To combat Covid-19 we must heed the lessons of 1990s pandemics

Anton Shelupanov
Thursday, 23 April 2020

In the months since I first publicly voiced concerns on 23 January 2020 about what the novel coronavirus, Covid-19 might do in the prison setting, one book has barely left my side.

It’s called Sentenced to Die: the problem of TB in Prisons in Eastern Europe and Central Asia. It was edited by my first boss, the remarkable Baroness Vivien Stern, and published in 1999. I know as a veteran of the fight against the 1990s TB pandemic and the co-concurrent HIV pandemic, both driven by the overuse of prison, that the lessons of this book are still relevant more than 20 years later as Covid-19 blasts its way around the world.

The parallels with the resurgent TB pandemic in the 1990s are clear. The disease is one of overcrowding and poverty. Immunocompromised people, many of whom experience health inequalities, are overrepresented among prisoners. Their health outcomes are significantly worse than for those who are not in prison. The same people are more likely to die from both diseases. Like tuberculosis, Covid-19 thrives in overcrowded unhygienic conditions, of which prisons are often a prime example.

As with TB, even a short prison term for a minor non-violent crime, or in some jurisdictions for a technical violation of probation conditions, an immunocompromised person being sent to live in conditions where the virus thrives can amount to a death sentence. As the Director of the Centre for Crime and Justice Studies, Richard Garside said in a recent interview, 'If you set out to create an institution with the express intent of concentrating and transmitting Covid-19, it would probably look much like a prison'.

In some ways, Covid-19 itself is not the crisis. Instead, it is yet another dangerous exacerbation of a crisis which already exists: one of excessive and often unnecessary use of prison, of overcrowding, of poor sanitation and of health inequalities. The same was true of TB and to an extent HIV in the prison setting. Countries with a significant prison problem will feel the impact of the Covid-19 pandemic more.

A pandemic does not discriminate. It has no respect for prison walls. People come in and out of prisons: staff, visitors, prisoners newly arriving and those being released. As we saw in the 1990s with TB and HIV, unsanitary overcrowded prisons amplify infectious diseases and reflect them back into society at an increased intensity.

At this stage in the pandemic, there is much we don’t know about Covid-19. We do know that a proven clinical intervention such as a vaccine does not currently exist. Non pharmaceutical interventions have limited effectiveness, and tactics such as social distancing are practically impossible in most prison settings. The only possible effective intervention is one which was instrumental in breaking the progress of the prison/community transmission cycle of the 90s TB pandemic: reducing the number of people going to prison. Russia, Kazakhstan, Baltic states and other countries saw how many citizens were dying from a previously controllable disease and went down that path, cumulatively reducing their prison populations by hundreds of thousands of people. Only when they achieved this did the pandemic in the community and prisons begin to abate.

After observing how quickly the Covid-19 pandemic developed and its impact in fragile environments like prisons, in early March, I had developed a tool to enable justice administrations to make the best policy decisions to safeguard public health. It was based on previous work to combat the transmission and amplification of TB and HIV between prisons and society, including with international bodies like the United Nations Office on Drugs and Crime and the World Health Organization Europe.

The tactics it sets out for reducing the prison population prioritise stemming the inflow of large numbers of immunocompromised people into the prison system by reducing the use of custodial remand, which can be led by judges and prosecutors. The next step is to accelerate early release, starting with those due to be released in the coming months, moving onto others from vulnerable groups and those accused of non-violent crimes, and so on. Bearing in mind how many prison staff will be off sick with the virus or forced to self-isolate, there are clearly not only health implications to an overcrowded prison system but safety and security ones too.

Since late March 2020, there has been no shortage of guidance and campaign materials being produced by NGOs and international organisations, with varying foci: for specific groups of people in detention or for particular stages of the justice system (police, courts, prisons). A number of countries have taken action to reduce prison numbers, be it judge led and around reducing the use of remand, or via early release, or via amnesties. Other jurisdictions which includes England & Wales have lagged behind. In many places we are seeing increasing case loads of Covid-19 among prisoners and prison staff, and an increasing number of deaths. This is despite the warnings before this began happening that urgent action was needed to reduce the impact of the pandemic.

Learning the lessons of recent past pandemics like TB which were driven by the overuse of prison is crucial: justice administrations should reduce the number of people in prison in order to safeguard public health.

Anton Shelupanov is a justice reformer. Over the past two decades he has worked with over 20 jurisdictions around the world, contributed to the development of transnational policy for bodies like the UNODC and WHO and is the author of two books and numerous reports and articles.