Experts call to include prisons in COVID-19 vaccine plans
Authors: Nayanah Siva
Journal: The Lancet (2020)

As some countries begin vaccination, experts are questioning the allocation and prioritisation lists. Nayanah Siva reports. The UK, the USA, and most of Europe are poised to start national vaccination programmes for COVID-19, but experts are concerned about the notable absence of prison populations in existing planning and guidance.The UK's Joint Committee on Vaccination and Immunisation have said that the first priority for vaccines will be to prevent deaths and protect health and social care staff and systems, with no specific mention of prisons. The US Centers for Disease Control and Prevention have not as yet made any decisions about prisoners, but experts have suggested that prison staff might be included in the second phase of vaccine allocation. In the UK, although the absolute numbers of cases in prisons is lower than initially projected, age-adjusted rates are substantially higher than those in the general population. In prisoners older than 60 years, the infection rate in September, 2020, was 15·5 per 1000 people, double that of the general population. “People think of imprisoned people as young and therefore at low risk from [COVID-19]”, said Emma Plugge, Associate Professor of Public Health at the University of Southampton, Southampton, UK. In the USA, the rates of COVID-19 in some prisons have become alarming. “According to the COVID Prison Project, by August, 2020, 90 of the largest 100 cluster outbreaks in the United States occurred in prisons and jails”, said Emily Wang, director of the SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA. “Correctional facilities are hotbeds for the pandemic”, she added. “From my perspective, and the information we have, we need to consider where prisoners fit in terms of their risk in relation to other high-risk groups. On the face of it, prisoners would be high-risk for a few reasons”, said Seena Fazel, Department of Psychiatry, University of Oxford, Oxford, UK. Fazel said that allocating a limited number of vaccines is a difficult balancing act, but he certainly thinks that prisoners are at high risk because of underlying chronic conditions, age, and their environment. A systematic review by his team found that prisons are high-risk settings for the transmission of contagious disease, with considerable challenges in managing outbreaks in this setting. “Our research suggests that people in prison should be among the first groups to receive any COVID-19 vaccine to protect against infection and to prevent further spread of the disease”, Fazel said. The significant movement of many people also increases risk. The Marshall Project and The New York Times found that in a given week more than 200 000 people are booked into jails across the USA, and the same number leave each week. “Prisons have high churn rates, with lots of people coming in and out of prison”, said Fazel. “People go to court, go back to their prison, and often people get moved to another prison once they have been sentenced. If a prison has filled up, prisoners may have to move again. This is an important group to consider in vaccine prioritisation as there's a lot of movement.” Wang explained that outbreaks in correctional facilities have affected correctional staff and the wider community, not just incarcerated people. “A recent paper reported that close to 16% of all COVID-19 cases in Chicago and in the state of Illinois early in the epidemic were associated with population cycling through the Cook County Jail.” The subject has become a contentious and political issue, particularly in the USA, with experts worrying that prisoners will be excluded from vaccination plans all together. Last week, Colorado Governor Jared Polis said, “there's no way [the COVID-19 vaccine] is going to go to prisoners before it goes to the people who haven’t committed any crime. That's obvious”. The American Medical Association (AMA), however, says that incarcerated people and staff at detention centres should be considered in initial phases of vaccine allocation. “Being incarcerated or detained should not be synonymous with being left totally vulnerable to COVID-19. These steps are vital to protect people and stop the spread of the virus”, said AMA board member Ilse Levin in a press release. Arthur Caplan, Professor of Bioethics at New York University Grossman School of Medicine, New York, NY, USA, thinks that from a human rights perspective it is essential that prisoners should not be left out, and he does not agree with vaccinating only prison staff. “If they’re at risk and they’re older or sicker, they should just get vaccinated. If they’re in conditions that don’t allow them to isolate, they should get vaccinated. I see no reason to distinguish.” For the systematic review on contagious disease in prisons see BMJ Global Health 2020; 5: e003201 For the systematic review on contagious disease in prisons see BMJ Global Health 2020; 5: e003201 Improving prisoner health for stronger public healthCOVID-19 vaccine policy for prisoners has been in the headlines across the USA and the UK. Discordant strategies exist, ranging from no vaccination, to vaccination equivalent to people in the community, to higher prioritisation for people in prison. Prisons are dangerous hotspots for acquiring SARS-CoV-2, and individuals who return to the community could unwittingly transmit the virus. In the USA alone, 372 583 prisoners have had COVID-19, with 2359 deaths, according to the Marshall Project. The COVID-19 pandemic has highlighted the need to address racial and social inequalities globally, but the same lens is often not applied to prison-related policies. Full-Text PDF