COVID-19 Vaccine Trials Omit Vulnerable Inmates from Testing

With COVID-19 plaguing the planet, scientists are scrambling to create a viable vaccine. So far, only China, Britain, and the United States have succeeded and are ready to begin human trials. In the United States, phase-3 vaccine trials may draw in over 30,000 high-risk participants. Even so, inmates cannot take part in these trials, despite their nature as a high-risk group.  

Decade of Unethical Research Leads to Inmate Abuse  

Inmates have not participated in research studies since 1978. Before 1978, research trials often failed to inform or otherwise protect inmates. Prisoners were not warned of any hazardous conditions they may experience during testing. Nor were they warned of any adverse side-effects they may experience. These experiments often occurred without any federal oversight. This increased the likelihood of permanent injury or even death.  

That changed when the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research intervened. Any studies that violated ethical standards or were exploitative in nature ended. Furthermore, the commission stopped any research that posed more than a minimal risk to inmate health. Studies that did not improve the health and well-being of any inmate were also terminated. The commission determined that the only trials inmates could occur only in the most compelling circumstances.  

But a 2006 report by National Academy of Medicine recommended revisions to allow inmates limited participation in clinical trials. Its recommendations encouraged inmates to participate in low-risk, proven testing. The Academy included phase-3 clinical trials among the permissible tests listed in the recommendation. Yet, they still sit in limbo, and the restrictions imposed by the original commission remain unchanged. 

The following outlines the current research permissible inside prisons and jails in the United States. 

1. Studies on cause and effect of incarceration and criminal behavior.
2. Studies of prisons as institutional facilities and/or of individuals occupying that space as imprisoned peoples.
3. Conditions that can impact or otherwise effect prisoners as a class.
4. Studies that may help improve the health and well-being of those involved with the trial.

Under these guidelines, inmates should take part in COVID-19 vaccine trials. However, it is imperative that inmates remain informed and aware throughout the testing.  

Research Overhaul Required in Time of COVID-19 

The guidelines listed above are not the only complicating factors. Oftentimes, federal or state regulations prevent researches from effectively carrying out their work. Federal regulations call for the assembly of a panel of experts before the research begins in any prison or jail.
However, these outdated policies are precisely the reason that an overhaul is necessary. Respiratory illnesses like influenza or COVID-19 thrive in prisons because most facilities cannot implement proper quarantine procedures. Additionally, inmates have a higher rate of chronic health issues. These issues could lead to serious complications in the event of a COVID-19 infection.  In the United States, 39 of the 50 largest COVID-19 outbreaks occurred behind prison walls.    

Stipulations for COVID-19 Vaccine Testing 

Should inmates participate in COVID-19 vaccine testing, there must be specific guidelines put in place to protect their welfare. First, inmates must volunteer to take part in the study. Their participation should come from a true desire to assist research effort. Informed consent is a must. No inmate should take part in the testing without the full and complete knowledge what the trial entails.

Most importantly, any testing should be run through an institutional review board with an inmate representative on it. The board would be responsible for the prevention of any inmate exploitation and coercion. With a board like this in place, inmates stand a better chance at fair, ethical and equal treatment. 

Conclusion 

The restrictions implemented in 1978 addressed the ethics of research trials in prisons. Yet, it may prevent more modern testing from taking place. With COVID-19 infecting a vast number of prisons across the country, it is imperative to include this high-risk group in vaccine trials. It is only in these settings that we will truly see the effectiveness of these vaccines in a large-scale setting

Wang EA, Zenilman J, Brinkley-Rubinstein L. Ethical Considerations for COVID-19 Vaccine Trials in Correctional Facilities. JAMA. Published online August 17, 2020. doi:10.1001/jama.2020.15589 

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