ICE must provide Covid-19 vaccines to all detained migrants

After months of public health and political debates on vaccine prioritization for incarcerated populations, Covid-19 vaccination has begun in prisons and jails across the United States. Yet little is known about vaccination programs in U.S. Immigration and Customs Enforcement (ICE) detention centers.

Some states have said they will vaccinate incarcerated populations in Phase 1b or 2 of the vaccines rollout, either alongside correctional officers or after they have been vaccinated. The Federal Bureau of Prisons first planned to prioritize correctional officers, in line with recommendations from the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices. But after pushback from public health experts highlighted the growing rates of Covid-19 among inmates, the Bureau of Prisons began vaccinating staff members and selected prisoners simultaneously.

Targeted vaccination efforts are essential in prisons and jails, where 90 of the 100 largest Covid-19 cluster outbreaks in the United States have occurred.

The spread of Covid-19 in ICE detention centers has also been rampant. On average, the monthly rate of cases in detention was 13.4 times higher than in the general population during the first five months of the pandemic. Yet ICE has been lax in implementing Covid-19 public health measures to protect detainees.

In collaboration with Physicians for Human Rights, we recently interviewed 50 formerly detained individuals. In this evaluation, published Jan. 12, those interviewed explained how ICE failed to comply with its own Covid-19 pandemic response requirements in at least 22 of its facilities — often denying detainees consistent access to soap, masks, and proper symptom-based testing and isolation.

We believe that, first and foremost, ICE should not be detaining individuals and that individuals who are currently detained should be released. But until that happens, the vaccine rollout is an opportunity for ICE to recognize that it is accountable for the health of detainees, who are at a similar risk level for Covid-19 as incarcerated individuals. They live in crowded, congregate facilities with limited social distancing, often sleeping only 3 feet from one another, as our interviews showed. Like incarcerated individuals, ICE detainees must be prioritized for Covid-19 vaccination.

To date, ICE has failed to publicly communicate a vaccination strategy for detainees. And since federal officials are distributing vaccines directly to states, it isn’t clear if ICE detainees will be incorporated in state vaccination plans. Only Louisiana’s plan explicitly mentions ICE detention centers.

ICE must immediately create, implement, and publicize a vaccination plan for those held in its detention centers. The agency can build upon the framework used by the Bureau of Prisons to vaccinate incarcerated populations by working closely with Operation Warp Speed and leveraging its partnerships with pharmaceutical companies to procure vaccines for its detainees.

Rather than relying on states to serve as intermediaries between the federal government and detainees, ICE should directly secure vaccine doses by designating detention facilities as federal entity sites, the term used by Operation Warp Speed to refer to any government department or agency that requests vaccines. Although the health of ICE detainees is the responsibility of the federal government, states can enforce public health standards to ensure that detention facilities within their borders fulfill the obligation to provide vaccines to detainees.

Congressional investigations have revealed that widespread failures in providing health care has led to deaths of detainees in multiple facilities. Remarkably substandard systems of medical care may explain ICE’s history of vaccine failures. The spread of vaccine-preventable infectious diseases, such as influenza, varicella, and mumps, among people in ICE detention centers has grown in the last few years. The additional failure to provide access to a Covid-19 vaccine would severely compound the disease burden already faced by detainees. As large numbers of detainees continue to be released to community settings, scaling vaccine administration to this population will be crucial in curbing their transmission of Covid-19 to these communities.

As ICE develops a vaccination plan, it must recognize that its previous health care and policy failures, such as its recent record of questionable hysterectomies, has bred distrust among its detained population. Less than half of those we interviewed were directly educated by ICE staff about Covid-19 symptoms. And when information was provided, it was often inaccessible for the many non-English-speaking detainees. We also found that solitary confinement, used as medical isolation, further strained relationships between detainees and ICE staff.

ICE must abide by CDC vaccine guidelines and provide linguistically and culturally appropriate education to build confidence in vaccine safety among detainees, especially individuals of color, who have reason to be skeptical of the vaccine. Where possible, ICE should enlist community-based workers and local public health departments as partners in ensuring widespread, voluntary vaccine adoption.

The federal government must abide by its responsibility to detained migrants and spearhead a vaccine-distribution plan for all ICE detention facilities. Only by vaccinating the people most vulnerable to Covid-19 can we move closer towards an equitable post-pandemic future.

Nishant Uppal, Parsa Erfani, and Raquel Sofia Sandoval are students at Harvard Medical School, medical evaluators at the Harvard Student Human Rights Collaborative Asylum Clinic, and research associates at the Peeler Immigration Lab at Harvard Medical School.