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HARRISBURG — Early in January, Angelo Romero sat in his cell at SCI-Smithfield and thought there would be no way people incarcerated, like himself, would get the COVID-19 vaccine.

“The inmates don’t stand a chance on being vaccinated if it’s going to cost the [Department of Corrections] money,” he wrote in a letter to Spotlight PA.

But to Romero’s surprise — along with prisoners’ rights advocates, public health experts, and even other inmates — the opposite has happened.

Three out of the state’s 23 prisons have so far offered vaccines to inmates and staff, and the number of inmates who have gotten the vaccine at two of those facilities is upwards of 70% — no small feat for a department that, on average, vaccinates just over a quarter of its population for the flu.

One of the reasons why that could be happening? Money.

As part of an incentive program, the department is offering inmates a $25 commissary credit to buy clothing, food, or other items, after they receive both their initial and booster shots. While some experts caution against incentivizing people to get vaccines — arguing the health and social benefits are self-apparent — in close quarters such as prisons, the need to stem the pandemic is the top priority.

Heather Lavelle, who is incarcerated at SCI-Muncy, the state’s all-female prison north of Lewisburg, received her first dose on March 1 in the prison chapel. Lavelle was skeptical, at first, that the money would persuade people to get their shots.

“I knew a lot of people who were suspicious ... like they were trying to coerce us into getting it,” Lavelle said. “But as it turns out, it did encourage some people to get it who had no good reason not to.”

The department also recruited people like Lavelle, who is a peer counselor at Muncy, to dispel rumors about the COVID-19 vaccine’s safety to other inmates. Corrections officers got their shots in front of entire rooms of prisoners.

Since then, at least two facilities, Laurel Highlands and Muncy, have vaccinated up to 73% of their incarcerated populations, according to the department. It’s unclear what the vaccination percentage is at Waymart, which is the third prison to have received vaccines.

The program is a replica of the department’s attempt to incentivize prisoners to get the flu vaccine in September last year.

Between 2017 and 2019, 26% to 28% of the state’s inmates would get their flu shots. In October last year, when the department offered a $5 incentive to inmates, 48.1% of the incarcerated population got the flu vaccine, according to numbers provided by the department.

Both incentive-based efforts were unprecedented in Pennsylvania and among just a few nationwide. The money for them was drawn from the Inmate General Welfare Fund, which is generated by fines and fees paid by inmates — not taxpayer funds.

Effectiveness varies

Incentive programs have been used elsewhere, as well.

The state offers extra paid time off for some employees, like those represented by American Federation of State, County, and Municipal Employees Council 13, which is a union that includes independent agencies as well as the Pennsylvania State System of Higher Education and Pennsylvania Higher Education Assistance Agency. They receive up to six hours of leave — three for each dose — in return for getting vaccinated, according to spokesperson Jennifer George.

Not all of the efforts pay off.

Officials in Northampton County used federal CARES Act money to offer workers at the county-run Gracedale Nursing Home a $750 bonus to get vaccinated. Gracedale was the site of one of the biggest coronavirus outbreaks at a long-term care facility in the state, with 99 deaths and 419 resident cases of COVID-19, and 154 staff cases, according to Health Department data.

When it concluded in February, the county paid out $224,250, but only about 48% of staff at the facility, which has 624 employees, had received the vaccine, according to figures provided by the county. A spokesperson said officials were not allowed to ask staff why they opted out, due to medical privacy laws.

Even though such programs are becoming increasingly common, it is unclear whether it’s the money that actually motivates more people to get vaccinated — and some experts warn that offering a monetary incentive could backfire.

Unlike benefits that coincide with receiving the vaccine, such as being able to socialize or go to work, offering people money might deter them, said George Loewenstein, a professor of economics and psychology at Carnegie Mellon University.

“With the monetary incentive, it conveys the opposite: This is something that you very well might not think is in your self-interest to do, but we’re trying to compensate for that with monetary payment,” Loewenstein said.

Jessica Fishman, a behavioral scientist at the University of Pennsylvania, is running a study to measure how different messages — comparing incentives vs. other prompts that only provide vaccine safety and efficacy information — influence whether or not people are more likely to get a vaccine.

“I think it’s worth testing since we don’t have evidence that speaks directly to the policy debate, where some are quite adamant that it would absolutely backfire and increase fears of vaccination,” Fishman said.

In prisons, the Pennsylvania Department of Corrections houses up to four people in cells the size of a bathroom — spaces that are ripe for spreading COVID-19. Vaccinations are the best way to avoid further outbreaks, public health experts said, so the benefits of incentive programs outweigh potential drawbacks.

“Definitely the overriding principle and goal is to make it so that people can get vaccinated. Reducing barriers and making it easy for them is critical,” said Joseph Amon, the director of the Office of Global Health at Drexel University and a specialist in prison care. “I think it’s a great example for other states to see that this works.”

At least one other state, North Carolina, is running an incentive program in its state prisons.

Instead of money, those who choose to get vaccinated receive five days off their sentence if they are eligible, four additional visits with clergy or family, a free 10-minute phone call, and the opportunity to return to work or programming early, said John Bull, spokesperson for the North Carolina Department of Public Safety.

North Carolina’s prison system reports that since Jan. 20, about 10% of the state’s roughly 29,000 inmates across 55 state prisons have received at least one dose of the vaccine, though it’s unclear what effect the incentives have had.

Incomplete data

Still, there are some Pennsylvania inmates, such as Romero, who won’t ever trust getting the vaccine from prison officials.

“I have never took the flu shot in my 24 years of being incarcerated and never will,” said Romero, the inmate who was incarcerated at Smithfield. “I just don’t trust the system.

It’s too early to fully gauge the success of vaccine programs in Pennsylvania’s prisons because of limited data. In January, the Department of Corrections admitted in response to a five-month analysis by Spotlight PA that its coronavirus data were seriously flawed.

The department removed its tracking data online and promised a new dashboard by March 1. But that release, which would include tracking of vaccine numbers, has been postponed, with officials citing technical difficulties. They have not set a new date.

“We have a complete blackout right now on testing data. We don’t know how many tests are being done or what the positivity rate of those tests are,” said Sean Damon, organizing director at the Amistad Law Project, a civil rights legal group for prisoners. “Similarly, we don’t know the percentage of people who have been vaccinated.”

And outbreaks continue among the state’s 20 remaining facilities that have not had access to vaccines yet.

“We have these facilities which cluster thousands of people in tight quarters and the vaccine is not being rolled out there, and it needs to be,” Damon said. “It’s urgent.”

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