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Medically Necessary: Prisons present unique challenges for vaccine supply chain

This is an excerpt from the March 18, 2021 edition of Medically Necessary, a health care supply chain newsletterSubscribe here.

Good afternoon. Medically Necessary is a newsletter by Matt Blois about the health care supply chain — how we get drugs, devices and medical supplies to health care providers and patients.

Prisons present unique challenges for vaccine supply chain

The challenge: The remote location of many jails and prisons, extra security measures and the unpredictability of a prison setting have complicated the vaccine supply chain for incarcerated people. 

  • In addition, correctional facilities have to communicate constantly with public health officials to coordinate vaccinations for new arrivals or people who are released.

Despite the challenges, some jails and prisons are vaccinating significant portions of their population quickly. However, crowded conditions allow the virus to spread easily, and unvaccinated people still face major health risks.

The need: Jails and prisons have been a major hot spot for COVID-19 outbreaks. The New York Times estimates that well over 600,000 people were infected in correctional facilities, and more than 2,700 incarcerated people and correctional officers have died from COVID-19.

  • A recent analysis by the COVID Data Dispatch found that jails and prisons were the most common setting for superspreader events.

So far, more than 87,000 incarcerated people and 64,000 correctional officers have received at least one dose of a COVID-19 vaccine, according to a tally by UCLA’s COVID Behind Bars project.

  • The Federal Bureau of Prisons has fully vaccinated about 45% of its staff, who were offered shots first, and nearly 13% of all inmates. The agency has also administered 97% of the doses it has received, far higher than most states.
  • Most states and federal corrections systems are currently giving vaccines to incarcerated people. Eight states are not and another eight aren’t reporting their plans, according to the COVID Prison Project.

Difficult locations: Most jails and prisons are located far from major population centers, which can complicate delivery, Susan Patrick Harris, director of procurement for the private corrections health care provider Wellpath, told FreightWaves.

  • “I tell our suppliers every day. We’re not located at 123 Main Street. We’re at 123 cornfield,” she said. 

The remote location means most facilities are also far from freezers used to store vaccines. That means a countdown starts as soon as shots arrive, and health care workers must administer them quickly.

  • “It’s hard when we’re working on such a tight timeline. We have just a week … so this is time sensitive for us,” Wellpath Chief Nursing Officer Heather Norman told FreightWaves. “We have to expect the unexpected, but you can’t plan for the things that happen in our line of work.”

Extra security: Security measures at jails and prisons can present obstacles for health care providers trying to deliver vaccines to incarcerated people.

  • Norman said that one or two correctional officers have to accompany each nurse administering vaccines, greatly increasing staffing needs for vaccine clinics compared to other settings.

At a prison Norman visited last month, buildings were located about a mile from each other. Health care staff had to go through security screenings before entering each building.

Her team spent an hour and a half transporting vaccine doses from a loading dock to a pharmacy and then to a housing unit. Then, she realized they had forgotten to write down the lot number for the vaccine. They had to go back through security at the loading dock to get it.

  • “I thought it would be a simple process for [a health care administrator] to do,” Norman said. “A lot can go wrong.” 

Later, at the same facility, the problem was port-a-potties. A large winter storm had disrupted the plumbing, so the prison brought in some port-a-potties.

  • “They were picking port-a-potties up, so they shut down movement. That put our ability to deliver vaccines on hold. They had to lock down all the inmates to do a count,” Norman said. “We had to stop everything we were doing in nursing so that they could count all the prisoners.”

Fluid populations: New people are constantly coming into the prison population, while others are released or transferred. This presents an additional challenge. 

In a February op-ed published in The Appeal, a group of corrections health care researchers pointed out that jails only hold people an average of 25 days, less than Moderna’s four-week gap between shots.

  • “Implementation plans will need to account for follow-up shots in the community for individuals who are released prior to receiving the second dose,” researchers Emily Wang, Lauren Brinkley-Rubinstein and Lisa Puglisi wrote in The Appeal

They note that, historically, public health officials have managed to provide the final dose of multidose vaccinations for other infectious diseases, such as hepatitis B, after people leave prison.

  • “The key to all of this is partnering with our health departments. That’s the only way to make this successful,” Norman said. 

That kind of communication is an important part of New Jersey’s efforts to vaccinate incarcerated people, New Jersey Department of Corrections spokesperson Liz Velez wrote in an email.

The Department of Corrections works with the state’s Department of Health and Parole Board, as well as other community institutions, to make sure people who are released have access to a second dose. 

  • “This is definitely a work in progress, a first-of-its-kind process with a lot of moving parts,” Velez wrote.

Expert opinion: While the number of incarcerated people receiving vaccines is growing, some public health experts would like to see more. 

Corrections health care researchers Wang, Brinkley-Rubinstein, Puglisi and Bruce Western of Columbia University published recommendations in December for vaccinating incarcerated people.

They argued that the U.S. could replicate the federal government’s program to vaccinate long-term care facilities as a way to make the vaccine supply chain more efficient.

  • “The responsibilities for vaccine distribution and administration should not lie entirely with Departments of Correction or local jails, many of which have staffing shortages and strained health services,” they wrote.

They also recommended creating distribution plans specific to corrections systems and including corrections experts in state-level committees planning vaccine distribution.

  • “Their expertise will enable states to anticipate problems and identify solutions for vaccine distribution challenges that pertain to prisons and jails,” they wrote.

Other researchers argue that vaccinating incarcerated people simply isn’t enough. In an essay in the The New England Journal of Medicine, a group of public health researchers argued that, in addition to providing vaccinations, corrections systems should release people as a way to stop the spread of the virus, a common practice last year.

Inside perspective: Craig Sherman, who is incarcerated at Northern State Prison in Newark, New Jersey, said he’s been impressed by vaccine rollout so far.

  • “Surprisingly, they have been doing a good job,” he wrote in an email. “They first came round with a request form asking if anyone would like to get the shot. I have some underlying medical issues, so it was in my best interest to get vaccinated. I filled out the form, and in about a week’s time I was at the gym getting my first shot.”

Sherman said he’s happy to see more and more incarcerated people get the vaccine. For him, it means a return to normal.

  • “We just got off a 22 hour lock down last week. That was our normal for the past year,” he wrote. “Now they’re starting to open up. … Everyone is ready to get back to some level of normalcy.”

Reading list: The best stories about the health care supply chain

  • ‘Super-Sized’ Vaccine Clinic Offers Food Workers Some Relief Kaiser Health News
  • America’s Covid Swab Supply Depends on Two Cousins Who Hate Each Other Bloomberg
  • Zeke Emanuel on where the vaccine rollout goes next Axios
  • Washington may become the second state to distribute its own generic drugs STAT

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Matt Blois