A matter of trust: Inside prison COVID-19 hot spots, many inmates fear the vaccine
Experiments on prisoners, then and now
Prisoners Oliver Duff and Billy Renshaw both cited the history of experimentation on prison inmates as reasons for refusing the vaccine.
Renshaw says he remembered news reports about experiments carried out on prisoners at the old Ohio State Penitentiary in Columbus. In the 1950s, a physician named Chester M. Southam injected prisoners there with cancer cells to see if they would spread. According to writer Rebecca Skloot, Southam’s subsequent experiments on dementia patients led to the creation of internal review boards, which now have to sign off that studies conducted on people are ethical.
Those guidelines prevented vaccine testing on American prisoners, even though some experts said prisoners should be allowed to volunteer for vaccine testing because they were at such high risk of infection. Elizabeth Victor, a bioethics professor at William Patterson University in New Jersey who focuses on incarceration, says it’s common for prisoners to volunteer for experimental treatments because they see it as the only way to access medical care.
But current ethics guidelines don’t completely bar experimentation on prisoners. Keramet Reiter, a criminology professor at University of California, Irvine, cites an experimental drug addiction treatment program run by a drug company called Hythian in five different states between 2006 and 2008, as well as a 1997 trial testing the anti-epilepsy drug Depakote to reduce aggression in incarcerated juveniles.
Victor says there’s no evidence that any COVID-19 vaccines were tested on any prisoners, and all the scientific research indicates they’re safe. But she says it’s hard to find a reason why prison inmates should believe that.
Reiter referred to the Tuskegee Syphilis Study in which Black sharecroppers with untreated syphilis were studied but not given any medical care, even when penicillin was available.
“I don’t think anything like Tuskegee is happening in our prisons right now, but I think there’s an expectation that that would never happen again because we have adequate oversight in place,” she says. “I think that’s a misperception.”
While guidelines limit federal funding for experiments involving prisoners, Reiter says there’s little oversight on privately funded studies on inmates in privately run prisons. More concerning, she says there’s little effort to verify that medical treatment in any prison is conducted according to regulations.
Prison vaccinations in other U.S. states
Sharon Dolovich of the COVID-19 Behind Bars project at the University of California at Berkeley says five states (Ohio, Delaware, Virginia, California and Colorado) and the federal Bureau of Prisons have begun releasing the number of prisoners vaccinated. None are routinely reporting data on how many prisoners refuse the vaccine.
It’s difficult to say if other states are vaccinating prisoners. The Prison Policy Initiative lists nine states that put prisoners in the highest priority category for vaccines, but some of those states, including Illinois, Connecticut and Pennsylvania, say they haven’t begun to distribute vaccines in prisons. Meanwhile, Ohio has not officially made prisoners a top priority, but is vaccinating certain prisoners who meet the state’s overall criteria for vaccine priorities.
California, where 195 prisoners have died of the coronavirus, started administering the vaccine in prisons on Dec. 22. As of Feb. 11, the California Department of Corrections and Rehabilitation website said over 28,000 inmates have been vaccinated.
The department didn’t respond to questions about how many prisoners refused the vaccine, but Michael Bien, an attorney representing prisoner’s in a lawsuit against the state, says the acceptance rate as of early February was roughly 70%, according to data given to the court.
The North Carolina prison system is also offering incentives for people who get vaccinated: five days off a prisoner’s sentence if they take both shots. Some prisoners won’t qualify for the reduction, and will be offered $5 instead. Prisoners who get vaccinated will also get permission for extra visits and free 10-minute phone calls, as well as being first in line for returning to prison jobs and activities that were suspended because of the pandemic.
“The intent of this incentive is to sweeten the pot a bit,” says spokesperson John Bull. “The North Carolina prison system would very much like everybody who’s eligible to get a vaccine to get a vaccine.”
North Carolina is pairing those incentives with a coordinated education campaign. Bull says? the prison system worked with a handful of doctors to produce videos laying out the risks and potential benefits of the vaccine—asking prisoners to weigh the probability of getting a sore arm against the possibility they could catch COVID-19 and die. Those videos have been played repeatedly on televisions in prisoner dorms. All North Carolina prisons are also hosting town halls where prisoners can ask questions about the vaccine, Bull says.
As of late January, Bull said 91% of the prisoners older than 75 had received the vaccine, and about 70% of those between 65 and 74 had been immunized. He wasn’t able to say how many of those not yet vaccinated had agreed to get it.
On the other hand, two of the states where COVID-19 in prisons has been the deadliest—Texas and Florida—have not vaccinated any prisoners at all.
