As of April 2022, over 6 million deaths from COVID-19 globally have been reported to the World Health Organization. Global data on COVID-19 infections and mortality in prisons was only collected until mid-2021. The impact, therefore, of new waves and variants on people in prison and staff working in detention facilities remains unclear, although national statistics suggest that it varies widely.
New waves of COVID-19 have led to fresh outbreaks in prisons with levels of infection similar or worse than the first wave of the pandemic in some places.
In a number of countries, new variants of COVID-19 and the loosening of restrictions have seen high levels of new infections among detainees and staff in prisons. New outbreaks in prisons have been reported in prisons in Bahrain, Canada, Ireland, Iran, and New Zealand, for instance, with new infections in some cases reaching peaks like those seen at the start of the pandemic in 2020. In Italy, over 1,000 detainees and prison staff tested positive for COVID-19 in January 2022.
Pandemic-related restrictions and impact on resources have sometimes limited healthcare to emergency services.
Data available shows that people in prison are more likely to die from COVID-19 than people in the community. In the US, the COVID-19 death rate in prisons is almost three times higher than that of the general population. Taking into account deaths resulting from COVID-19, in Florida, the overall lifespan of people in state prisons has been reduced by four years. In the UK, there has been a 40% increase in the number of deaths in prisons in the 12 months to September 2021, with most of these being attributed to COVID-19.
Analysis of Europe shows that, in many countries, COVID-19 infection rates in prison appear to have mirrored those in the community. Where infection rates were high in the community, they were also likely to be high in prisons, such as in Slovenia, Estonia, and Belgium. However, these figures can veil the reality that cases might be under-reported, as prisons often do not have the capacity and resources to collect such data systematically. In addition, where infection rates in prison had been kept low, this was often through strict infection prevention and control measures, including punitive and prolonged restrictions, at a huge cost to people’s mental and physical well-being.
As of 30 September 2021, available figures indicate that vaccination of people in prison had commenced in 120 countries, but priority afforded to detained persons in vaccination plans globally was low.
While the focus of infection prevention and control measures to mitigate the impact of COVID-19 has shifted from testing and isolation to vaccinations, many countries have low rates of vaccinations due to the inequality of supply. As of March 2022, 11 billion doses have been administered globally, but only around 14.4% of people in low-income countries have received at least one dose. An in-depth study of vaccinations in prisons by PRI and Harm Reduction International (HRI) published in December 2021 concluded that the inclusion of people detained and working in prison as an at-risk or priority group in national vaccination plans has been contentious, leading to piecemeal and often insufficient implementation. Out of the 131 countries for which vaccination plans or other resources could be found, only 56 explicitly mention people in prison (43% of total). Prison staff are clearly, explicitly mentioned in 66 vaccination plans. As regards the roll-out of vaccinations in practice, as of 30 September 2021, available figures indicate that vaccination of people in prison had commenced in 120 countries.
Even where vaccinations were readily available for prison populations, vaccination rates were sometimes lower than hoped due to a high level of vaccine hesitancy. This has been explained by wide-spread scepticism regarding prison medical systems and a lack of trust in prison authorities in some countries, as well as a lack of quality targeted evidence-based information on the COVID-19 vaccination. In some cases, such low vaccination rates were linked to new outbreaks, for example, in New South Wales, Australia, where the virus spread rapidly among those who had not yet been offered vaccination. Therefore, education initiatives to address questions and concerns about the COVID-19 vaccination have been crucial in many countries to increase vaccination rates among people in prison, such as in Ireland.
There has also been a widespread lack of clarity and transparency regarding planned and implemented vaccinations in prisons. Official government policies or other resources outlining national vaccination plans could only be obtained for 131 out of 177 countries surveyed (74%). Official information was particularly scant for African countries: out of 54 countries included in the analysis, official COVID-19 vaccination plans were only found for 34 countries (62%) and it could not be confirmed whether vaccination of detainees and prison staff had started in 27 and 31 countries, respectively.
