People in prisons are at an increased risk of Covid-19, with a death rate more than three times higher than that of the general population, and should be made a vaccine priority, according to public health experts. There were 118 deaths related to Covid-19 among people in prisons in England and Wales between March 2020 and February 2021, representing a risk of dying more than three times higher than that of people of the same age and sex outside secure environments, the research team at University College London (UCL) found. The higher rate of death comes despite extensive physical distancing measures, including prisons keeping many inmates in their cells for 23 hours a day. The Ministry of Justice challenged the authors’ work, however, arguing it failed to adjust for worse health among the prison population than the community and movements of prisoners in and out of prison. And while 118 prisoners have died having tested positive for Covid-19 within 28 days of death, 93 of the deaths were suspected or confirmed to be caused by the coronavirus. Confirmed cases of the virus are significantly higher in prisons, the researchers said, with 7.6 confirmed cases per 1,000 people in prisons in England and Wales during the first wave of the pandemic, compared with 4.9 per 1,000 in the general population. The findings have been published in The Lancet Respiratory Medicine. The lead author of the study, Dr Isobel Braithwaite of UCL Institute of Health Informatics, said: “Our findings show that people in prisons are at a much higher risk of dying from Covid-19 than the general population, and we make the case that both they and prison staff should be given high priority in the rollout of vaccines. “This has recently been agreed for people experiencing homelessness, who face similarly high risks. “We believe the current methods of regime restriction are not enough to protect people adequately, and a systematic, ‘whole-prison’ approach to vaccination is key to preventing further outbreaks and reducing overall deaths in prisons.” Prisoners are being vaccinated in line with the general vaccine rollout. Last week, the government heeded official advice that homeless people and those sleeping rough should be prioritised for coronavirus vaccines, given they are more likely to have undiagnosed conditions and have less regular access to healthcare. The researchers said institutional settings such as prisons are high-risk environments for infectious disease outbreaks, as they are typically overcrowded with inconsistent access to washing and toilet facilities. In addition to the higher risk of transmission, people in prison often have underlying health problems or other risk factors that increase the likelihood of severe disease, the researchers said. Hypertension – high blood pressure – and asthma are common among prisoners, according to some studies, increasing risk to the effects of Covid. A Ministry of Justice spokesperson said: “The suggested death rate is highly misleading and fails to take into account tens of thousands of additional offenders who move in and out of prisons every year. “We have protected the lives of thousands of staff and prisoners – deaths are significantly lower than predicted and cases have fallen for seven consecutive weeks as our strict measures limit the spread of the virus.” Prof Wei Shen Lim, Covid-19 chair for the JCVI, said: “The Joint Committee on Vaccination and Immunisation’s advice on Covid-19 vaccine prioritisation was developed with the aim of preventing as many deaths as possible. As the single greatest risk of death from Covid-19 is older age, prioritisation is primarily based on age. “It is estimated that vaccinating everyone in the priority groups would prevent around 99% of deaths from Covid-19.”