Cruel and unusual

No matter how you feel about incarceration, it's a dangerous business. Inmates have high rates of serious transmissible diseases which aren't turned into the warden when they are released. Around 2.5 million people are held in American correctional facilities. HIV rates for imprisoned men 1.6% and for women is 2.4% (compared to about 0.4% among Americans as a whole). About 4.5% of inmates reported sexual victimization. Of the facilities that provide hepatitis B vaccination, 65% target "high risk" groups only. Tuberculosis rates are also very high. This is just a sampling of the horrifying health conditions in jails and prisons.  

Prisons are a set up for the transmission of infectious diseases, and when prisoners are released, they return these infections to the public at large.  This is one of the many reasons to pay better attention to health care in prisons.  

There has been a recent brouhaha about some corrections facilities receiving swine flu vaccines before "the public".  Swine flu vaccines are being distributed based on risk and need.  Prisons are a high risk environment.  If influenza sweeps through a prison, not only will there be human suffering, but imagine trying to care for a facility full of sick convicts.  The potential for chaos in an already dangerous environment is sobering.

What this really betrays is our own prejudices.  First, it may seem like flu vaccination is a zero sum game---supplies are limited to an extent, and we must prioritize, but vaccinating one population does not automatically put another at risk. Second, we aren't talking about giving free HBO to convicts, but protecting a vulnerable population from a dangerous infectious disease.  When we incarcerate people we are responsible for their care.  We may not want to keep them comfortable and happy, but we must make every effort to keep them alive and healthy.  The outcry over this is frankly disgusting.  

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The other, pragmatic, reason for quickly vaccinating the prison population is to keep down the overall cost of prisoner health care. Vaccines for the entire population in most jails cost less than treating one case of flu induced pneumonia requiring a ventilator.

JSM, the same math applies to all populations.

Pragmatic and humane, but would never fly.

Though weighing the choice between the prisoner and the equally at risk non-prisoner, I'd vaccinate the non-prisoner, since they've shown they're much more valuable alive than the non-prisoner.

By Katharine (not verified) on 04 Nov 2009 #permalink

The "wonderful" thing about prison medical care is that it is readily available to anyone. Jealous of the great care prisoners are getting? Just go out and commit a crime or even just confess to an unsolved crime and it can be yours. For free no less. Any takers? I thought not.

My cousin spent 4 years in jail for drug-related crimes. He was a good kid who ended up doing some bad things over the years (non-violent, mostly theft) to support an addiction. He's sober now and trying to get back into life. I believe the system was fair to send him there, but I do not believe his life is worth less just because he was in prison. We're supposed to be a better society than that, aren't we? Not everyone in jail is Hannibal Lecter, mostly they're just people who made poor decisions or got mixed up in a bad life.

Yes, I believe there are horrible people who deserve severe punishment for their crimes. That's what our justice system is supposed to do. But prisons touch everyone's life--no one is immune. Aside from those who are released, as PalMD says, into your (or my) community, there are the people who work there, and take the bus/train right next to you. Or you may find yourself learning firsthand what it's like to experience incarceration, like I did through my cousin. So there is a pragmatic reason to inoculate, even if not all can find it in their conscience to grant prisoners humanity.

Crowded prisons make it so easy for diseases to spread. Vaccinating prisoners helps everyone. Even for those who thinks prisoners' lives are worthless, it's still in their best interest to have prisoners vaccinated. I'm always amazed that some people would prefer that they and the rest of the population be put at higher risk, simply to ensure that some bad people get the punishment they deserve.

I'm happy to vaccinate prisoners. In this particular case, I'm hesitant to vaccinate prisoners before babies and daycare workers.
Scientifically, I don't understand why "aging prisoners" are the most vulnerable population (though I can intuitively grasp why HIV positive prisoners need it).
It's not a zero-sum game, but I'm not sure the priority order is wise.

