An Analysis of Interim COVID-19 Vaccination Plans

Each U.S. state is developing programs to plan and operationalize a vaccination response to COVID-19 within their jurisdiction based on the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations, released October 29, 2020. States were tasked with developing a vaccine plan that includes three phases, ordered from highest to lowest priority, and ensuring equitable access for CDC defined “critical populations,” including (1) critical infrastructure workforce, (2) people at increased risk for severe COVID-19 illness, (3) people at increased risk of acquiring or transmitting COVID-19, and (4) people with limited access to routine vaccination services. 

CPP analyzed each of these plans to identify in which phase incarcerated people are targeted for COVID-19 vaccination. Fourteen (14) States/Territories have, so far, included incarcerated populations as part of their Phase 1 vaccine distribution; of these 14 States/Territories, two (2) have specifically prioritized incarcerated populations that are medically vulnerable to COVID-19. These populations include incarcerated people that are over the age of 65 or have two or more chronic conditions. Twenty (20) states include incarcerated populations as part of their Phase 2 vaccine distribution. Tennessee and Missouri designate incarcerated populations for vaccination in phase 3; in Missouri, incarcerated people are identified as targets for Phase 3 while correctional staff are targeted for Phase 1. We have categorized Montana as Phase 1 but must note that they organized their prioritization categories as tiers, making their plan more difficult to discern. In addition, in both Michigan and Rhode Island, they distinguish between medically vulnerable incarcerated people and the rest of the population. They have included only the medically vulnerable incarcerated people in Phase 1. Fourteen (14) states did not explicitly identify how they would prioritize incarcerated populations in the distribution of vaccines. The image below shows how states have categorized incarcerated people into various phases for vaccine distribution. This analysis and figure are being updated as information about the states’ final plans (turned into the CDC on Friday, December 4) become available. 

MO: Changes in data reporting

On November 9th, Missouri stopped reporting deaths of incarcerated people and staff and the number of incarcerated people tested for COVID-19. On November 24th, CPP began reporting these variables as not reported (“NR”). On November 25th, Missouri resumed reporting of deaths but did not resume reporting the number of people tested. CPP reached out to Missouri’s DOC to understand why there was a change in data reporting and have not yet received a response.

CO: Changes in data reporting; count decrease

Colorado began reporting cumulative inmate positives and inmates tested under different variable names. With these changes, there was a significant decrease in the reported number of incarcerated people tested for COVID-19. CPP was told by a DOC representative that this decrease was due to changes in data reporting and that these values will likely continue to fluctuate until data has been merged to their new system.

Language Matters: Reporting COVID-19 in Prison Systems

CPP collects and analyzes data on five primary variables reported by 53 sources: each state prison system, ICE, the Federal Bureau of Prisons, and Puerto Rico. In an analysis of definitions available on each system’s website, discrepancies in language used to report COVID-related data were identified. Specifically, definitions of the number of people who are incarcerated who are tested for COVID-19 (“Inmates Tested”)  and positive cases in staff (“Staff Positive”) vary. These differences in terminology are important: reporting the number of tests given does not capture how many of them are re-tests of the same individual, due to either re-exposure to the virus or sentinel surveillance testing. 

Historically, CPP has defined “Inmates Tested” as the total number of incarcerated individuals in prisons who have received a COVID test. This was mostly the case early in the course of the pandemic wherein testing was slow to ramp up. However, more recently, as reductions in population have occurred and more robust testing efforts have been deployed, systems have begun defining their testing data disparately. Our team recently did a content analysis of reporting across all of the systems we are tracking. What we found is detailed here in Table 1. 

Definition of “Inmates Tested”Percentage  
Number of COVID tests given 23%
Number of people tested26%
Undefined 30%
Variable not reported by DOC 26%
Table 1. System Definitions of “Inmates Tested.” Note: Colorado, Vermont, and Washington report both the number of people tested and the number of tests given. 

Very few of the systems reporting data are providing information relevant to staff testing. Out of 53 systems, only 7 are reporting the number of staff that have been tested (defined by CPP as “Staff Tested”). Of these 7 systems, only 1 defines the variable as the number of DOC-administered tests to staff. For the remaining systems, 3 leave “staff tested” as undefined, and 3 specify that testing is self-reported by staff members. 

Systems should aim to be clear in how they define variables related to COVID-19 testing and cases, particularly when it comes to re-exposures and retesting incarcerated people and staff members. In light of these findings, CPP will begin to report two categories of data for relevant systems: both the number of people tested and the number of tests given. For more insight into how systems and CPP define these COVID-related variables, check out our “Data Dictionary” here. We continue to re-evaluate how these definitions differ between systems and what it means for the standardization of data on CPP’s platform.