Four steps to increase COVID-19 vaccinations among correctional officers

As the United States faces a deadly new wave of COVID-19 infections, we must address the low rates of vaccination among the nation’s half-million correctional officers. Across the nation’s 7,000 jails, prisons and other detention settings, these low rates threaten the lives of not only these staff and their communities but also detained and incarcerated people. These low rates also reflect deeper problems relating to the lack of attention to the health of correctional officers and detained people alike by the Centers for Disease Control and Prevention (CDC) and state departments of health.

Most correctional staff have been offered the vaccine, but the low acceptance rates create a common scenario in which more incarcerated people than correctional staff have been vaccinated. Inside correctional facilities, even a single infection can spark a rapid explosion of cases.

A year ago, the number of infections behind bars was many times higher among detained people than staff. But now we see more infections among staff, despite them being a smaller group. As officers become sick, many of the basic functions of the facilities can grind to a halt, with dangerous results, including forced multiple overtime shifts for staff and extended lockdown for incarcerated people, including those with serious health problems.

One of the hidden consequences of incomplete staff vaccination relates to high-risk incarcerated people who remain unvaccinated. I have encountered a striking number of very ill people, with complicated medical problems and medication regimens, who were listed as refusing vaccination but in reality simply had questions that nobody answered.

This breakdown is driven by a “take it or leave it” approach to vaccine offers in housing areas, mess halls and other large-scale settings behind bars. When there isn’t any follow-up to answer questions, some of the sickest people remain unvaccinated. Those people represent the most vulnerable cohort for new Delta variant infections that will be brought in by unvaccinated staff.

The low rates of vaccination among correctional staff are a serious problem for the nation’s COVID-19 response. But they are unfortunately the tip of the iceberg in terms of how traumatic and unhealthy carceral settings are for staff and incarcerated people alike.

Research before COVID-19 revealed elevated rates of suicidal thinking among correctional staff as well as high rates of serious physical health problems. With more than 200 deaths and 100,000 COVID-19 infections just among prison staff, these problems have dramatically worsened.

The high rates of physical and behavioral health problems among correctional officers, like those among incarcerated people, have been largely ignored by our national public health structure. For example, I’ve conducted trainings with correctional officers regarding traumatic brain injury (TBI) and been stunned at how many of the officers themselves have sustained blows to the head and never received diagnosis for a TBI let alone treatment. The organizations that track health outcomes and care in other parts of society, including the CDC and state departments of health, aren’t really involved behind bars.

We can take four steps today to increase COVID-19 vaccination among correctional officers and reduce mortality and morbidity from the Delta variant.

First, each system can survey correctional staff to learn about their concerns. Very few of the settings I’ve investigated have taken this basic step to understand the nature of staff reservations or even whether staff were already vaccinated outside work.

Second, correctional settings should provide additional incentives and compensation for vaccination. One concern I hear from correctional officers is that they were ill with COVID-19 a year ago, and their facility allotted them just five or 10 days of “COVID time.” Having burned through that time when they were ill, many officers have told me they don’t want to risk getting sick from the vaccine now.

Third, like elsewhere, we need to leverage credible messengers. There is plenty of good news in this realm with half or more of correctional officers getting vaccinated. Those officers are the most likely credible messengers for their colleagues, and identifying them and even paying them to work as public health messengers in neighboring jurisdictions would help engage reluctant staff and address misinformation.

Finally, we must expand the roles of state departments of health and the CDC behind bars. The CDC has already provided some guidance on how facilities should respond to COVID-19, but they need to go further and help state health departments set up tracking of both acute COVID-19 and “long COVID,” as well as injuries and other health outcomes among correctional officers as well as incarcerated people. This information rarely escapes law enforcement agencies but represents core public health data that we need to establish the true health risks of working in carceral spaces as well as incarceration itself.

Low rates of vaccination among correctional officers represents an especially alarming deficit in our nation’s COVID-19 response. Their constant close contact in densely packed jails, prisons, immigration and juvenile detention facilities, often with extremely high-risk people, is a feature of our pandemic response. It requires much more investment and effort from individual systems up through state departments of health and the CDC.

Dr. Homer Venters is the former chief medical officer of the New York City jail system, a clinical associate professor at the New York University College of Global Public Health and a member of the Biden-Harris COVID-19 Health Equity Task Force. (The views expressed in this op-ed are those of Dr. Venters, and do not reflect the opinions of the Biden-Harris COVID-19 Health Equity Task Force.