"Crowded prisons make it so easy for diseases to spread. Vaccinating prisoners helps everyone. "
Actually, it's kinda cruel and if the vaccine were in surplus I'd never advocate doing this instead of vaccinating prisoners, but it has been pointed out we can keep the flu from spreading from the prisoners to the general population, for the most part, if we simply vaccinate the staff and anyone who needs to be in contact with them and then keep them in isolation.

I doubt vaccinating the staff will be sufficient because prisoners arrive and leave all the time, not to mention visits by lawyers and family.

If we say, "heck with it, let them get sick" then inevitably if an influenza pandemic breaks out in the prison some prisoners will become sick enough to need admission to the hospital and the ICU. Are we to deny them that as well? Or overwhelm the local hospital and make ICU beds unavailable for others who might need them?

Criminal justice suffers the world over because a lot of people don't make rational decisions about punishment. They want retribution above all, regardless of whether it's ultimately good for their society.

On the other hand, not a whole lot of rational thought went into the execution of many of those criminal acts.

Should a prison outbreak ensue, the corrections/rehabilitation system would invariably be hit by a lawsuit (whether from inamte advocate groups orthe ACLU). The state would most likely settle with the inmates and their families. In the end, that hits the taxpayers. Remind your average Joe what the real result would be, and I'm sure they'd be in favor of immunizing the incarcerated.

Jails have a turn-around time ranging from a few hours (drunk tanks and holding) to 364 days. Prisons are generally sentences that extend longer than 1 year. But with people coming and in out, it can definitely be a hotbed of infection. I've seen this happen with norovirus outbreaks.

By Rogue Epidemiologist (not verified) on 05 Nov 2009 #permalink

I totally think its fair to put prisoners on the bottom of the list, afterall everyone in jail is not just guilty, but guilty of heinous crimes.

resident of fantasy land

johnnyv, why do you hate children?

Don't be silly joe. Children can get vaccinated. JohnV hates babies < 6 months.

true, i do hate babies.

an aside, MRSA is also more prevalent in prisons.

I haven't heard the out cry, so I can not confirm whether it is disgusting or not. I can say that at this point H1N1 vaccines are not readily available to children in high risk age groups or hospital workers. I have been calling around and the earliest I could get an appt for my (4 yo and 6 yo) kids through the county was January. I've talked to other mom's that seems to be the norm.

I talked to the therapist and receptionist who work at the Childrens' Hospital where my son receives his speech therapy and they have not been vaccinated because the hospital does not have vaccine available yet (they are doing it in small groups as they get vaccine in). This office provides SP and OT to out-patient and in-patient children.

So I don't know if the outcry is associated with a 45 year old healthy prisoner being given vaccines before a 3 year old child with respiratory disease or a NICU nurse or just that prisoners are receiving vaccines at all.

Note: Since the docs are saying that H1N1 hits kids harder than adults over 24, shouldn't juvenile facilities take precedent over adult prisons? Have they?

I understand that prisons are enclosed and susceptible to airborne illnesses, so are schools, daycare, hospitals and the later, all have the age group that seems highly susceptible to H1N1. I think the vaccine should be given according to highest risk groups and those most likely to pass the illness on to high risk groups (including prisoners, where ever they stand in the risk continuum.)

While it may be costly to the state and difficult to take care of prisoners during a flu outbreak I'm not sure that that should rank higher than the cost (to the parents or insurance company) of treating a child, or handling a school outbreak. While we have a moral obligation to take care of prisoners, I don't think that extends to taking care of them better than the rest of the high risk population.

And how about the homeless and mentally ill population? Do they have less rights to receive care because they are not in prison and they are not advocated for?

Really, from an my perspective the public health aspects of this vaccine release seem really poorly managed. I know it must be a huge task for the CDC, but I hope that they figure out a better system for distribution to their high risk groups or at least communicate the distribution time line realistically.

By micheleinmichigan (not verified) on 08 Nov 2009 #permalink