Oliver Duff, 64, spent most of the COVID-19 outbreak at Pickaway Correctional Institution in Frazier Health Center, a dorm for roughly 150 prisoners who need intensive medical care. Fifteen of the men in Frazier died of the coronavirus in April and May. Another 20 people from the prison’s general population were killed by the virus.
So Duff has no doubt that the coronavirus is real and deadly. And when a staff member asked him in early January if he’d like to take the vaccine, he said yes. But then he talked to his wife about it.
“To her, it seemed like they did a lot of shortcuts in order for inmates to be able to take it,” says Duff, who suffers from chronic heart problems. “She felt we’re being used as guinea pigs, and used as an experiment.”
When patients from the prison health center lined up to take the shot roughly a week later, Duff wasn’t among them.
Many of the country’s deadliest outbreaks have been in prisons and jails, where social distancing is often impossible and health is generally poor. At least 134 Ohio prison inmates have died of the coronavirus, and more than 7,000 have been infected. Experts and advocates have called for aggressive and early vaccination campaigns in prisons. But many prisoners distrust prison medical staff, putting the drive for vaccinations in jeopardy.
Currently only a handful of states are regularly releasing data on prisoner vaccinations, and none are publicly tracking vaccine refusals (see sidebar Prison Vaccinations in other U.S. states).
Ohio announced on Dec. 28 it was offering vaccines to prisoners in long-term medical care units. That included Franklin Medical Center; Frazier Health Center inside Pickaway Correctional; and a unit in Allen-Oakwood Correctional Institution in Lima that houses prisoners with severe mental illness. As Ohio’s phased rollout plan for the general population progressed, additional prisoners were offered the vaccine as well.
As of Feb. 26, 1,358 Ohio prisoners were vaccinated, JoEllen Smith, ODRC spokesperson said. Seventy percent of inmates who were offered the vaccine accepted, according to the state.
That’s higher than the 60% of Americans overall who say they would definitely or probably get the vaccine, according to Pew Research. But among free Americans over the age of 65, who face a much higher chance of death if they get the coronavirus, three-quarters say they’ll get the vaccine.
Legal experts said a court might uphold a vaccine mandate if prisons tried to issue one, but past experience might give them pause.
Michael Benza, law professor at Case Western Reserve UniversityMichael Benza, a law professor at Case Western Reserve University, cites the riots that gripped Southern Ohio Correctional Facility at Lucasville in 1993. When the prison announced that inmates were required to take a vaccine for tuberculosis, it touched off an 11-day conflagration that killed nine inmates and one guard.
“No prison is going to want to deal with that issue,” Benza says.
The Ohio Department of Rehabilitation and Corrections (ODRC) said through a spokesperson that prisoners are free to decide for themselves whether to get vaccinated.
Of the four Pickaway prisoners contacted by Northeast Ohio Solutions Journalism Collaborative (NEO SoJo), three said they had refused the vaccine. And even the one who accepted it said he thinks many others will refuse it.
Frazier resident Daniel Crim, age 53, has been in prison since 2006 for robbery and was diagnosed in September with lung cancer. He says his doctors estimated he had about six months to live.
Crim, who was infected with COVID-19 last spring, is scheduled for release in February 2022. ODRC said his application for compassionate release has been denied.
People who recover from the coronavirus acquire immunity, but scientists don’t know yet whether that immunity lasts forever. The CDC recommends people who have had the virus get vaccinated anyway.
Crim said he’s frightened of what another bout of the coronavirus could do to him, and he’s eager to take the vaccine. But he says he thinks many of his fellow inmates are more hesitant.
“I’ve been in prison a long time,” he says, “and one thing I’ve always noticed is, inmates become conspiracy theorists.”
Nancy McHugh, a Wittenberg University philosophy professor who works with prisoners, said many are skeptical of information from prison administrators.
“People who are incarcerated have a good reason to not trust people who are supposed to be caring for their health,” she says. “When you build up systems of distrust, why would you even trust the things that would potentially be good for you?”
Behind bars, prisoners’ information intake is often limited to whatever news is played on communal televisions. They don’t have free access to the Internet to search for articles and scientific studies that can answer their questions. And prisoners interviewed for this story brought up the history of medical experimentation on prisoners in America (See sidebar Experiments on prisoners, then and now).
McHugh said that reckless treatment of inmates’ health isn’t a thing of the past. She pointed to investigations finding that California prison doctors illegally sterilized 148 women without their knowledge or consent between 2006 and 2010.
“[The women were] being told they’re going in for something therapeutic, and in fact what’s happening is harm,” McHugh says. “And people who are incarcerated are very astute. They know those cases. They hear about those cases.”
Billy Renshaw, a 66-year-old prisoner at Pickaway, echoed that sentiment. “I’m not going to trust the government, because a lot of times they say this is for your own good, and this is for the good of everybody, and it’s not,” he says. “They’re going to keep me the rest of my life and kill me anyway. Why are they going to give me a vaccine?”
