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Protecting the health and safety of those in the custody of the state is the responsibility that the state assumes when it imprisons someone. It has been proven that the health of imprisoned persons impacts the health and well-being of the entire community, and effective health care in jails and prisons has been proven to generate health benefits in the community.

This is a phenomenon referred to as “community dividend.”

As we are now 15 months into this pandemic and its many mutations, the way that Hawaii addresses congregate settings is crucial for the health of everyone in every community. The growing outbreak at the Hilo jail just made that painfully clear.

Staff enter and exit jails and prisons multiple times a day. This increases the likelihood of transmission and places people with nowhere else to go in great jeopardy while increasing the state’s (taxpayer’s) liability.

Vaccinating people who live in congregate settings is common sense and sound public health policy that protects our communities in Hawaii from COVID-19 and its many mutations. Congregate environments where people are living and breathing on top of each other are petri dishes for infection.

The growing outbreak of this airborne virus at the Hilo jail is disturbing not only for the people who live and work there, but for the community whose homes are right across the street.

We have been told by many people inside and their families that jails and prisons appear to be “making it up” as they go along. The messaging is therefore confusing and inconsistent.

We have learned that the lack of trust in taking the vaccine is not just from the people who are imprisoned but from staff as well. Some have said that the department has shown that it cares little about them, so why should they believe that the department suddenly cares about them now?

A good way to build trust is for the department to show that they care about their staff and the people entrusted to their care. There are things that can be done to start the trust-building process while stemming the spread of the virus:

• The essential element to good communication is respect. Communications from the department to imprisoned people should always be respectful and mindful of the person’s human dignity.
• Distribute up-to-date and understandable information in plain language from credible independent sources to imprisoned persons and staff about the virus, its mutations and the vaccine efficacy. This can start to address the lack of trust that is behind much of the resistance to the vaccine.
• Develop a coordinated statewide campaign for all locations where Hawaii’s people are detained, with simple, clear messaging about the virus and how to protect one’s own health as well as the health of one’s neighbors.
• Hold town hall meetings at facilities with credible independent health care professionals to provide up-to-the-minute information and answer all questions that both imprisoned folks and the staff may have.
• In addition to town hall meetings, teams of independent health care professionals (such as students from John A. Burns School of Medicine) should conduct individual cell-to-cell visits to discuss the virus, its mutations, vaccinations and answer all questions a person may have. The state is using this census-like approach to increase vaccinations in communities with low vaccine uptake.
• The department should hold weekly safety meetings at every facility so that everyone is working with the same up-to-date information and statewide protocols are consistently and equitably followed.

Other jurisdictions have found ways to encourage their imprisoned persons to take the vaccine. North Dakota provides educational information about vaccines, including holding town hall discussions where medical experts answer questions. The agency believes that full transparency is the key to winning people over.

Ohio’s incarcerated are given information about the vaccine in one-on-one meetings with health care providers before they decide whether to get the vaccination.

In fact, four jurisdictions (Massachusetts, Oregon, Rhode Island and Virginia) have a 70% vaccination rate and recently Illinois reported vaccinating 69% of its incarcerated people.

In Hawaii, we learned that the Department of Public Safety doesn’t keep track of vaccinations and therefore cannot report the percentage of imprisoned people who are vaccinated.

When a person gets vaccinated in the community, they receive a card listing the dates of their first and second shots as well as the vaccine received. Since this seems to be standard public health protocol, one would assume the department does know who has gotten vaccinated. We have since learned that imprisoned people who get vaccinated do get a card, however, the facility puts it directly into the personʻs file.

Transparency and clear messaging is crucial, especially during a public health crisis that affects the entire community.

For the health and safety of all, let’s remember that prison health is public health.