As the more transmissible Omicron variant descends upon the American winter, we will soon see a sharp increase in COVID-19 outbreaks. As this unfolds, those held in the uniquely high-risk settings posed by jails, prisons, and ICE facilities will again suffer from US government refusals to enact preventive policies like mask mandates, vaccine mandates, and publicly provided at-home tests.

Public health studies have shown that, due to overcrowding and unsafe conditions characterized by systematic health care neglect, the coronavirus spreads faster in US carceral institutions than in any other setting in the world. And the risk of death or otherwise severe outcome faced by incarcerated people is far greater than in the general population.

It is in this context that refusals earlier this year by the Centers for Disease Control and Prevention (CDC) and nearly all state public health departments to prioritize incarcerated people for initial vaccination stood in blatant contradiction with basic bioethical and epidemiological principles. These were not innocuous bureaucratic decisions. No one can say how many people have died or been permanently disabled as a consequence, but it is certain to have been a large number.

Now, a year after the CDC issued guidelines that deliberately excluded incarcerated people from protection while granting priority vaccine access only to their guards, US officials are again recycling the same public health illogic in relation to vaccine boosters, which the Biden administration hopes will ward off an Omicron-related crush of hospitalizations and death. There is no plausible justification for this irrationality, which is rooted in a lack of political courage to assert that the lives of incarcerated people matter.

Against this backdrop, the Prison Policy Initiative has published a new report showing that more than forty states have no public plans to make boosters available to incarcerated people. And only twenty-two states are publicly reporting their vaccination rates among incarcerated populations — who, it should be noted, have understandable reason to distrust US prison authorities, notorious as they are for abusive practices.

Only fifteen states have reported vaccination data for guards, who have refused the vaccine at high rates despite the deadly risk this imposes on the people whose safety they are tasked with ensuring. Meanwhile, as states have chosen not to fulfill their legal obligations to ensure safety in jails and prisons, the CDC has failed to show either ethical or pragmatic leadership on this issue. As a result, extraordinarily few incarcerated individuals or their guards have received a COVID-19 vaccine booster.

It is now essential that the CDC and US Department of Justice, as well as governors and state departments of corrections, correct course and move to ensure the highest possible vaccination rates in jails and prisons and to make boosters available to every single incarcerated individual in America. In addition to physically delivering vaccines to these facilities, federal and state authorities’ power to do this includes implementing vaccine and booster requirements for all carceral staff and providing emergency, community-led educational sessions to address any lingering vaccine distrust among incarcerated people.

Furthermore, when international evidence has made it clear that vaccination alone is not sufficient to protect against dangerous Omicron outbreaks in group settings, officials must finally implement what has been the consensus policy recommendation from public health and safety experts for over a year: large-scale, safe decarceration measures.

The data make very clear that there is no plausible public safety reason for the continued incarceration of at least hundreds of thousands of people who remain stuck behind bars, despite the risk this poses to them and to the general public. Hundreds of thousands of people should be released immediately and supplied with housing and health care support — including Medicaid coverage — to facilitate their safe and successful reentry into communities. If US officials fail to take these necessary steps to stop outbreaks in carceral institutions, they will be flagrant disregarding incarcerated peoples’ constitutional rights to safe conditions.

But a refusal at this critical juncture to protect one of the most vulnerable groups among us is not only an ethical and legal travesty — it’s also a recipe for nationwide public health disaster.

Unmitigated outbreaks in jails and prisons transform these institutions — as we’ve seen with prior waves of coronavirus infections — into epidemic engines that spread sickness and death throughout American communities. Millions of cases and tens of thousands of COVID-19 deaths across the United States have been driven by COVID-19 outbreaks in jails and prisons that spread into surrounding communities via the movement of more than 405,000 guards and 30,000 people released each day.

Now, after two plague years and approximately 20 million deaths worldwide, it should be clear: the virus does not respect prison walls, nor any other tools of racial or economic segregation. In this context, policymakers are multiplying harm for everyone by insisting on a cruel “tough on crime” framework that separates between citizens supposedly “worthy” of care and others — usually poor people and people of color — it condemns to death-making warehouses of neglect.

Until federal, state, and local governments implement sensible policies to secure the safety of the 2 million people currently locked inside US jails and prisons, there will be no genuine possibility of effective public health in America. This was true before the pandemic, is exceptionally clear during it, and will remain the case long after COVID-19 has faded from the news. The public in public health, after all, does not include just the people our unequal society most values; it must also include — indeed, prioritize — those who it has most devalued. Their neglect ultimately boomerangs back to harm everyone.