SciLine interviewed: Dr. Lauren Brinkley-Rubinstein, an assistant professor of social medicine and an adjunct assistant professor of health behavior at the University of North Carolina School of Medicine. In her research, she investigates how incarceration affects health. She has been tracking the pandemic in prisons through the COVID Prison Project, which she co-founded, and examining testing and vaccination strategies in prisons.
What is the reasoning for prioritizing incarcerated people for COVID-19 vaccination?
LAUREN BRINKLEY-RUBINSTEIN:So there’s two really important reasons why we should prioritize people who are incarcerated for COVID-19 vaccination. The first is the epidemiology of COVID-19 itself. And so if we think about where we would want to deploy vaccines in the most optimal way, we look at how many cases there have been and what places have been disproportionately impacted. And when we do that, we see that 90 of the top 100 largest single-site cluster outbreaks over the course of the pandemic have been in prisons and jails, and so that is a place where we need vaccination because there’s been more infection; there’s been more death. And so it reduces severity of disease for people who are incarcerated and staff and their risk of death. The second reason why it’s really important is because there’s a population health benefit. And so we suspect that when you vaccinate people, it lowers the risk of transmission. And so if we have staff who are moving in and out from their home to prisons or jails, people who are incarcerated, who are being released, who are going back home to their communities – if we’re vaccinating them while they’re incarcerated, then we are lowering the risk of spread to the larger community.
To what extent are incarcerated people being prioritized for COVID-19 vaccination?
LAUREN BRINKLEY-RUBINSTEIN: So the COVID Prison Project analyzed all interim state plans that were turned into the CDC at the end of last year, and we found that 14 states and one territory, Puerto Rico, had prioritized incarcerated people or some proportion of the incarcerated population to be in phase one of vaccination efforts. And we’ve also now been looking at how it’s going now that vaccine rollout has began – begun. And we have found that to date, 35 states have some vaccination effort happening across the country, although the numbers are still much lower than we would like.
How do COVID-19 infections in prisons put their surrounding communities at risk?
LAUREN BRINKLEY-RUBINSTEIN: So COVID-19 outbreaks in correctional facilities do put communities at risk, and it happens because it’s not a closed setting, right? So we have people who are moving in and out. And so correctional settings – their built environment, their architecture, really makes people vulnerable to rapid transmission. We have a lot of people in overcrowded settings who cannot engage in a lot of the common interventions that you and I have had access to – so lack of access to masks, to hygienic products, inability to engage in social distancing. And so when you have these settings that are congregate in nature, we see infections spread very rapidly. We see high case numbers. And when we have staff move in and out into their community or we have incarcerated people who are released back home, they bring that exposure back home with them. And so we see this clear connection between what happens in prisons and jails and community rates as well.
Is vaccination voluntary for incarcerated people, and what kind of information is offered to them about COVID-19 vaccines?
LAUREN BRINKLEY-RUBINSTEIN: Vaccination in the context of correctional settings should be voluntary in the same way that it is in the general population. So people should have the right to refuse vaccination if they want to. And departments of corrections and jails should have policies and places in place to make sure that, you know, there’s a proper procedure for when people do decide to not take the vaccine. As far as what vaccination efforts look like and what is in the toolbox of information that’s offered when people have access to the vaccine, it’s really varied across the country. So, you know, lots of jails and prison settings are very different from place to place, and so it’s hard to say what it looks like uniformly across the country. But what it should look like is some information relevant to how vaccines work, some information around what COVID-19 is and why it’s so important for people in these settings to get the vaccine and what the vaccine benefit to the larger population is.
What has the history of vaccination efforts in prisons taught us about how to successfully distribute vaccines in this context?
LAUREN BRINKLEY-RUBINSTEIN: There’s actually a very thin body of literature looking at how vaccines roll out in correctional settings and what our best practices should be. You know, historically, correctional facilities have been under-resourced and not really paid much attention to in the context of larger public health interventions. We see some research looking at flu vaccines. We certainly have some information to rely on relevant to HIV interventions in the early days of HIV. But what we found is that there’s not a lot to go on, but there’s some information that has showed us that there’s very low levels of uptake in the context of vaccines. And so one thing that we as a field have started to think hard about is vaccine hesitancy and how to address vaccine hesitancy among people who are incarcerated. But some early evidence actually shows that for varied reasons, people are more willing to take the vaccine than we might imagine. And I think this is for a lot of different reasons. But I think, you know, people know that the risk of COVID is very high and that that could have a detrimental impact on them and their family and so are willing to get the vaccine, I think, at higher rates than we’ve seen in previous pandemics.
What role do public health professionals have to play in the COVID-19 vaccination process?
LAUREN BRINKLEY-RUBINSTEIN: It’s really important for us to think about the field of public health and relationships between department of corrections and jails and public health, and the strength of those relationships will really have a big impact on how well implementation of vaccine rollout goes. And so I think one of the things I like to talk to people about is, you know, we need to intervene and think about how best to implement vaccine programs in collaboration with departments of correction and also local jails, but we also need public health professionals to be on board and really think about jails and prisons as a part of their overall public health mission and to really believe in and get behind the fact that what happens inside of prisons and jails doesn’t stay there.