A grave indicator of the under-resourcing of prison health is the shortages of healthcare staff reported widely. For example, in Spain there are 200 vacancies for prison healthcare staff; in Pakistan, out of the 193 posts of medical officers in jail, 108 have been reported vacant and shortages are also reported in Armenia. In Finland, despite a transfer of prison health to the Ministry of Social Affairs and Health, there is a lack of specialists in prisons, placing an increased burden on prison nurses. In many countries, the situation is equally if not more dire with regard to mental healthcare staff. In Romania, only 6 out of 38 penitentiary units employ psychiatrists.
Positively, there have been cases in some countries where the number of healthcare staff has been increased directly in response to the pandemic, including in Japan and Romania (by about 50 staff). There has been a more significant increase in Canada where there are now over 500 additional healthcare staff compared to February 2020, including 340 employed on a temporary basis in response to the pandemic. In Serbia, the prison administration is funding six medical specialisation programmes for young doctors as an incentive to join the prison service.
A recent global study on the impact of the pandemic on prison health by the Thailand Institute of Justice found that not all countries have been able to provide timely diagnosis and medical attention for non-COVID-19 conditions. Due to restrictions in many countries, coupled with the substantial resources directed to pandemic response, healthcare services for people in prison have had periods where they were limited to emergency services, sometimes for months. There are reports from Bulgaria, Iran, Sri Lanka, Turkey and elsewhere, that people in prison with chronic health conditions were unable to access treatment or to be transferred to hospitals. External medical appointments including for physiotherapy, optical and dental care have been suspended for various periods in the UK and South Africa.
COVID-19-related measures in prisons have impacted the delivery of drug use-related interventions in some prisons, including group activities, interventions provided by external service-providers and pre-release support. While in Georgia, Estonia and Bosnia and Herzegovina, opioid agonist therapy continued to be provided to people in prison on a regular basis, in other places, like Lebanon, there were difficulties reported in implementing medical care and other support for people who use drugs. In Kenya, the large number of people released from prison in response to the pandemic – while positive in reducing prison overcrowding – reportedly curtailed access to critical drug treatment. Between March and June 2020, 15 European Union countries with available data reported severe disruptions to drug use services in prisons, including psychosocial counselling, group therapy and peer-led interventions, which continued to some extent throughout 2020. In a few countries, such as France and Luxembourg, drug use services were scaled up again as of June 2020.
Other infectious diseases including tuberculosis (TB), HIV and hepatitis C remain a major challenge in many prisons around the world and new data shows cases are on the increase in prisons. In Central and South America, a study published in 2021 found that TB cases among people in prison have increased by 269% between 2000 and 2018. TB prevalence is concentrated among people in prison, with 11% of all TB cases occurring among people in prison. Outbreaks of TB have been reported over the past year in Brazil’s prisons as well as Venezuela.
Since 2017, the estimated prevalence of HIV among people in prison has increased from 3.8% to 4.3%, meaning that people in prison are six times more likely to be living with HIV than the general population. There have been recent reports about HIV outbreaks in prison in India and a hepatitis C outbreak at a jail in Karachi, Pakistan.
The disproportionate burden of HIV and hepatitis C in prisons remains linked to insufficient access to comprehensive harm reduction services in prisons, among other factors. The number of countries providing HIV services has not significantly increased in recent years and, where they are available, coverage of and access to these essential services remain inadequate. For example, the number of countries providing condoms and lubricants in at least one prison increased from 40 in 2017 to 45 in 2020; those with needle and syringe programmes increased from 8 to 10; and those providing opioid agonist therapy increased from 52 to 59. Out of the 124 countries with national viral hepatitis testing and treatment plans, only 28 (23%) have such interventions for people in prison. Women in prison continue to be even more likely to be living with HIV than men in prison. The latest data from UNAIDS shows that through 2020, the average HIV prevalence among women in prison was 5.2% (n=63 countries) and 2.9% (n=74 countries) among men.