Question: I just read this article about LA and the issue of social distancing in a crowded household. It made me think of whether any of the vaccine efforts should or have prioritized those in living situations that are hard to social distance, such as these, and nursing homes, prisons, etc. I have mostly seen age (b/c of severity) and health care works/teachers (understandably), but from a public health perspective, should we also be prioritizing places that are harder to social distance? and/or have other vaccine roll out plans (even in other countries) prioritized it in this way?
Answer: Prioritization of scarce, lifesaving resources is full of ethical dilemmas. We know that those individuals living and working in congregate settings are at increased risk of contracting COVID– we’ve seen it in nursing homes, prisons, meatpacking plants, crowded households, and more. Some of these individuals– those living in nursing homes and those essential workers like meatpackers– have been consistently prioritized by key groups like the Advisory Council on Immunization Practices (ACIP). However, because vaccine prioritization policy is state-led, there are numerous, varying policies being enacted across the country. A recent NY Times article, Where Do Vaccine Doses Go, and Who Gets Them? The Algorithms Decide, offers a helpful summary of some of the complexity. For example, Tennessee has developed vaccine prioritization algorithms using variables like poverty and crowded housing to identify neighborhoods that would receive extra doses to facilitate faster vaccination.
When it comes to incarcerated individuals, the variation in vaccination policy by state is striking. The Prison Policy Initiative offers a thorough overview of the issue– “COVID-19 case rate is four times higher in state and federal prisons than in the general population — and twice as deadly. And despite the danger of close quarters and high rates of preexisting health conditions among incarcerated people, prisons and jails have widely failed to reduce their populations enough to prevent the spread of the virus… The federal Bureau of Prisons announced in November that it plans to reserve its early allotments of the vaccinations for staff, not incarcerated people…” The Initiative also keeps an updated chart of incarcerated population vaccination policy by state (Table 1). As you can see from the table, there are 9 states who include incarcerated people in Phase 1 vaccination plans and there are 9 states who do not include incarcerated people in any Phase. The American Medical Association recommends compassionate release policies among other measures to ethically care for those living in jails and prisons, particularly in the face of the pandemic. And CDC recommends that incarcerated people and corrections staff receive vaccination at the same time because of their shared risk.
Table 1. State-level vaccination prioritization for incarcerated people and corrections staff (from Prison Policy Initiative)
