*The interviewee’s name has been changed for safety reasons

Last month, the news broke that convicted sex offender Gary Glitter had reportedly received a Covid vaccination in prison. The reports sparked uproar from members of the public and justice campaigners who said it was wrong to single out criminals ahead of keyworkers and vulnerable people – but despite his prisoner status, the 76-year-old ex-singer was in an eligible cohort.

The decision for prisoners to be vaccinated in line with the Joint Committee on Vaccination and Immunisation’s (JCVI) priority cohorts is something that prison pharmacist, Rob James* has also grappled with. A former community pharmacist, Mr James left his job in search of a more clinical role and accepted a position in a prison just a few months before the pandemic started.

He is now leading on the Covid vaccination programme in one of the largest high-security male prisons in the country.

‘It is an ethical one,’ Mr James says. ‘It was initially hard to accept that hardened criminals were being vaccinated ahead of ordinary, hard-working people.’

He adds that he initially thought prisoners should not be prioritised for their Covid vaccine, but after seeing just how quickly the virus spread in the prison, his view changed.

‘People are in such close proximity to one other, they are also constantly being moved around and even when we were not letting new prisoners in, outbreaks were still happening,’ he says.

Higher risk of deaths in prisons

Research published in The Lancet Respiratory Medicine last week revealed that there were 121 deaths related to Covid-19 among people in prisons in England and Wales between March 2020 and February 2021. This represented a risk of dying from Covid 3.3 times higher than that of people of the same age and sex outside prisons, the research found.

The researchers concluded that prisoners and prison staff need to be prioritised for vaccination and called for a systematic ‘whole prison approach to prevent outbreaks and reduce deaths, adding that the current methods of regime restriction do not offer enough protection.’

These methods are something Mr James has seen firsthand – with prisoners currently spending most of a day locked in their cell, as the prison attempts to limit the spread of the virus.

‘Just over a week ago we had an outbreak and over 100 prisoners were found positive,’ he says. ‘They’ve [the prison] had pretty strict rules throughout the pandemic, but they’ve stepped it up a notch over the last few weeks - prisoners have been stuck in their cells for 23 hours a day.'

It’s a measure that other prisons across England and Wales have also intermittently implemented throughout the pandemic and one that was criticised by one chief inspector of prisons, Peter Clare, who described it as ‘degrading’ in an interview on BBC Newsnight.

PPE, visits and vaccinations

Mr James has vaccinated over 100 people so far, however this figure is set to rise now that they have been given the go ahead to vaccinate cohort nine. Mr James explains that everyone walking through the prison must be kitted out in full PPE and visits have been limited for ‘quite some time’.

‘Anytime a new cohort gets announced we have to wait a bit before we start vaccinating as we cannot be seen to vaccinate people here ahead of people in the community as there might be commotion from the outside,’ he says.

According to Mr James, the ‘majority of prisoners’ are ‘thankful to get their vaccines’, although he says some have needed some moral support to get the jab done.

‘It’s quite funny, I’m vaccinating these big burly, hardened criminals some of whom are in for atrocious crimes, and they are terrified of needles. I’ve had some of them had to put their T-shirt over their head so they would not see me jab them, or they have had to squeeze my hand.

‘As weird as it sounds, you forget they are criminals sometimes,’ he adds.

‘You learn to separate the crime from the person’

Mr James says that he still does, however, sometimes struggle to separate the patient from the crime they committed, as some prisoners seem ‘just like you or me’ until he reads their files and finds out they have committed ‘horrific crimes’. The prison also houses a number of older patients who have committed sex offences – something he says can be ‘very hard to deal with mentally’.

‘When I first arrived here, I would wonder what each of my patients was in here for, but now I have come to the conclusion that ignorance is bliss — sometimes it can impair how you see them and it’s better to take them at face value,’ he adds.

Mr James says he has also not had any unpleasant or scary experiences in the prison during his first six months – with most prisoners ‘respectful generally’. But he has seen individuals become aggressive towards GPs, ‘especially if they don’t get prescribed what they want’.

‘It is hard to know who's lying and who’s genuine at times’

The prison itself has a separate healthcare facility, he says that the prisoners are treated a lot better than he expected when it comes to healthcare – they have access to GPs, physios, opticians, nurses, pharmacists and dentists.

One that this is probably handled ‘better in the prison than on the outside’, he says, is drug use of diazepam and sleeping tablets, for which the prison has stringent policies in place.

‘You get patients who have ulterior motives; some lie about how they are feeling so that they get moved or get put on a drug, like pregabalin, codeine or diazepam. It is hard to know who's lying and who’s genuine at times,’ he says.

‘With diazepam, we have a strict policy on how patients take it, we do a quick detox and they will not be prescribed it long term. The same goes for sleeping tablets: very rarely do you see them prescribed here — rates in here are probably lower than on the outside.’

Comparison with community pharmacy

Before working as a prison pharmacist, Mr James says he found the workload for his role in community pharmacy ‘a bit insane’ and he knew it was time to leave when ‘it got to the point where I used to dread the moment when I had to download the scripts’.

‘I just felt like [I was] a checking robot, and I wanted to further my clinical skills,’ he explains.

Despite managing over 700 prisoners with around half of these on prescription medication – he says working in a prison is a lot less pressure than a community pharmacy due to the improved staffing levels and nicer pace.

‘The two jobs are quite different to be honest, the prison phamacy is a lot more clinically-based, I spend most of my time dealing with queries from the nursing team, reviewing prescriptions, adjusting doses or analysing blood results,’ he adds.

‘It’s also exposed me to greater variety of medications such as anticancer or HIV medication, which I wouldn’t have been otherwise.’