Access to health care is the best way to protect prisons from COVID-19

On Nelson Mandela International Day, 18 July, WHO/Europe focuses on how prisons can develop and implement effective COVID-19 vaccination policies as part of quality health-care programmes for both inmates and staff. To support countries, WHO has developed a package of new materials for protecting health in prisons, including by ensuring equitable access to vaccines.

100 000 COVID-19 cases in prisons

The COVID-19 pandemic has shown how important it is to guarantee the right to health care in detention facilities. Overcrowded conditions that may be unhygienic and poorly ventilated, together with stressful environments and, in some cases, the poor nutritional status of individuals, can make COVID-19 an even more dangerous disease for people in prison.

During the pandemic, many prisons in the WHO European Region experienced shortages of protective and diagnostic equipment, as well as the most basic commodities to prevent infection, including water and soap. Even when vaccines became available, many prisons did not have the correct equipment to vaccinate all inmates.

In addition, the mobility of prison officers and support staff between detention centres and surrounding communities, coupled with the transfer of prisoners between facilities, increased the risk of the virus entering prison walls and quickly spreading inside before being exported back to the outside community.

According to the most recent available data, more than 100 000 COVID-19 cases have been registered in prisons in the Region since May 2020.

Higher health risks for people in detention

The new WHO/Europe advocacy brief “Why people living and working in detention facilities should be included in national COVID-19 vaccination plans” explains why Member States have the duty to protect all citizens, regardless of their legal condition. The publication presents good examples of COVID-19 vaccination policies.

“Compared to the outside community, people living in prisons have a higher burden of both communicable and noncommunicable diseases. In addition to having a higher risk of contracting COVID-19, the burden makes them more vulnerable to suffering severe health outcomes, including death,” says Dr Carina Ferreira-Borges, Acting Head of the WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), which produced the new policy brief.

“Therefore, it is crucial that we not only continue to provide health care and vaccination measures in detention facilities, but also improve them for the sake of those who work and live in prisons.”

Vaccination in prisons: WHO recommendations

The WHO policy brief recommends the following measures to tackle the risks of further COVID-19 spread in prisons across the Region.

• People living in prisons should be included in national COVID-19 vaccination plans.
• People living in prisons should have a guaranteed right to be informed about how to protect themselves from COVID-19 with immunization and other public health measures.
• If facility-wide vaccination for everyone is not possible, vulnerable groups in detention settings should be prioritized.
• The prison workforce (health-care workers and prison staff) should be prioritized for vaccination.

“We need to remember that wisely chosen and evidence-based practices in prisons can be a good opportunity to provide health services and products to vulnerable groups of society that may have had very limited access to health care in general ahead of incarceration,” explains Dr Ferreira-Borges.

“It is very important that detention facilities continue all measures to protect people from the virus, but at the same time remain open for health care so no one is left behind – in line with the aim of the WHO European Programme of Work.”

Reliable data from prisons using WHO instruments

Information is key for creating evidence-based policies, so important priorities include the development of a quality health information system for prisons and the inclusion of prison health in public health.

The recently published “WHO COVID-19 prison surveillance protocol” is based on previous surveillance systems for infectious diseases and enriched by the experience of fighting the pandemic across the Region in 2020–2021. The protocol establishes standards of reporting while allowing countries to adapt reporting mechanisms and levels of data disaggregation to local conditions.

With this data, WHO produces country-specific bulletins that allow countries to benchmark their practices and improve policy actions in detention facilities to improve their information systems. Reporting is also linked to an alert-driven system that triggers WHO’s technical support to countries when COVID-19 outbreaks are identified in prisons.

“To monitor the situation in prisons and react to a rapidly changing situation, we need reliable data. It is always a challenge for detention facilities, so we have developed a tool that will help countries and prison authorities to gather and report information that is crucial for addressing the current pandemic,” says Dr Filipa Costa, a health policy specialist working for the alcohol, illicit drugs and prison health programme at the NCD Office.