This puts prison administrators who want to prevent COVID-19 deaths in a bind: the more they push prisoners to get the vaccine, the more some prisoners become suspicious of their motives, potentially dropping the number who will take the vaccine.
Ohio is offering prisoners a financial incentive to take the vaccine. Every year prisoners are offered $5 to take a flu vaccine, and now the prisons are offering $5 for each of the two doses most of the coronavirus vaccines require.
Experts are divided on whether the incentive is coercive, especially given that prisoners often make pennies per hour at prison jobs, and just sending emails or making phone calls to loved ones costs money. There’s also concern that it could backfire, making prisoners more wary of the vaccine.
Duff said the incentive deepened his suspicion that the vaccine was unsafe.
“I know that can’t be, that’s not right,” he said. “They’re almost paying you to experiment with this.”
Experts agree that honest, open information campaigns are essential to build prisoners’ trust.
ODRC spokespeople say prisoners are given information about the vaccine in one-on-one meetings with healthcare providers before they decide whether to get it. Renshaw provided a copy of an email sent out to all prisoners describing possible side effects of the vaccine and stressing that vaccination is part of a strategy that includes continued use of masks.
66-year-old prisoner Billy Renshaw, with the two styles of masks being distributed to Pickaway prisoners.But Crim, Duff, Renshaw, and Russell Green, who is battling colon cancer while in Pickaway, all say their conversations with staff were perfunctory. Duff and Crim both describe a staff member going from patient to patient in Frazier with a list of names, asking them if they wanted to take the COVID-19 vaccine, and marking their responses before moving on without discussion.
Renshaw says that he was among prisoners summoned to Frazier on Feb. 5 for brief meetings with a doctor who asked if he would like to take the vaccine. Renshaw declined. Later on, he asked this reporter a list of questions about the vaccine that weren’t covered by the mass email, like whether it was FDA-approved, how it had been tested, and whether it contained the virus or a mix of chemicals. He mentioned he was taking notes on the answers to share with other prisoners.
Green describes a similar interaction with a doctor. He decided not to take the vaccine offered by the prison because it’s produced by Moderna. His sister recommended he wait to take the Pfizer vaccine once he gets out, though he’s not sure why.
Green said he didn’t feel like he could ask the doctors at Pickaway questions about the vaccine—like the differences between the types of vaccines—before making a decision.
“They barely even know about my cancer,” he says. “I’ll ask them about [the cancer] treatment, and they say, look, we don’t know, we’re not cancer doctors.”
Green’s cancer treatment regime is planned by doctors at an Ohio State University facility that routinely treats Pickaway prisoners in need of intensive or specialized care. He says he’d be much more likely to take the vaccine if his doctors there recommended it.
“I trust OSU,” he adds.
Part of the problem is that many prisoners don’t trust the professionals entrusted with their health. McHugh says that healthcare providers in prison are far outnumbered by guards, who sometimes see it as their job to help punish prisoners for whatever crime they committed. It can be difficult, she says, for doctors and nurses to swim against that professional culture.
Duff thinks prison healthcare staff prioritize control over care. He says, for example, that when he once fell and damaged his spine, he was ordered to change out of his prison clothes and into an orange jumpsuit before being rushed to the hospital for emergency surgery.
Victor suggests that people from outside the prison system should be brought in to handle vaccine distribution.
“What’s important, if we’re trying to gain the trust of the public in general and prisoners in particular, is transparency,” she says. “And being sure that the people administering the vaccine to prisoners or offering it to them are not the same people that are providing them with inadequate or maybe no healthcare services in general.”
Duff concedes that if a doctor who didn’t work for the prison offered him the vaccine, he might be more inclined to take it. Renshaw, though, says there was nothing that could convince him.
Crim shares Duff and Renshaw’s mistrust of the system, but says he was won over by well-known figures like Joe Biden getting the vaccine on television. He reasons such important people wouldn’t get the vaccine if it were dangerous. He’s still cynical, though, of officials’ motivations for vaccinating inmates.
“I’m fortunate, grateful, but I know why I’m being given the vaccine,” Crim says. “They’re trying to protect themselves from further lawsuits and things of that nature, to try to control the situation as much as possible. The system’s not doing it for me because they care about Daniel Crim.”
After Crim volunteered to take the vaccine, he says he had to be transferred to a hospital because of a chemotherapy-related infection. Since he returned to Pickaway, he says, no one has given him a chance to take the vaccine.
This story is sponsored by the Northeast Ohio Solutions Journalism Collaborative, which is composed of 20-plus Northeast Ohio news outlets including FreshWater Cleveland.