People in prisons are at an increased risk of COVID-19 -
with a death rate over three times higher than that of the
general population - and should be made a vaccine priority,
according to a team of UCL researchers.
In an article published today in The Lancet Respiratory
Medicine, the research team reveals that there were
121 deaths related to COVID-19 among people in
prisons in England and Wales between March 2020 and February
2021, representing a risk of dying 3.3 times higher than that of
people of the same age and sex outside secure environments. This
is despite extensive physical distancing measures, including
prisons keeping many inmates in their cells for 23 hours a
day.
As well as deaths, cases of the virus are significantly
higher in prisons; during the first wave of the pandemic, there
were 7.6 confirmed COVID-19 cases per 1,000 people in prisons in
England and Wales compared with 4.9 per 1,000 in the general
population. Furthermore, the research team report that 85% of
Prison or Youth Custody Service sites reported cases in January
2021 alone, between them totalling over 4,000 new cases. Some of
these outbreaks have involved hundreds of cases, with local areas
containing prisons often having the highest overall rates of
COVID-19 in England.
Lead author of the study, Dr Isobel Braithwaite (UCL
Institute of Health Informatics), said: “Our findings show that
people in prisons are at a much higher risk of dying from
COVID-19 than the general population, and we make the case that
both they and prison staff should be given high priority in the
rollout of vaccines. This has recently been agreed for people
experiencing homelessness, who face similarly high risks.
“We believe the current methods of regime restriction are
not enough to protect people adequately, and a systematic,
‘whole-prison’ approach to vaccination is key to preventing
further outbreaks and reducing overall deaths in
prisons.”
The researchers highlight that institutional settings like
prisons are high-risk environments for infectious disease
outbreaks, as they’re typically overcrowded with inconsistent
access to washing and toilet facilities. In addition to the
higher risk of transmission, the team emphasises that people in
prison often have underlying health problems or other risk
factors that increase the likelihood of severe disease. Whilst
research is limited, the authors note that several
studies have found that hypertension and asthma are common
amongst prisoners, with many having a history of smoking tobacco,
increasing risks from COVID-19 through multiple pathways.
As well as the prisoners themselves, prison staff have also
been impacted by the COVID-19; the researchers highlight that The
Prison Officers’ Association recently revealed that there were 20
deaths among staff up to mid-January 2021, and 4,800 staff absent
at that time - over 10% of the prison workforce.
Currently, people in prisons are being offered COVID-19
vaccines in line with the general UK prioritisation criteria,
based on age and presence of long-term conditions. However, the
team says that identifying eligible people in prisons can be
difficult due to a lack of previous health information and
limited interaction with health services - both during and before
prison. Many people in prisons are therefore considered low
priority by default, despite their much higher risk of death to
date in the pandemic.
A recent survey by the peer support organisation Empowering
People: Inspiring Change (EP:IC) found that four out of five
people in prison said they would accept a vaccine if offered it;
a number of the respondents also commented that they thought
prisoners and staff should be vaccinated at the same time.
Dr Jake Hard, co-author and Chair of the Royal College of
GPs’ Secure Environments Group said: “At the moment, vaccinating
the small numbers of people in any specific risk group in a
single prison risks leftover doses and possible wastage of
vaccine - and isn’t happening fast enough to protect either
people in prison or prison staff. We believe that simultaneous
vaccination of whole prison populations - including staff - is
vital and could help alleviate mistrust, increase uptake and
speed up recovery. A change of approach is urgently needed to
help prevent further outbreaks in prisons and to ensure that the
unacceptable higher rate of death we found in our study doesn’t
continue.”
Notes to Editors
Braithwaite I., Edge C. Lewer D, Hard, J., High COVID-19
death rates in prisons in England and Wales, and the need for
early vaccination will be published in Lancet
Respiratory Medicine on Tuesday 16 March 2021, 23.30 UK
time/ 18.30 US time and is under a strict embargo until this
time. It will be available at http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00137-5/fulltext
