As states usher the most vulnerable Americans to the front of the line for the first rounds of vaccinations, many across the country say the “vulnerable” category needs to include an often over-looked population: prisoners.

Several groups even say prisoners — around 2.3 million Americans — should be vaccinated ahead of people like health care workers and nursing home staff.

Nationwide, prisons remain hotbeds for COVID-19 infections, with at least 276,235 incarcerated people testing positive since March — and at least 1,738 have died, the Marshall Project reports.

The Marshall Project, a nonprofit and nonpartisan advocacy group, has been tracking the coronavirus in prisons since March — a difficult task since state testing methods and reporting vary.

In Massachusetts, thousands of inmates will be some of the first residents to receive the vaccine. But the state is among the few planning to target prisoners. In Texas, the state’s plan for vaccines — as does that of many states — is intended to roll out in stages. But the state’s vaccination plan doesn’t list a stage for prisoners at all.

Along with Texas, Florida and South Dakota include no language about how inmate vaccination will begin or function.

While people in prison share many of the same complications as the “vulnerable,” nationwide, they aren’t being treated the same.

Why prisoners?

Out of the two million-plus prison population, an estimated 20% have been infected. Based on information so far, prisoners are also four times more likely to be infected than others and twice as likely to die from COVID-19.

Florida and Texas rank as the states with the highest numbers of prisoner COVID-19 fatalities, with 189 and 172, respectively. Both of which currently have no mention of a plan for vaccinating prisoners.

(Courtesy of Prison Policy Initiative)

Prison spread is easily linked to the fact that inmates can’t adequately social distance in their highly population. In addition to living in cells together, groups share bathrooms. An August report published by the Johns Hopkins Center for Health Security lists prisoners as a priority, as it does any groups who live in densely populated facilities.

Lack of access to proper care and resources are also a concern. And many inmates already have poor health due to being in prison.

“We aren’t saying that prisoners should be treated any better than anybody else, but they shouldn’t be treated any worse than anybody else who is forced to live in a congregate setting,” Dr. Eric Toner, a co-author of the report, told the New York Times.

Why should ‘they‘ get vaccinated before me?

Many argue prisoners shouldn’t get the earliest access ahead of those not in prison, or, those people who have not “done anything wrong.”

But the idea that all those in prison are inherently dangerous and violent people isn’t reflected in the statistics.

Prison Policy Initiative, a nonprofit/nonpartisan research and advocacy group, reports that most people in the U.S. justice system are not accused of serious crimes, but misdemeanors and non-criminal violations. But low-level offenses like technical probation and parole violations often result in incarceration.

Those charged with misdemeanors account for 13 million charges in the justice system each year — and for crimes like sitting on a sidewalk or jaywalking. PPI says over 25% of daily jail population is due to low-level offenses.

In addition to those imprisoned or jailed for low-level offenses, “incarcerated” populations in the U.S. also include youths who are held for offenses that are either petty or incidental.

PPI reports 6,600 of the youth behind bars are there for minor probation violations and over 1,700 are locked up for regular teenage-level offenses like skipping classes. And nearly 1 in 10 youth held for criminal or delinquent offenses ends up in an adult jail or prison.

Adding to these worries are questions of equity, as data shows Black and Latinx populations are overrepresented in the criminal justice system — and more likely to be incarcerated due to various policing policies.

There isn’t an across-the-board metric for sentencing offenders, especially as it comes to race.

“Black and Latinx defendants facing drug and weapon charges were more likely to be convicted, more likely to be incarcerated, and receive longer sentences than white people who were facing similar charges,” Felix Owusu, fellow at the Criminal Justice Policy Program at Harvard Law School said.

Owesu says the reports further reveals how “institutional racism permeates the whole criminal justice system.”

The NAACP reports 32% of the U.S. population are Black and Latino, but 56% of the incarcerated are Black and Latino. The Pew Research Center estimates that for Black men, who are most likely to be imprisoned, there are 2,272 inmates per 100,000 Black men.

Beyond prisoners

Another reason for the push to vaccinate prisoners is that despite their seclusion, infected inmates can still spread the coronavirus to staff and even prison outsiders.

The Marshall Project, reports at least 67,883 COVID-19 cases among prison staff and at least 113 deaths.

Additionally, inmate infections can harm those outside the prison walls.

In Chicago, 1 in 7 infections have been linked to traffic through the Cook County Jail, a study in the Health Affairs journal found. Cook County Jail was also the largest known spot for COVID-19 spread in the country, until an Ohio state prison topped the list.

For these reasons, Dr. Toner said vaccinating prisoners would be smartest to prevent further spread.

He told the NYT, “Prisons are incubators of infectious disease. It’s a fundamental tenet of public health to try and stop epidemics at their source.”

For now, U.S. prisoners await their time to be accounted for in a country that often looks the other way.

“Incarcerated people are members of our society, too — ones often at high risk during crises because their health and well-being are rarely prioritized,” write Ashish Prashar and DeAnna Hoskins for NBC News. “They are left behind during natural disasters when others are evacuating, and they are not always provided medicine they need in a timely manner.”