When the number of covid-19 cases among inmates in Pennsylvania state prisons last fall topped 1,000 and staff cases hovered in the hundreds, the union representing 11,000 corrections officers began lobbying to get prison staffers to the front of the line for vaccinations.
John Eckenrode, president of the Pennsylvania State Corrections Officers Association, pressed state officials for months to give prison workers the same status as hospital staff members, first responders and teachers.
"This is a health and public safety crisis," Eckenrode said in a January statement. "It's time to prioritize vaccinating staff, so they can do their jobs and also not worry about bringing the virus home to their loved ones."
Yet, after the lifesaving shots became widely available, Pennsylvania prison guards have not rushed out to get them — even though the corrections department has had more than 4,700 staff members test positive over the course of the pandemic and eight die.
By mid-June, 22% of Department of Corrections employees were inoculated, according to voluntary reports collected by the department. At one prison, just 7% of staffers had received shots.
Meanwhile, more than 75% of the 39,000 men and women incarcerated in Pennsylvania's 24 state prisons have had the shots, according to the department.
That disparity is evident across the country. While a majority of inmates in most states are fully vaccinated, prison staffers are not, according to data on 36 states and the federal Bureau of Prisons compiled by the Prison Policy Initiative using information from several prison advocacy and journalism groups.
That report — released in April, when the vaccine was becoming more easily accessible — found 48% of prison staff members nationwide had received at least one dose, although in some states rates were in the teens or lower.
Eckenrode declined to comment to KHN. But he recently told WHYY, the NPR member station in Philadelphia, that he believes many more officers are vaccinated and not reporting their status to prison officials.
He acknowledged reluctance among his members. "I think that no matter what kind of demographic you look at, there's vaccine hesitancy," he said. The vaccines were "approved under experimental conditions, and I believe that it should be an individual choice."
One officer with the New York Department of Corrections and Community Supervision, which reported last month that it had vaccinated 43% of inmates, compared with 30% of staffers, said he waited until late June because he and his wife had survived a bout of covid and felt they had natural protection from the virus.
Some colleagues have been spooked by internet videos from anti-vaccination groups showing doctors talking about vaccine-related deaths or stoking concerns that the Food and Drug Administration's emergency use authorization for the vaccines — rather than formal approval — means they are less dependable, said the officer, who asked to remain anonymous because corrections staffers are not authorized to speak to reporters. He added that a sense of "I don't want people to think I'm weak" machismo and right-wing politics play into the decision-making.
"There are a lot of conspiracy theorists," the New York guard said.
Covid has taken a high toll inside prisons. Two news organizations, the Marshall Project and The Associated Press, have found nearly 400,000 covid cases in U.S. prisons and more than 2,700 inmate deaths. Among staff members, more than 114,000 cases and more than 200 deaths have been reported nationwide.
Staff vaccination statistics often do not give the full picture, since states generally don't require corrections staffers to report their status.
In California, which has the nation's second-largest prison system, a reform group is suing over low staff vaccination rates, arguing that unprotected prison workers put vulnerable inmates at risk.
State tallies show that in late June 52% of prison staffers had been fully vaccinated versus 71% of inmates. In its court filing, the Prison Law Office said that, despite efforts by California officials encouraging vaccinations, "infected and unvaccinated staff members continue to pose a significant threat to incarcerated communities."
Health experts say prison staff members also endanger surrounding communities.
Unvaccinated officers are a common cause of infection, because they go back and forth between the prison and the community, said Dr. Anne Spaulding, an associate professor in epidemiology at Emory University and former medical director at the Rhode Island Department of Corrections.
Spaulding also pointed to the "downstream effects" of unvaccinated staffers — especially corrections officers (known as COs), who are in daily close contact with inmates — on the inmates' mental health.
"If it passes from CO to CO, what does that mean with staff shortages? More lockdowns, less programming," she said. "It's going to affect the mental health of those incarcerated, who already have restricted lives."
Kirstin Cornnell, social services director with the Pennsylvania Prison Society, which advocates for reforms, said lockdowns resulting from sick staff members could lead to suspension of family visitation, disrupting connections critical to inmates' mental health.
"We have really serious concerns about how low the rate of staff vaccination is," said Cornnell. "This increases tension in an already stressful situation."
Pennsylvania Corrections Secretary John Wetzel and officials in other states say that, while they are not considering making the shots mandatory, they are pressing employees to get vaccinated.
"We continue to educate our staff and encourage them to get vaccinated for their own protection, but also for those around them," said Wetzel. "Everyone knows that prisons are breeding grounds for infectious diseases like covid-19, largely because inmates live so close together."
While union officials in several states did not respond to queries, prison officials said their employees have the same concerns as the general public: religious or other objections, false conspiracy theories about the vaccines, worries about a new shot that was developed quickly.
"They want to see how it plays out with others who are vaccinated," said John Bull, a spokesperson for the Department of Public Safety in North Carolina — where 6,607 department employees, or roughly half the staff at 55 facilities, have been vaccinated through prison clinics. "They didn't want to be guinea pigs."
Incentives, such as gift cards, cash lotteries and paid time off, have boosted staff rates in some states, officials said. But Chris Gautz, a spokesperson for the Michigan corrections department, said his state will not provide incentives, despite having only about 15% of staffers vaccinated. He said his agency decided disease prevention was a better motivator.
"The benefit of not dying is not dying," he said. "A $5 gift card to Frosty Boy is not going to put someone over the edge."
The Prison Law Office and other groups are advocating for mandatory prison staff vaccinations, but the potential face-off with powerful prison worker unions has thwarted that idea in some states.
California Gov. Gavin Newsom said at a May news conference that he had no plans to make vaccinations mandatory and would instead urge the corrections officers union to persuade its members to get the shots.
Health experts point to other public institutions, such as schools and colleges, that require vaccination.
"States have the ability to mandate vaccination when it puts someone at risk," said Joseph Amon, an epidemiologist and director of the Office of Global Health at Drexel University in Philadelphia. "This is a case that makes sense. There could be limited exemption, but there should be an expectation that all staff be vaccinated."