H1N1 vaccine: Should inmates move up in line?

Should those in prison and jails across the country receive priority status for getting the H1N1 vaccine?

With vaccines in short supply, it's become a difficult issue for public health departments and correctional facilities across the country.

Earlier this week, the White House had to rebut erroneous reports that the vaccine had been given to detainees at the Guantánamo prison camp in Cuba.

"There is no vaccine in Guantánamo and there's no vaccine on the way to Guantánamo," said White House spokesman Robert Gibbs at a press briefing.

But a cohesive national strategy seems lacking. Local departments of public health are deferring to federal Centers for Disease Control and Prevention (CDC) guidelines for establishing high-priority groups. According to the CDC, vaccination planning is a state issue.

The nation's top public health agency issues recommendations, but "states are in charge of vaccinations," says CDC spokesman Tom Skinner.

Though the CDC has acknowledged that certain settings – including prisons, schools, day care centers, and universities, among others – may increase the risk of contracting the H1N1 virus, they do not give vaccine priority to those groups.

Instead, they limit priority to those with individual risk factors, including pregnant women, those who care for young children, individuals younger than 24, healthcare workers, or people with certain underlying health conditions.

"Certain settings may increase the risk of infections, but we haven't prioritized vaccinations for those settings," says Mr. Skinner. "Our recommendations are based on population risk factors."

Many states, including Massachusetts and Ohio, have decided to prioritize those at high risk in the general population over those in prison.

In Texas, the Department of State Health Services says it will vaccinate all high-risk individuals at the same time, regardless of whether or not they're incarcerated. But while they have begun vaccinating the high-risk general population, they have not done the same for high-risk inmates.

"It's all a question of vaccine availability," said John Jacob, a spokesperson with the Massachusetts Department of Public Health in an e-mail. "As soon as significant enough quantities have arrived in the state and have begun to be distributed to high-risk groups in the general population such as adults 25-64 with underlying conditions, some vaccine will begin to be distributed to those same high-risk populations within prisons."

Though high-risk inmates will be prioritized over some in the general prison population, in Massachusetts, as in Texas, they will not receive the vaccine at the same time as their non-incarcerated peers.

For example, the state "will be getting vaccine to pregnant women who are incarcerated as soon as we have been able to vaccinate a significant percentage of pregnant women overall" writes Mr. Jacob.

The idea that high-risk people inside prisons would be treated differently from those outside is "invidious and discriminatory," says Nancy Stoller, coordinator of the American Public Health Association's jail and prison health group.

Incarcerated individuals are at a higher risk for H1N1 than the general population, Ms. Stoller says, and therefore should receive vaccination priority.

Inmates' higher risk is largely due to the close proximity in which they are confined. They also tend to be more susceptible to H1N1 because of their age (the average jail population is under 30), and also because they tend to come from poorer backgrounds and therefore are less likely to have received regular medical attention.

"Not only do they have a higher risk of getting the flu, but they're more likely to have a more serious case," says Stoller.

Ohio has developed a tiered priority system within its correctional facilities once vaccination becomes available. The first wave of vaccinations will include pregnant women, those who have given birth while incarcerated, healthcare staff, 10 percent of the general staff, juveniles, and inmates with compromised immune systems. A second tier will provide for the rest of the prison staff and inmates.

But Ohio hasn't yet distributed any vaccinations for that first, high-risk tier. So despite having distributed 984,700 vaccinations thus far, Ohio has yet to vaccinate the 66 pregnant women currently in its prison system, or its healthcare staff.

Neither the Ohio Department of Rehabilitation and Correction nor the Ohio Department of Health had any estimates on when vaccination might begin, due to its limited supply.

"Sometimes, there's a lot of pressure on health departments to think of the health needs of prisoners as less important than the health needs of people outside," says Stoller.

But there's a concern that without vaccinations, correctional facilities may experience H1N1 epidemics. With the flow of visitors, staff, and inmates through prisons, that could put the general population at risk.

"Prisons are not sealed institutions," says Stoller. "Whatever happens in prisons will leak out."

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