{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T05:54:52Z","timestamp":1774245292122,"version":"3.50.1"},"reference-count":45,"publisher":"Emerald","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Purpose<\/jats:title>\n Vaccination coverage among people deprived of liberty remains suboptimal worldwide, despite disproportionate vulnerability to infectious diseases and potential for outbreaks within correctional settings. The COVID-19 pandemic further exposed inequities in prison health systems and underscored the ethical imperative for equitable vaccine access. This paper examines environmental, individual and organisational barriers to vaccination in prisons within the European and global landscape.<\/jats:p>\n <\/jats:sec>\n \n Design\/methodology\/approach<\/jats:title>\n This Viewpoint is informed by recent international and regional literature, policy documents and guidance from organisations including the World Health Organization, United Nations Office on Drugs and Crime and the RISE-Vac consortium. These sources were used to frame a narrative discussion of vaccine availability, uptake and hesitancy among people in custody and prison staff, as well as ethical, human rights and public health implications of inequitable access. Examples from European and global contexts illustrate key issues raised in the paper.<\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n Barriers to vaccination in prisons include overcrowding, limited health-care infrastructure, high inmate turnover and resource constraints, as well as individual-level factors such as distrust, misinformation, stigma and low health literacy. Despite strong national vaccination performance, gaps persist in correctional facilities, reflecting trends across Europe. Evidence supports interventions such as peer-led health promotion, opt-out vaccination approaches, improved record-keeping, staff training and continuity of care upon release.<\/jats:p>\n <\/jats:sec>\n \n Research limitations\/implications<\/jats:title>\n Although not empirical, this viewpoint identifies critical gaps in data and evaluation frameworks for vaccination in correctional settings, highlighting the need for participatory, equity-driven research and harmonised surveillance systems.<\/jats:p>\n <\/jats:sec>\n \n Practical implications<\/jats:title>\n Sustainable vaccination strategies in prisons require integrated, culturally competent approaches that simultaneously address systemic constraints and individual hesitancy. Ensuring continuity, transparency and intersectoral collaboration is essential for effective implementation.<\/jats:p>\n <\/jats:sec>\n \n Social implications<\/jats:title>\n Promoting equitable access to vaccination in prisons protects incarcerated individuals, correctional staff and surrounding communities. Advancing vaccine equity in detention is not only a public health priority but also a matter of social justice and human rights.<\/jats:p>\n <\/jats:sec>\n \n Originality\/value<\/jats:title>\n This viewpoint provides an interdisciplinary synthesis of European and global evidence, articulating the ethical, structural and operational imperatives for strengthening vaccination programs in prisons while uniquely linking vaccination delivery to governance structures, health information system, and continuity of care between custodial and community health services.<\/jats:p>\n <\/jats:sec>","DOI":"10.1108\/ijoph-11-2025-0089","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T05:07:36Z","timestamp":1774242456000},"page":"1-11","source":"Crossref","is-referenced-by-count":0,"title":["Behind bars, beyond barriers: a viewpoint on vaccination challenges and opportunities in prison settings"],"prefix":"10.1108","author":[{"given":"Jo\u00e3o Pedro","family":"Ramos","sequence":"first","affiliation":[{"name":"EPIUnit ITR, Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, Universidade do Porto , Porto, , and Instituto de Ciencias Biomedicas Abel Salazar, Universidade do Porto, Porto, Portugal","place":["Portugal"]}]},{"given":"Mariana","family":"Vieira","sequence":"additional","affiliation":[{"name":"EPIUnit ITR, Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, Universidade do Porto , Porto, , and Instituto de Ciencias Biomedicas Abel Salazar, Universidade do Porto, Porto, Portugal","place":["Portugal"]}]},{"given":"Ana","family":"Aguiar","sequence":"additional","affiliation":[{"name":"EPIUnit ITR, Instituto de Sa\u00fade P\u00fablica da Universidade do Porto, Universidade do Porto , Porto, , and Instituto de Ciencias Biomedicas Abel Salazar, Universidade