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H1N1 vaccine: prisoners before us?
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The recent announcement in Boston that the planned distribution of H1N1 vaccine in the state of Massachusetts is well behind schedule has reignited a controversy over the intention to give it to county jail prisoners before most of the public. This prompted many questions, but now, with delayed distribution a certainty and President Obama declaring a national emergency over the flu epidemic, the debate is on again. But the question may not be as simple as asking ‘why prisoners first?’
First, just who is in the county jail? Many of those held in the facility are not people found guilty of anything but are awaiting initial hearing on cases from lower level misdemeanors to felonies because they could not produce bond. Some jail inmates here, as in all other states, are those who went “FTA” over a traffic ticket they could not pay. That means failure to appear and failing to do so generates a new offense, one for which a person can be jailed. Other portions of the inmate population include those who have been convicted and either serve their time there or have not yet been transported to another state facility. Some are prisoners waiting extradition to other states and still others are federal prisoners awaiting transport. In other words, it is not a prison, just a holding facility.
It is not just a holding facility, either, it is a revolving door of people coming and going to other places including being bonded out or going to court hearings. Inmates are also allowed visitors, including family and lawyers. Moreover, it is heavily overcrowded, a fact related to the recent riot inside the jail. Those two facts - overcrowding and high turnover rates - explain the need to immunize inmates in jails. Because it is crowded, and because it is not largely a “clean” environment, any infection would spread quickly. And, given the “in and out” nature of jails as opposed to prisons, it would spread quickly on the outside. Prisoners being released, transported, or heading to hearings would carry it with them into the public. So would lawyers, visitors, and jail employees.
In other words, it is the easiest place to start containing the spread of an epidemic. The other essential, and more easily contained locations, are hospitals and schools. There is another problem for authorities. Prisoners are the only citizens for whom the state must provide medical care 24/7. It is not optional. Years ago the U. S. Supreme Court made it clear that if you detain someone, you must give them medical care. It is one of the greatest portions of the cost of incarceration at all levels of government. This has implications for the debate over health care. It means all prisoners in the United States receive better health care than about 20% of the population.
Accordingly, we expect that when shipments start arriving prisoners will be inoculated quickly, particularly upon first arriving at the facility. We will be watching this debate closely.
