Why people living and working in detention facilities should be included in national COVID-19 vaccination plans: advocacy brief

28th May 2021

Developed by WHO Health in Prisons Programme (HIPP), United Nations Office on Drugs and Crime (UNODC) and Penal Reform International (PRI), ‘Why people living and working in detention facilities should be included in national COVID-19 vaccination plans: advocacy brief’ calls for the inclusion of people living and working in prisons in COVID-19 national vaccination plans and highlights the evidence of enhanced risk of congregate living.

The brief highlights that it is crucial for people living in prisons to be included in national COVID-19 vaccination plans on the basis of their increased vulnerability, the principle of equivalence, and the duty of governments to protect those deprived of their liberty, leaving no one behind.

The brief also advocates that the prison workforce (health-care workers and prison staff) should be prioritized for vaccination as health and care workers and as personnel at higher risk as a result of direct exposure to COVID-19 patients while delivering “an essential societal service”.

Echoing evidence and briefings published by international experts throughout the pandemic (see more here), this brief points to the nature of prisons (overcrowding/poor ventilation/movement of people through the prison) and underlying health problems of the imprisoned population as rationales for why people in detention are at increased vulnerability to COVID-19.

Considering the broader approach to vaccination in any given country, the brief notes that failing to include people in prisons in national COVID-19 vaccination plans is also “likely to undermine efforts to ensure equitable access to all population groups in a country and thereby to control the disease”.

With regard to any age-based vaccination strategy, the brief notes that the cut-off for age bands should be lowered for people in prison because of the poor health status of people in detention and the ageing effect of prison itself. The brief outlines that in Ireland, where around 14% of the prison population are aged over 50 years, 46% of all COVID-19 cases recorded in February 2021 were among this age group. (See IPRT’s 2016 research for more on the ageing effect of imprisonment.)

Other reasons for the inclusion of prisons in national vaccination plans as outlined by WHO, UNODC and PRI include:

• prison populations are unable to take appropriate public health measures to prevent infection (including physical distancing and hygiene)
• prisons can never be completely isolated from surrounding communities, so failing to protect those in prison increases the risk of infectious diseases spreading into the community
• people in prison often come from marginalized groups of society with a higher burden of poverty and discrimination and with limited prior access to health care, and this results in increased risk from COVID-19.

Notably, given the approach to minimising the spread of infection in prisons in Ireland, the brief points to research that stresses the importance of the principle of ethics in including people in prison in vaccination given that “more punitive and damaging alternatives such as prolonged periods of isolation should not be imposed on what is already a physically and mentally vulnerable group”.

The briefing concludes with the principles for inclusion of prisons in national COVID-19 vaccination plans, namely: ethics and duty of care; equivalence; universal health coverage; and continuity of care.

Read the advocacy brief in full on the WHO website.