For Prisoners, Vaccine Trial Participation May Do More Harm Than Good

From nursing homes to workspaces, there is no doubt communities in confined spaces have been hit hard by the pandemic. Prisons, especially, have become hotspots for the virus, making incarcerated people vulnerable to contracting COVID-19. Amid some efforts to curb the virus in prisons, researchers are considering whether incarcerated people should be included in COVID-19 vaccine trials. 

In a new October article published by the New England Journal of Medicine, there were three main arguments for enrolling incarcerated people in vaccine trials: 

1. Vaccine trials would offer incarcerated people early access to a potentially effective vaccine.
2. It would give incarcerated people an opportunity to participate in medical research that is not offered to people in prison.
3. It could potentially shorten the amount of time needed to study and develop a successful vaccine.

Despite these arguments, the current state of COVID-19 care and testing in United States prisons would impact the ethics of a potential vaccine trial. Confined spaces, poor prison conditions, and lack of frequent and accurate testing hinder incarcerated people’s autonomy.

COVID-19 Care in Prisons

In mid-March 2020, the first case of COVID-19 was confirmed at Riker’s Island Correctional Facility in New York City. Within two weeks, more than 200 cases were confirmed in that one facility. In early April, hundreds of COVID-19 cases wreaked havoc in prisons and jails across the United States. By June 6, 2020, over 42,000 cases of COVID-19 and 510 deaths among 1,295,000 incarcerated individuals were recorded.

The rate of COVID-19 cases among the prison population was 5.5 times higher than the rest of the U.S. population.

“There’s a reason they are hotbeds of infection,” Wanda Bertram, communication strategist of Prison Policy Initiative, tells Verywell. “Most prison systems in the U.S. are overcrowded, meaning that they hold more people than they were designed to hold.” In U.S. prisons, there could be three people in a cell designed for two individuals. 

To practice social distancing, the Centers for Disease Control and Prevention (CDC) recommends people stay at least six feet apart. However, incarcerated people cannot physically distance themselves in their cells. “You have holding or common areas where people are sleeping, head to foot, right in bunks that are about three feet away from each other,” Bertram explains. “That doesn’t allow for a lot of social distancing.” 

In addition to social distancing, the CDC also recommends people wear a mask to reduce the spread of COVID-19 through respiratory droplets.

However, people in prisons may only have limited access to masks, Dave Rini, Esq, incarcerated survivor support program manager at the Boston Area Rape Crisis Center (BARCC), tells Verywell. “Most prisoners were getting a mask or two,” Rini says.

In the U.S., only half of all states required correctional staff to wear masks at work. Un-masked staff leaves incarcerated people vulnerable.

Basic cleaning supplies appear scant as well. In a report conducted by the Essie Justice Group, only 7% of survey respondents believed their loved ones had adequate access to basic necessities to prevent the spread of COVID-19 such as hand sanitizer, soap, and disinfectant.

Without adequate cleaning supplies, people in prison are not able to sanitize their hands or spaces and access basic services that require a phone such as advocacy, legal help, and phone calls with family. Rini, who serves on the Prison Rape Elimination Act (PREA) team at BARCC, supports incarcerated people who were sexually assaulted through their PREA hotline. During the pandemic, Rini has witnessed a decrease in calls. “Folks were afraid to touch the phones because they weren’t getting cleaned enough to know that they were safe,” Rini says. “We saw the number of folks who reached out to us go down pretty substantially.”

Testing For COVID-19

Some states are not properly testing or accurately reporting infections and deaths, according to the Prison Policy Initiative. Frequent and comprehensive testing offers a more transparent and clearer understanding of how the virus is spreading. Research suggests prisons are only conducting testing when incarcerated people are expressing visible or extreme symptoms. 

Tennessee and Alabama, which have similarly-sized prison systems, both reported four COVID-19 deaths in late June. According to Bertram, this can distort people’s perception of the kinds of testing that is being conducted.

“Tennessee was reporting about 700 or 800 infections for every death, and Alabama was reporting 10 infections for every death. It may look as though Tennessee is a much safer place than Alabama, but it is not. Tennessee is doing a ton of testing and Alabama is not,” Bertram says. “They’re not doing a lot of testing because they can afford to not do it.” 

Can Incarcerated People's Involvement in Vaccine Trials Be Ethical?

Including incarcerated people in COVID-19 vaccine trials raises a number of ethical concerns.

“If none of those measures are happening [social distancing and mask wearing], people are going to feel more pressured into participating in a trial,” Bertram says. “That’s just not right.” 

There is a history of medical research exploitation among incarcerated people. “I don’t think people in prison should be singled out for participation in vaccine trials," Bertram says. "We have a dangerous pattern in this country of treating incarcerated people as second class citizens to conduct potentially lethal experiments."

Including incarcerated people in vaccine trials also raises the issue of choice. According to Rini, correctional officers are trained to be in control during all situations with incarcerated people. “When a prisoner is complaining about stomach upset or that they’re feeling dizzy, they [correctional officers] don’t let them go see medical,” Rini says.

Incarcerated people might participate in a clinical trial because they might think they'll receive medical attention more often. “It seems difficult to find a route where you could have real true informed consent, " Rini says. "Realistically, can you say no? Would folks sign up to be part of a vaccine trial just because they think that it means that they would see medical more often?"

With minimal safety measures available in prisons and jails, incarcerated people may be more inclined to see a vaccine trial as the only effective form of protecting themselves.

“How much choice do you really have when you’re in prison, and you have no money and you need money to be able to get by?” Bertram says. “If a vaccine trial is the only opportunity that a person in prison has to potentially protect themselves from the virus, because the prison isn’t providing hygiene supplies, and is not making sure people are able to socially distance, people are going to feel more pressured into participating in a trial.”

According to Stacey Springs, PhD, a research associate at the Brown University School of Public Health, for clinical research to be ethical, it must be balanced to ensure that individuals are being represented in research and not being exploited. “We have to balance that representation with ensuring these individuals are not being exploited for the purposes of furthering a drug trial,” Springs tells Verywell. 

One way to balance representation of people in COVID-19 trials and eliminate exploitation in trials is by “bringing in researchers looking at public health issues, incarcerated individuals, or individuals living in the community who’ve been previously incarcerated and have lived experiences of being incarcerated to inform and advise researchers on how to design and deploy a study,” Springs says.

Rini believes that institutional review boards—formally designated groups reviewing and monitoring biomedical research involving human subjects—should be rigorous, external, and independently-run from the prisons. In addition, explanations about the trial need to be clear. “It has to be super clear to prisoners what will be available as a part of the program and what will not,” Rini says. 

The future of COVID-19 vaccine trials and the ethics of incarcerated people’s involvement depends on the safety precautions being taken in prisons right now. The state of COVID-19 care and testing in prison is not just an issue for incarcerated people, but for greater communities as well. “Correctional staff are going in and out every single day. So this is an issue that comes back to people’s communities in a real way,” Bertram says. “It’s an issue that affects everybody. The more people recognize that the sooner we’re going to get a humane response to the virus inside prisons and jails.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.