No prisoners should be abandoned even in COVID-19

Author: Yudai Kaneda

School of Medicine, Hokkaido University

Editor: Chiharu Kawasaki

School of Medicine, Teikyo University

This article is translated from Japanese MRIC published on August 13, 2021.

Vol.154 コロナ禍で受刑者を取り残さないために | MRIC by 医療ガバナンス学会 (

I am a fourth-year medical student at Hokkaido University School of Medicine. I was able to intern for about a week at Dr. Kami's lab during the university's online class period.

I know there are some controversial opinions out there about alternative online classes we are having right now. But for me, the fact that I enjoyed a new type of “youth” by doing an internship in Tokyo while attending classes online away from Hokkaido is more than enough to make me happy. (Actually, Hokkaido and Tokyo locate in a different island.) In my previous student life, it was "normal" to have to get up early in the morning to go to the university and stay there at least from 8:00 to 17:00.

However, with online classes, I can wake up at 8:43 a.m. and still be on time for my 8:45 a.m. lecture. Also, since I did not have to go to school, I did not have to handle with the harsh snowy roads of Hokkaido, especially in winter, and could take classes in the comfort environment of my warm room. I don't think there is much difference in learning efficiency whether you take classes in an auditorium or online because the lectures of clinical subjects in medical school are basically one-way lecture. I hope that the pandemic will finish soon. Still, I sincerely hope that the advantages of online courses, especially the ability to go through the time and place restrictions, will remain in the future.

As for things that can be replaced remotely, such as medical school lectures, we have adapted over the past year and are now getting used to that way of life. However, there are some things and environments in the world where there are no remote alternatives. One example is prisons.

I had been studying prison medicine since I was in my first year in university. Maybe you are curious about how a medical student and a prison can have a contact. I have always been interested in public health, and after some secret history (it’s a long, long story), I enrolled in a medical school. I have been actively participating in lectures and study groups since I was a freshman. At one of them, there happened to be a professor who said, "Prisons are the best place to learn public health," and I was carried away by the sound of his words and joined his seminar without knowing what was right or wrong. Since then, I have studied topics such as correctional medicine and the re-employment system for former inmates at Sapporo Prison, the closest prison to Hokkaido University.

Sapporo Prison was established in December of the 3rd year of Meiji (1970), when part of the Hokkaido Kaitakushi (Hokkaido Development Office) building in Kita 1-jo Nishi 1-Chome, Sapporo. Ten years later, it was moved to its current location and renamed Sapporo Prison in 1922. The existing building was completed in September 2014 and is relatively new. It has the Sapporo Detention Center and Muroran Detention Center for criminal defendants and the Sapporo Prison Branch for women, with a capacity of approximately 2,500 inmates. (Indicator B), foreign inmates with no customs or special needs (Indicator F), and inmates with severe mental or physical disabilities (Indicators M and P). The Center also serves as a research center to determine the treatment and housing of first-time offenders under 26 years of age who have done a sentence of 1 year and 6 months or more at one of the facilities within its jurisdiction.

How many of you have ever seen the inside of a prison? Such people may be really few, and perhaps it is normal if you have never seen it. The inside of the prison is surprisingly clean. It may be because Sapporo Prison is new; it does not give the impression of being damp, dirty, or dark as seen in TV dramas. My first impression was that it was cleaner than my room. I was amazed to hear how well they are treated. Three meals a day are served on a health-conscious menu (and they look delicious!), even osechi (traditional New Year's dishes) are served on New Year's day. Moreover, medical expenses are free.

Also, Sapporo Prison does not seem to have a very high incarceration rate (about 50%). In many cases, three or four people are housed in a large room, which should be a six-person room, so I felt that they have a lot of space to live. There were many single cells, and each person's items showed individuality, such as albums and books. A photo of what appeared to be a family member on a desk was very sad, and it made me realize that the people here are also human beings no different from us. I was horrified by the accidental and impulsive nature of the crimes. I was also strongly reminded that prisons are not places to torment criminals but isolate them from society and rehabilitate them as good citizens.

All of the inmates in Japan who end up in prisons are subject to a liberal sentence. In other words, those who commit crimes are deprived of physical freedom in imprisonment, confinement, or detention. Inmates are forced to live in a world where correctional officers control their lives 24 hours, inside walls isolated from society and bound in time and space. The daily schedule of inmates at Sapporo Prison on a weekday is as follows.

