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Prisons are covid hot spots. But few countries are prioritizing vaccines for inmates.

Medical workers prepare to conduct coronavirus tests of inmates at Dongbu Detention Center in Seoul on Jan. 5. (Yonhap/EPA-EFE/REX/Shutterstock)

When Israel began to vaccinate its citizens against the coronavirus in December, the Ministry of Health set aside doses for incarcerated people 60 and above, in line with its national guidelines prioritizing the age group.

They are still sitting in freezers. The minister in charge of Israel’s prison services is refusing to allocate coronavirus vaccines to inmates, said epidemiologist Hagai Levine, who was a member of the country’s coronavirus task force before resigning last week to run in an upcoming election after he voiced concerns with the government’s pandemic response.

The situation in Israel, while stark, mirrors a tendency around the world. Prisoners, given the challenges to social distancing and compounding health disparities, are especially at risk of contracting and transmitting the coronavirus. But many countries have not prioritized their inoculation or have stoked controversy in doing so.

In late December, Israeli Public Security Minister Amir Ohana first announced that he would not vaccinate inmates before prison guards. In subsequent statements, Ohana doubled down and added that “security prisoners” — a category that currently includes only Palestinians — would not be vaccinated until after Israel’s general population. Deputy Attorney General Amit Marari pushed back, telling Ohana he did not have the power to override the Health Ministry’s directive and decide who deserved a dose.

Israel is starting to vaccinate, but Palestinians may have to wait months

The impasse has escalated to Israel’s Supreme Court, after five human rights organizations Sunday filed a petition to challenge Ohana. “Prisoners are an at-risk population and action must be taken to vaccinate them in parallel with the at-risk populations at large,” the petitioners wrote. Israel’s health minister said Thursday that prisoners would be vaccinated starting next week, but it still remains unclear if they will or not.

Around the world, prisons have proved pandemic hot spots. Although strategies differ, governments have sought in general to prioritize doses for those most vulnerable to both infection and transmission. That’s a category, public health experts told The Washington Post, that should include incarcerated people.

“Whatever your politics are, it’s just science here,” said Ashish Prashar, an advocate for prison reform in Britain and the United States. “If you don’t vaccinate inside prisons, you’re never going to stop outbreaks outside of prisons.”

At a minimum, public health professionals have called for prisoners to be vaccinated in tandem with their age groups on the outside. But because of their living conditions and high rates of comorbidities, among other vulnerabilities, inmates are often at especially high risk.

“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,” Seena Fazel, a University of Oxford psychiatrist, told the Lancet medical journal last month.

Fazel was part of a team of researchers who conducted a systematic review of prisons and the transmission of contagious diseases, concluding these environments posed several layers of risks.

“The idea that people are behind the wall and you can forget about them doesn’t really apply, actually,” he told The Post.

In many countries, including the United States and Britain, prisoners disproportionately come from minority or marginalized communities already at higher risk for comorbidities such as diabetes, hypertension and heart disease, which are linked to serious risk from covid-19, said Fazel. These underlying health concerns coupled with prison conditions and stress can mean that inmates, from a medical perspective, can be "about 10 years older than their chronological age would suggest,” he said.

Inmates restricted to enclosed and crowded cells or dormitories have limited recourse for social distancing or other anti-virus measures. even when authorities take preventive steps. Outbreaks inside prisons frequently find their way into the general public because of the high turnover of residents, as well as the movement in and out of guards and visitors, said Fazel.

Neither the World Health Organization nor the European Union have specific guidelines for when prison populations should be vaccinated, a decision they said should be determined by member nations.

Early vaccination in prisons, a public health priority, proves politically charged

In the United States, which has the highest incarceration rate in the world, one in five prisoners have had covid-19, according to the Marshal Project. While vaccination priorities and distribution are set by each state, groups like the American Medical Association have lobbied for inmates to be included in initial rollouts, along with essential workers in the criminal justice sector. The federal prison system will inoculate prison employees first.

About a dozen states, including Maryland, Massachusetts and New Jersey, have prioritized inmates in the first phases of inoculation. But in some places, the issue is politically charge: After public backlash, Colorado backtracked on proposed plans to vaccinate incarcerated people ahead of the elderly living outside of congregate facilities.

South Korea, which saw a major prison outbreak beginning in December, has put in place strict new distancing measures for prisoners, but has yet to begin mass vaccination, inside prisons or out. This week the Korea Disease Control and Prevention Agency announced that inmates and adults aged 50 to 64 could be among the first groups to be inoculated when the program begins.

Many other countries, including China and Russia, have not publicized any plans for targeted vaccinations in prisons. Neither have most European countries, including France and Germany, although Switzerland’s Zurich region said it would inoculate residents of institutions after the elderly, alongside health care workers, before the rest of the population. The British Joint Committee on Vaccination and Immunization did not single out people in prison in its allocation plans, though Fazel said he expected that those in prison who qualified in the first round based on age or health conditions would receive one. The British Prison Service referred questions to the National Health Services, which did not immediately respond to a request for comment.

Canada, in contrast, started vaccinating older and medically vulnerable federal inmates in the first phase of its vaccine program, launched this month. James Worthington, the national medical adviser for Correctional Service Canada, said around 600 people 70 years old and above would be offered the Moderna vaccine, in keeping with national guidelines.

News of the plan drew the ire of some.

Erin O’Toole, the Canadian opposition leader and head of the country’s conservative party, took to Twitter to criticize the plans. “Not one criminal should be vaccinated ahead of any vulnerable Canadian or front line health worker,” he wrote.

Mark Gerretsen, a Parliament member from the Liberal Party, responded to the tweet, writing: “Here’s a thought. How about we let health professionals decide who gets a vaccine and when.”

Anita Ho, associate professor in bioethics and public health ethics at the University of British Columbia and University of California at San Francisco, said Canada had a good start but should consider expanding prison vaccine access given the level of other risks inmates face. Canada’s Indigenous populations, she cited as one example, are disproportionately represented in prisons and statistically have more medical issues.

“Covid-19 doesn’t discriminate, but there is a concern that our criminal justice system, our social system and our health system might discriminate,” she said.

Ho urged prisons to conduct campaigns to educate prisoners about the vaccine and encourage them to take it. “There is so little trust among inmates in terms of what we are doing to them,” she said.