The High-Risk Group Left Out of New York’s Vaccine Rollout

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When New York announced new vaccine eligibility guidelines two weeks ago covering millions of additional state residents, one particularly hard-hit group remained unmentioned: the nearly 50,000 people incarcerated in the state’s prisons and jails.

Now, with state supplies dwindling and no clear plan for vaccinating incarcerated people, the virus that tore through the state’s correctional facilities in the spring is roaring back behind bars. At least 5,100 people living and working in New York’s prisons have tested positive and 12 have died in recent weeks, outpacing even the early days of the pandemic.

But how and when to vaccinate incarcerated people as millions around the state wait has raised legal, logistical and ethical questions that the state has so far struggled to answer.

Across the country, the arrival of a vaccine was hailed as a harbinger of the pandemic’s eventual end. But administering the limited supply has proved challenging, and correctional facilities — where more than half a million people have tested positive for the virus since the start of the pandemic — present additional complications.

Officials grappling with the same difficult questions have come to different conclusions, creating a patchwork of policies and timelines that vary dramatically, according to an analysis by the Prison Policy Initiative, a research nonprofit devoted to reducing mass incarceration. But at least 27 states directly name inmates in their public plans, and about a dozen place them in the first phases of vaccine distribution — including Massachusetts, where tens of thousands of prisoners are set to be vaccinated by the end of next month.

Others plan to vaccinate prison and jail workers before incarcerated people, breaking with guidance from the Centers for Disease Control and Prevention, which recommends vaccinating everyone at correctional facilities simultaneously. Some, like New York, do not address those behind bars at all.

“We have people dying on a weekly basis,” said Stefen Short, a lawyer for the Prisoners’ Rights Project at the Legal Aid Society. “What are the plans? There’s got to be a consistent message coming out of Albany and coming out of these agencies on this. Otherwise, you’re just generating a lot of fear.”

Vaccinating incarcerated people in the early stages of distribution has proved politically fraught. In New York, state senators have questioned whether prioritizing people in prisons makes sense. In Colorado, a draft plan to offer the vaccine inside prisons was met with fierce backlash for, as one district attorney wrote in The Denver Post, prioritizing “the health of incarcerated murderers” ahead of “law-abiding Coloradans 65 and older.”

New York officials said the state was preparing a plan. But public health experts broadly agree that incarcerated people are at particularly high risk for contracting and spreading the virus, as at least 8,800 people living or working in New York’s prison system have tested positive since the start of the pandemic.

And because guards, lawyers, workers and people entering and leaving custody move between the facilities and the community at large, the public health implications of outbreaks behind bars extend far beyond the prison walls. Officials said last fall that an outbreak at Greene Correctional Facility near Albany was linked to cases at an assisted-living facility and an elementary school.

The absence of any clear plan for incarcerated people has left their relatives and advocates confused and concerned.

“I really don’t understand it,” said Dr. Robert Cohen, a member of the Board of Correction in New York City. “But the consequences will be quite severe.”

For Jeanette Velazquez, the uncertainty has been frustrating.

Her brother, José Leon, is incarcerated at Adirondack Correctional Facility in upstate New York with several underlying health conditions, including hypertension and colitis. But he was not among the thousands of inmates granted early release last year to stem the spread of the virus.

Now, Ms. Velazquez said, her brother has taken his own precautions out of fear: Mr. Leon, 62, stopped going to communal mess halls and began skipping meals; he stays as isolated as possible; and, after years of his calling her regularly, Ms. Velazquez said she has not heard from him in days, unsure whether he is avoiding public spaces or if something went wrong.

Mr. Leon, who is one of three plaintiffs in a federal lawsuit over prison conditions during the pandemic, is serving a sentence of 15 years to life for sexual abuse, prison and court records show.

“I’m scared that he’s not going to make it,” she said, adding: “He’s not getting the medical attention that he really needs, and him not making it home alive, that’s my concern. It’s like he has a death sentence.”

To be sure, the first weeks of the state’s vaccine rollout have not been seamless for the public at large either. Medical providers were forced to throw out shots early on as other doses sat unused for weeks. Once the rollout sped up, New York’s reserve of first doses was depleted, and thousands of vaccination appointments were canceled. Even as inmates clamor for eligibility, millions of people who already qualify continue to wait.

