The biggest coronavirus outbreak in Alaska is unfolding in a prison. Will the incarcerated be prioritized for vaccines?

The largest Alaska outbreak of the coronavirus pandemic so far is unfolding right now, within the walls of a prison in the Mat-Su Borough. At Goose Creek Correctional Center, 708 inmates had active coronavirus infections as of Monday.

Other jails face worsening outbreaks, too: 112 inmates at the Anchorage Correctional Complex and 68 in Yukon-Kuskokwim Correctional Center have the virus. Statewide, 19 incarcerated people have been hospitalized during the pandemic. Three have died.

With a limited supply of vaccines now arriving, a debate over when incarcerated people should receive the vaccine is playing out across the country -- and in Alaska. The question: Should prisoners be seen as a vulnerable population living in a congregate setting and given priority access to the vaccine?

In November, the American Medical Association called for people in jails and prisons to be prioritized for vaccination. Prisoners are at high-risk of contracting COVID-19 because the disease has spread so quickly in densely populated facilities, with devastating effects. At least 249,883 prisoners have been infected and 1,657 have died of COVID-19 in U.S. correctional facilities, according to The Marshall Project.

“Being incarcerated or detained should not be synonymous with being left totally vulnerable to COVID-19,” the medical association said.

Some states, such as Massachusetts, have made prisoners among the first to receive vaccines, prioritizing them alongside other people living in congregate settings, such as homeless shelters.

Groups such as the ACLU of Alaska have taken the position that prisoners should be prioritized for vaccines because they live in congregate settings with limited medical resources.

“In the most favorable of circumstances, our prisons have a hard time maintaining health and sanitation standards,” said Megan Edge, a spokeswoman for the ACLU of Alaska. “It’s a breeding ground.”

According to the advocacy group Prison Policy Initiative, Alaska is one of 10 states where vaccination rollout plans are so far silent on when incarcerated people will be offered vaccines. Alaska hasn’t made a decision yet about where incarcerated people will fall on the vaccine rollout plan, said Sarah Gallagher, a spokeswoman for the Department of Corrections.

“This has not yet been determined,” Gallagher said.

The idea of prioritizing prisoners while limited vaccine supplies exist has been politically unpalatable to some leaders nationally. In Colorado, Gov. Jared Polis told reporters that inmates shouldn’t receive priority for vaccines.

“There’s no way (the vaccine is) going to go to prisoners before it goes to people who haven’t committed any crime. That’s obvious,” he said.

(A substantial proportion of incarcerated Alaskans are detained pre-trial, meaning they have been charged with a crime but not yet convicted.)

Gov. Mike Dunleavy did not respond to a request for comment about vaccination prioritization.

While the state’s plan isn’t finalized yet, correctional officers and prison medical staff are considered first responders and will be prioritized with other first responders around the state, Gallagher said. As of Dec. 9, some 149 people who work in correctional facilities across the state have tested positive for COVID-19. That includes correctional officers as well as other workers.

And some of medically compromised prisoners living in hospital-level medical housing units will also get first crack at the vaccine. Staff and residents of prison medical infirmaries, along with front-line health care workers, emergency responders and long-term care resident facilities and staff will be among the first Alaskans to be offered vaccination, the Department of Health and Social Services said Monday.

“People in infirmary and high risk people within the prison system are considered the equivalent to long term care facility as well as the staff who treat them,” said state chief medical Dr. Anne Zink in a media call Monday.

Mark Carr is a regional ethicist for Providence Health & Services Alaska, and a member of a statewide task force making decisions about which populations will be given access to limited coronavirus vaccine supply, in which order.

The committee is “very robust, it’s broad minded, it’s well represented, with persons and agencies all across the state,” Carr said.

Public health is guided by a philosophy that makes decisions based on a utilitarian analysis, he said: Where the vaccine has the potential to make the biggest positive impact. That’s why essential health workers, crucial to the entire system of providing medical care, are first in line.

“In response to a pandemic, (public health experts) are going to focus attention on instrumental value of persons in the society — it has nothing to say about the moral value of a person, but whether or not a person is essential to the functioning of society,” Carr said.

Vaccine allocation decisions have to be “neutral, objective and data driven, by science,” he said. On the other hand, deciding who gets a lifesaving vaccine first “is an inherently political venture. It’s not as if you can take the human out of it.”

There’s several ways to analyze the question of when prisoners should be vaccinated, Carr said, speaking in general as a medical ethicist and not specifically about Alaska’s plans.

In one version of that theoretical calculus, people in prisons aren’t essential workers in any way, and therefore should be lower priority. In that argument, “those people, as dignified and valuable as we may want to assert they are, are not instrumental to the functioning of our society and therefore should fall in a lower tier of the rollout of the vaccine,” he said. “They are not going to keep food being delivered to grocery stores, planes in the air, fuel in vehicles, and so on and so forth.”

Another approach could revolve around the notion that prisoners live in a dense congregate housing and should be prioritized — as should people living in other dense housing — say, the Begich Towers in Whittier, Carr said. In that analysis, you get a lot of bang for your buck by vaccinating people in big facilities, because vaccinating people could prevent a lot of disease spread.

Both approaches “are focused on the consequences for our actions.” A duty perspective might focus on vulnerability -- in the United Kingdom, the government is highlighting “giving vaccine to the oldest among us,” as a duty to protect, he said.

Carr declined to talk about the specifics of what the committee is discussing. But how to deal with incarcerated people is a topic of conversation.

“We would be negligent not to,” he said.

No matter where prisoners fall on the priority spectrum, DOC officials will face additional challenges in stemming outbreaks within facilities. Logistical complications to vaccinating in prisons could include the transiency of inmates, who cycle through jails and prisons for highly variable timeframes -- an extra big problem with a two-dose immunization. And there’s also the question of whether inmates will choose to take a vaccine, if offered by their jailers.