do Porto, Porto, Portugal","place":["Portugal"]}]}],"member":"140","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"issue":"2","key":"2026032301073093100_ref001","first-page":"145","article-title":"Drug use in prison: epidemiology, determinants, and interventions","volume":"19","author":"Austin","year":"2023","journal-title":"International Journal of Prisoner Health"},{"issue":"1","key":"2026032301073093100_ref002","article-title":"Factors associated with drug use in prison: a systematic review of quantitative and qualitative evidence","volume":"122","author":"Austin","year":"2023","journal-title":"International Journal of Drug Policy"},{"issue":"11","key":"2026032301073093100_ref003","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003201","article-title":"Managing outbreaks of highly contagious diseases in prisons: a systematic review","volume":"5","author":"Beaudry","year":"2020","journal-title":"BMJ Global Health"},{"issue":"5","key":"2026032301073093100_ref004","first-page":"824","article-title":"Mortality after prison release: opioid overdose and other causes of death, risk factors, and time trends","volume":"88","author":"Binswanger","year":"2011","journal-title":"Journal of Urban Health"},{"issue":"1","key":"2026032301073093100_ref005","first-page":"28","article-title":"Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors","volume":"2","author":"Binswanger","year":"2007","journal-title":"Addiction Science & Clinical Practice"},{"key":"2026032301073093100_ref006","doi-asserted-by":"crossref","DOI":"10.1016\/j.lanepe.2024.100958","article-title":"Cancer-preventing vaccination programs in prison: promoting health equity in Europe","volume":"43","author":"Cocco","year":"2024","journal-title":"The Lancet Regional Health - Europe"},{"issue":"3","key":"2026032301073093100_ref007","first-page":"284","article-title":"Digital health and continuity of care in prison settings: a scoping review","volume":"15","author":"Davies","year":"2019","journal-title":"International Journal of Prisoner Health"},{"issue":"1","key":"2026032301073093100_ref008","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1467-9566.2007.00474.x","article-title":"Unhealthy prisons: exploring structural determinants of prison health","volume":"29","author":"De Viggiani","year":"2007","journal-title":"Sociology of Health & Illness"},{"issue":"2","key":"2026032301073093100_ref009","doi-asserted-by":"crossref","DOI":"10.1111\/jvh.14049","article-title":"A qualitative systematic review of barriers and facilitators to hepatitis B and C programmes in prisons","volume":"32","author":"Emery","year":"2024","journal-title":"Journal of Viral Hepatitis"},{"key":"2026032301073093100_ref010","unstructured":"European Centre for Disease Prevention and Control (ECDC) and The European Union Drugs Agency (EUDA)\n (2021), \u201cPublic health guidance on prevention and control of communicable diseases in prison settings\u201d, available at:Link to the cited article"},{"key":"2026032301073093100_ref011","unstructured":"Fair, H. and Walmsley, R. (2024), \u201cWorld prison population list (14th ed.)\u201d, available at:Link to the cited article"},{"issue":"9","key":"2026032301073093100_ref012","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/S2215-0366(22)00243-7","article-title":"HIV, substance use, and mental health care in prisons","volume":"9","author":"Fazel","year":"2022","journal-title":"The Lancet Psychiatry"},{"issue":"9","key":"2026032301073093100_ref013","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/S2215-0366(16)30142-0","article-title":"Mental health of prisoners: prevalence, adverse outcomes, and interventions","volume":"3","author":"Fazel","year":"2016","journal-title":"The Lancet Psychiatry"},{"key":"2026032301073093100_ref014","unstructured":"International Committee of the Red Cross (ICRC)\n (2023), \u201cHealthcare in detention: a practice guide\u201d, available at:Link to the cited article"},{"issue":"9","key":"2026032301073093100_ref015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0267070","article-title":"COVID-19 vaccine for people who live and work in prisons worldwide: a scoping review","volume":"17","author":"Ismail","year":"2022","journal-title":"Plos One"},{"issue":"13","key":"2026032301073093100_ref016","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1017\/S0950268818001991","article-title":"Mass vaccination response to a measles outbreak is not always possible: lessons from a london prison","volume":"146","author":"Junghans","year":"2018","journal-title":"Epidemiology and