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Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

But incarcerated people are four times as likely to be infected and twice as likely to die from the virus compared with the general population, studies suggest. They often live in congested units and eat in crowded facilities where social distancing is nearly impossible.

They also lack the political power and societal favor of other vulnerable groups — a dynamic that has pinned state officials between the ethical responsibility for the health of people in state custody and potential public backlash. A disproportionate number are also Black and Latino, racial and ethnic groups that have been hit harder by the pandemic.

In October, the state released plans outlining the vaccine prioritization order. Individuals who live in “congregate settings” were designated to receive doses after frontline health care workers but before people under 65 with underlying health conditions. Those guidelines, however, did not specify whether those in prisons and jails were included.

Contributing to the uncertainty, some lawmakers said they received conflicting information about the timeline. Several members of the Republican conference in the State Senate and Assembly said that in a Jan. 5 briefing, the state’s health commissioner, Dr. Howard Zucker, said that incarcerated people would be allowed to receive the vaccine in Phase 2.

But two in the Democratic conference said they were told separately that would happen in Phase 1B, the state’s current stage of vaccination, as first reported by NY1. The current stage includes police officers, teachers and public transit workers.

Patrick M. Gallivan, a Republican from the Buffalo area on the Senate’s health committee, said he was concerned about vaccinating incarcerated people in the earliest phases when many essential workers and residents of long-term care facilities have not been inoculated.

“I understand the issues in congregate settings,” Mr. Gallivan said. “My concern is that if we were to use the short supply of vaccines, it’s at the expense of some of these other priority groups.”

Spokespeople from Gov. Andrew M. Cuomo’s office and the Department of Corrections and Community Supervision said only that a plan for incarcerated people was still being developed. The first groups of people within Phase 1B were declared eligible on Jan. 11, though the announcement made no mention of incarcerated people.

Despite the absence of a statewide plan, New York City officials received permission to start vaccinating the highest-risk people held at Rikers Island and other facilities on Jan. 5, according to a spokeswoman for Correctional Health Services.

Two days later, medical staff began distributing doses to the roughly 500 eligible people incarcerated there. The group represents only about 10 percent of the more than 5,000 total people held at city-run jails.

Last week, a state judge also ordered the New York corrections department to vaccinate one 65-year-old inmate at the Adirondack prison with chronic lung disease, in what appears to be the first ruling of its kind in the state and could signal similar legal battles ahead.

The prison has confirmed two virus cases during the pandemic, though there are widespread concerns over testing and reporting practices at several facilities — as well as the particularly high-risk population of seniors at Adirondack.

In most areas, however, the situation is less clear.

Peter Kehoe, the executive director of the New York State Sheriffs’ Association, said that out of concern he had reached out to the state last month for details on vaccinations in county jails, which sheriffs oversee. “But we’ve heard nothing back,” he said, adding that he was not aware of anyone at jails outside of New York City receiving doses.

He wondered whether the spotty communication was meant to avoid political pushback, which officials have yielded to elsewhere in the country.

In Colorado, following ire on social media and from conservative critics, the state eventually changed course. “There’s no way it’s going to go to prisoners before it goes to people who haven’t committed any crime,” Gov. Jared Polis of Colorado, a Democrat, said in December.

Even beyond eligibility, health experts worried that other obstacles would arise in New York.

The Pfizer-BioNTech vaccine must be stored at extremely low temperatures, but correctional facilities do not have the required freezers. Many are also located in isolated areas of the state, creating potential challenges for distribution. And people are routinely transferred between correctional facilities, which could create difficulties in tracking who has received doses.

There is also growing concern among several advocacy groups that incarcerated people may be skeptical of the vaccine and be reluctant to accept doses, largely because of the government’s history of medical experimentation on prison populations and people of color.

Surveys in two Massachusetts counties found that more than half of the inmates who participated would decline doses. Some states have even offered incentives like snack bags, visitation time and days off sentences in exchange for their consent.

Theresa Grady said those anxieties resonate.

Her husband, who is 66, is serving a 40-year sentence for robbery and attempted murder at Green Haven Correctional Facility in Dutchess County, prison records show.

He has high blood pressure and diabetes, and has shared stories of breakdowns in safety and accounts of correctional officers not wearing face coverings, his wife said.

Ms. Grady said her husband wants more information around the vaccine before he feels safe enough to take it, but little outreach has occurred.

“I’m afraid that by the time they offer this vaccine and get the education around it, it’ll be too late for him,” she said.

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