and jails in the United States have been widespread, but inmates have been neglected as policymakers determine who should be prioritized for vaccinations.

Inmates of US prisons and jails have largely been left behind as the country rolls out its first set of COVID-19 vaccines. Public health experts and advocates have been pushing for states and the federal government to make this vulnerable population a priority.

More than 1.3 million people are incarcerated in the United States. One tracking project reported more than 270,000 cases and more than 1,700 deaths in the prison system since April.

Inmates are twice as likely to die from the coronavirus as the general population, and 19 of the top 20 hotspots in the US are inside prisons, according to the National Commission on COVID-19 and Criminal Justice. Poor living conditions and overpopulation have exacerbated the problem.

"They have been the source of so many cases because they are a confined population, because they can't do social separation," Dr. William Schaffner, professor of preventive medicine and health policy at Vanderbilt University, told DW. "They are a high-risk circumstance."

Health experts warn that the consequences could be disastrous if nothing is done to mitigate infections among the incarcerated. The American Medical Association had recommended inmates and correctional workers "should be prioritized in receiving access" to the vaccines in the first phase of inoculations.

Still, the Centers for Disease Control and Prevention (CDC) advisory committee in mid-December did not recommend prisoners be included in the initial phase. The federal government has largely left state governments on their own to determine how to distribute the vaccines.

"The federal government has mismanaged this process, specifically developing logistics," said Ryan King, director of research and policy at the Justice Policy Institute. "This was avoidable ... there's been a lack of real federal leadership."

Public backlash

A handful of states have added prisoners and staff to the first tier of candidates, but most have not designated them as a priority.

In Colorado health officials had recommended prisoners be part of the second tier of vaccine recipients. That prompted a backlash driven by state Republicans and conservative media.

Colorado Governor Jared Polis changed course in early December, saying "there's no way prisoners are going to get it before members of a vulnerable population." 

Civil rights advocates are concerned that as the numbers of COVID-19 cases continue to grow, more politicians will cave to public pressure because vaccines and resources are limited.

"Science should dictate this, not politics," says Denise Maes, director of public policy at the ACLU of Colorado. "Science tells us that we do need to start vaccinations in the prisons."

Dangerous jails

Jails, too, are especially risky. They hold suspects for short periods of time — sometimes only for hours — before sending them back into their communities, possibly exposed to infected people.

"Jail settings are heightened because of the degree of people coming in and out," said King. "They are coming from the highest risk environments."

Correctional staff and prison inmates are also constantly being moved to balance out the population size, and in the process, making contact with people outside prison walls.

State prisons throughout the country are not taking the necessary measures to protect the public, prisoners or staff, according to DeAnna Hoskins, president and CEO of JustLeadership USA, an organization focused on cutting the prison population.

"They transfer prisoners from facility to facility. They are not testing them," she said. "This is a super-spreader situation."

After a major coronavirus outbreak in San Francisco's San Quentin Prison in late May, the US Appeals Court ordered the facility to cut its population to 1,700 people, or by one half.

Some states have decided to thin out their prison populations in the hopes of creating more space to allow for social distancing. Officials have been releasing prisoners who are either near the end of their sentence or don't pose a threat to the community.

In New Jersey, Governor Phil Murphy freed more than 2,000 inmates in November to reduce the spread of the coronavirus there.

Stuck in cells

Prisons are facing another ethical dilemma as coronavirus deaths multiply and they impose lockdowns to limit interaction between inmates and staff. Civil rights advocates say that isolating people for long stretches punishes them for something that is not their fault and essentially creates a prison within a prison.

"They are stuck in their cells, and that creates a serious situation," says Maes. "They don't get visitations, outdoor activities or cafeteria time and that cannot be sustained." 

Hoskins said prisoners are afraid. They are getting sick and worried they're going to die. It's "like a burning building" that they are stuck inside without any help, she said.

The vaccines could relieve those problems, if prisoners could get them. Advocates say that the handling of the virus in the correctional system is adding stress and unnecessary burdens to inmates' lives and infringing on their rights as human beings. 

"You are sentenced to prison, not to die," King said.