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Prisoners should be made priority group for COVID vaccine

People in prison are at an increased risk of COVID-19 and should be made a vaccine priority, research by UCL has urged.

The research 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.

Lead author Dr Isobel Braithwaite, of the 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,” Dr Braithwaite added.

The risks to prisoners are despite extensive physical distancing measures, including prisons keeping many inmates in their cells for 23 hours a day.

Cases of the virus are also 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. There were 4,000 new cases in January 2021 alone following reports from 85% of Prison or Youth Custody Service sites.

Institutional settings like prisons are high-risk environments for infectious disease outbreaks, the research warns, due to the following reasons:

- They are typically overcrowded.

- There are inconsistent access to washing and toilet facilities.

- People in prison often have underlying health problems or other risk factors that increase the likelihood of severe disease.

- 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.

Prison staff have also been impacted by the COVID-19 as The Prison Officers’ Association recently revealed that there were 20 deaths among staff up to mid-January 2021, and there were 4,800 staff absent at that time - over 10% of the prison workforce.

People in prisons are currently being offered COVID-19 vaccines in line with the general UK prioritisation criteria, based on age and presence of long-term conditions. However, the researchers say 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.

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.”

The Lancet Respiratory Medicine full article:

High COVID-19 death rates in prisons in England and Wales, and the need for early vaccination

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