6:30 Wake up

7:00 Morning inspection

7:10 Breakfast

7:35 Exit from room

8:00 Correctional treatment begins

10:00 Break

12:00 Lunch

12:20 Start of correctional treatment

14:30 Break

16:40 End of correctional treatment

16:50 Entering the room

17:00 Evening inspection

17:10 Dinner

18:00 Leisure time

21:00 Bedtime

During leisure time after dinner, individual activities such as watching TV or reading are allowed, but the basic concept is based on group living in a closed space. And what surprised me when I visited the prison was a large number of elderly people. In fact, over the past 25 years, the aging rate of Japan's inmates has risen steadily, from 1.7% (1990) to 16.5% (2015) for men and from 3.9% to 33.1% for women over the same period. Given that the aging rate of the Japanese population changed from 9.9% for men and 14.2% for women in 1990 to 23.4% and 29.1%, respectively, in 2015, the aging of the inmates is occurring at a faster rate than the aging of the Japanese population. At the Sapporo Prison, I visited, the oldest inmate was 85 years old.

Another problem is that many of the elderly inmates are re-entrants. According to the "White Paper on Crime," re-entrants accounted for nearly 60% of all inmates (20,467) admitted in fiscal 2016. Looking at this statistic by age group, the older the age group, the higher the reentry rate and the shorter the time to reoffence. The elderly, in particular, have difficulty rebuilding their lives due to a lack of relatives and employment opportunities after release from prison, which leads to a negative spiral that leads them to commit crimes again.

One former inmate I spoke to said, "It is harder after I get out of prison. No one will hire me, and my family had already gave up. Even if I wanted to be rehabilitated, society would not accept me." He seemed to have given up on the idea. To prevent recidivism, efforts on the part of ex-prisoners are significant, without a doubt. Still, it is also necessary for us to make efforts to be broad-minded and understanding to accept them in society. We cannot deny the fact that, as it is now, society has created criminals. In Sapporo Prison, the largest number of people have been in and out of prison 25 times due to recidivism, and the seminar I am a member of is trying to figure out how we can approach such people.

The increase in the number of elderly inmates in prisons, where group living is the basic rule, is a major challenge at a time when the new coronavirus is spreading. Many of them have chronic illnesses. The Ministry of Health, Labor and Welfare has reported that they are at high risk of becoming seriously ill if infected with the new coronavirus. Prisons are also prone to clusters due to the nature of their environment. Last winter, there were reports of a hundred inmates infected with the novel coronavirus at Chiba Prison and Yokohama Prison. However, according to the Ministry of Justice, most prisoners have not yet been vaccinated.

Therefore, I have one proposal. How about prioritizing elderly inmates to receive the AstraZeneca (AZ) vaccine, which has been prioritized for delivery to areas where a state of emergency has been declared, but Japan's stock of the vaccine is not yet being used effectively?

The UK's Medicines and Healthcare Products Regulatory Agency reports that the AZ vaccine poses a risk of thrombosis in young women. On the flip side, there is no particular problem when it is given to the elderly. And fortunately, Japan has 120 million doses of AZ vaccine in stock. AZ vaccine is also available in Japan, and the University of Oxford and other research groups have reported that even when different types of vaccine were given in the first and second doses, for example, AZ and Pfizer, the immune response was stronger than when two doses of the same type of vaccine were given. I can't help but feel that it would be a shame to keep them just to warm the bench.

Of the 120 million doses of AZ vaccine that Japan has in stock, Japan is already making up its mind to provide 30 million doses to overseas countries such as Southeast Asia and Taiwan. However, we cannot turn our eyes away from the current shortage of vaccines distributed in Japan. The Ministry of Health, Labor and Welfare (MHLW) has announced its policy to deliver up to 1,000 doses of AZ vaccine to prefectures that have not declared a state of emergency after August 23. But where did the limit the delivery to 1,000 doses come from? Based on the scientific evidence, we need to be proactive in delivering AZ vaccine to those who need it.

To protect the human rights of socially vulnerable people like prisoners, why not be flexible with what we already have inside of our hands?

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