***Update***
Prisons have been included among residential facilities in previous communications from the Health Protection Surveillance Centre so prison staff and older prisoners will likely be among the early groups to receive vaccinations. Augmenting our argument on the need to prioritise all those who live and work in prisons, Fíona Ní Chinnéide, from the Irish Penal Reform Trust helpfully suggests that, based on accelerated ageing within prison, there are clear arguments to support extending vaccinations to men and women aged over-50 in prison (not only the over-65s) in Allocation 1 not Allocation 8.
Allocating Vaccines
With the advent of multiple Covid-19 vaccinations, hope is emergent for many as this annus horribilis draws to a close. With an initial limited supply in Ireland, public health and political decisions are currently being made to answer a simple question: Who should receive a Covid-19 vaccination?
As a means of making its current thinking clear, the National Immunisation Advisory Committee and the Government published a provisional list for vaccine allocation groups with residents of long-term care facilities, frontline healthcare workers, and people aged over 70 having priority. Aware of the level of isolation experienced by these groups during the year as they cocooned from family members and friends, few would disagree with this. The finalised Vaccination Strategy and Implementation Plan released on Tuesday 15th December, contains no mention at all of prisoners or prison staff.
Prisons contain many people who satisfy the criteria of these upper allocative tiers: people aged 70 and above; people aged 18-64 with certain medical conditions; and people living in crowded settings. However, when healthcare resources such as vaccinations are limited, the suggestions that prisoners should receive this treatment before the general population is met with outrage.
It is important to ask why a request to vaccinate prisoners in the early stages of the programme is met with vehemence and opposition. The force of emotion expressed reflects something of our punitive instinct around justice and this particular instance exposes how in the end, that desire is self-destructive.
Heroic Solidarity
The pandemic has affected everyone. Social distancing and lockdowns have affected us in a range of ways from mild inconvenience to general upheaval and, in many cases, genuine suffering. We could all make a case for having suffered in some manner—socially, mentally, professionally, or financially— in the last nine months. As an act of sacrificial solidarity, we limited our freedoms to ensure the safety of others, many with whom we had no connection. Our lockdown meant “heroic solidarity.”
This type of “heroic solidarity” which was asked of us and praised by our political leaders had an initial binding effect for the general population. We were strangely united by our collective loss of freedom and the individual sacrifices we would make. However, when a sacrifice is made, an easy moralism can quickly follow unchecked. We saw evidence of this happen when the collective fragmented as certain cohorts, such as young people, were quickly targeted for blame for rising case numbers.
This moralistic instinct is on display when we discuss vaccines for prisoners. They have been found guilty of a crime after all! (Let us leave aside the important fact that many haven’t, as they are on remand, often for minor offences). These people, we think, deserve to be last. The reaction betrays no strain of mercy, but plenty of revenge. If we take this as our starting point for ethical judgements, we will never get around to justice. We will be held captive in a cell of our own making, hemmed in by self-referential moral judgements.
The Irish Prison Service’s Infection Control team has avoided that trap. Noting the confined nature of prisons and the high rate of prisoners with immunosuppressive diseases, it has requested that prisoners should receive vaccinations in advance of the general population. Irish prison staff are expected to receive vaccination as a priority because they are classified as front-line workers. Similar debates are beginning to occur in the US, where the rate of infections and deaths in prison and jails far exceeds Europe, though little consideration is being given beyond correctional officers.
The number of prisoners who have tested positive for Covid-19 in Ireland has remained small, a total of 22, but numbers often do not reveal the human cost involved. Harsh infection protocols were implemented which included quarantine on admission, a ban on visits, and cocooning for older prisoners. Prisoners are part of the unified effort. How they have joined in our heroic solidarity is a story waiting to be told. Others have compared the experience of prisoners through the pandemic with cocooning, a phenomenon we know has huge personal cost.
Looking at the use of solitary confinement in October, 327 people were spending more than 22 hours in their cell. In January, only 75 prisoners were in solitary confinement but numbers have increased each quarter since then. Despite numbers quadrupling in only nine months, it is impossible to discern the number in solitary confinement for medical reasons such as quarantine and those for non-medical reasons.
Collective Health and Wellbeing
People may not be easily convinced of our moral responsibility to our prisoners but, as the majority of us are now aspiring epidemiologists and public health experts, I want to outline why we should at least forsake a weakened moral imagination and commit to vaccination programmes extended to all who live and work in prisons.
The risk of acquiring communicable diseases during a prison sentence exceeds that of the general population. Prison life has a rotational dynamic, with a high turnover of people in often overcrowded settings. Staff enter and exit daily to carry out their duties. Prisoners are admitted and released daily, particularly with remand prisons. In the past, this shared environment has demonstrated its potential to act as a “reservoir” for outbreaks of respiratory diseases such as TB and seasonal influenza. An easily transmittable virus is likely to utilise this environmental niche to seed within the prison and from there to the wider community. As the Director of the Yale Institute for Global Health has put it, any plan which is not laser-focused on mitigating the risk of infection is immoral. It follows that a failure to vaccinate everyone in the prison system is immoral. The virus will not respect the prison walls. It will spill out from there and threaten the families of prison staff and eventually threaten you.
It is not just unmerciful, or unjust, it is self-defeating to oppose the early vaccination of the entire prison population.
A vaccination programme provides an opportunity for prison life to return to a normalcy, where prisoners can receive family visits, attend education and training opportunities, and not be restricted to a cell for over 22 hours in a day. Rehabilitation will be back on the agenda. The severity of Covid-19 will likely pass but some of the effects of deteriorating physical and mental health reported by prisoners will endure as a result of long hours in cells (reports of up to 30 hours with no out-of-cell time), no social connection, feelings of deeper alienation, or the activities of a meaningful existence will linger. The reality is that in order to prevent prisons becoming incubators of disease, we exerted an even greater toll on the minds, bodies, and welfare of our prisoners. To overcome this threat, we have seeded significant future problems.
There is strong opposition to vaccinating prisoners early. But this is a punitive impulse which does not understand what we intend prisons to do. Our places of detention are not there to punish. The sentence itself is the punishment. The prison is designed and operated to carry that sentence out safely while providing hope for rehabilitation. Our collective public health is best served by vaccinating prisoners, and our collective wellbeing is best served by helping the rehabilitation of prisoners. Lots of people posture that they do not care about prisoners. Fine. But if those same people care about prison officers and nurses and chaplains and if they care about themselves, then it becomes straightforward: prisoners should be vaccinated as soon as possible.