Infection"},{"issue":"10049","key":"2026032301073093100_ref017","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/S0140-6736(16)30769-3","article-title":"Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners","volume":"388","author":"Kamarulzaman","year":"2016","journal-title":"The Lancet"},{"issue":"13","key":"2026032301073093100_ref018","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3201\/eid3013.230705","article-title":"Infection prevention and control in correctional settings","volume":"30","author":"Kendig","year":"2024","journal-title":"Emerging Infectious Diseases"},{"issue":"1","key":"2026032301073093100_ref019","doi-asserted-by":"crossref","first-page":"27043","DOI":"10.3402\/jmahp.v3.27043","article-title":"Role of vaccination in the sustainability of healthcare systems","volume":"3","author":"Largeron","year":"2015","journal-title":"Journal of Market Access & Health Policy"},{"issue":"4","key":"2026032301073093100_ref020","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1080\/17449200601069676","article-title":"From equivalence of standards to equivalence of objectives: the entitlement of prisoners to health care standards higher than those outside prisons","volume":"2","author":"Lines","year":"2006","journal-title":"International Journal of Prisoner Health"},{"issue":"2","key":"2026032301073093100_ref021","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1377\/hlthaff.2015.1088","article-title":"The social value of vaccination programs: beyond Cost-Effectiveness","volume":"35","author":"Luyten","year":"2016","journal-title":"Health Affairs"},{"issue":"35","key":"2026032301073093100_ref022","doi-asserted-by":"crossref","first-page":"4906","DOI":"10.1016\/j.vaccine.2019.07.014","article-title":"Vaccinations in prison settings: a systematic review to assess the situation in EU\/EEA countries and in other high-income countries","volume":"37","author":"Madeddu","year":"2019","journal-title":"Vaccine"},{"key":"2026032301073093100_ref023","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1323195","article-title":"Vaccination against emerging and reemerging infectious diseases in places of detention: a global multistage scoping review","volume":"12","author":"Moazen","year":"2024","journal-title":"Frontiers in Public Health"},{"issue":"1","key":"2026032301073093100_ref024","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-20207-3","article-title":"Vaccines and vaccination in prison settings: availability and model of service delivery in 20 European countries","volume":"24","author":"Moazen","year":"2024","journal-title":"BMC Public Health"},{"key":"2026032301073093100_ref025","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S0950268821000169","article-title":"Hepatitis B virus infection in EU\/EEA and United Kingdom prisons: a descriptive analysis","volume":"149","author":"Nakitanda","year":"2021","journal-title":"Epidemiology and Infection"},{"issue":"1","key":"2026032301073093100_ref026","doi-asserted-by":"crossref","DOI":"10.1016\/j.pulmoe.2023.07.002","article-title":"Vaccination in post-tuberculosis lung disease management: a review of the evidence","volume":"31","author":"Nasiri","year":"2025","journal-title":"Pulmonology"},{"issue":"3","key":"2026032301073093100_ref027","doi-asserted-by":"crossref","first-page":"41","DOI":"10.7146\/torture.v34i3.147571","article-title":"Overcrowding in prisons: health and legal implications","volume":"34","author":"Nudd","year":"2024","journal-title":"Torture Journal"},{"key":"2026032301073093100_ref028","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijregi.2025.100621","article-title":"Global perspectives on tuberculosis in prisons and incarceration centers\u2014risk factors, priority needs, challenges for control and the way forward","volume":"14","author":"Nyasulu","year":"2025","journal-title":"IJID Regions"},{"issue":"1","key":"2026032301073093100_ref029","doi-asserted-by":"crossref","DOI":"10.1186\/s40352-023-00240-x","article-title":"Facilitators and barriers to COVID-19 vaccination among incarcerated people and staff in three large state prisons: a cross-sectional study","volume":"11","author":"Osman","year":"2023","journal-title":"Health & Justice"},{"key":"2026032301073093100_ref030","unstructured":"Penal Reform International and Harm Reduction International\n (2021), \u201cCOVID-19 vaccinations for prison populations and staff: report on global scan\u201d, available at:Link to the cited article"},{"issue":"4","key":"2026032301073093100_ref031","doi-asserted-by":"crossref","first-page":"e2020027037","DOI":"10.1542\/peds.2020-027037","article-title":"Societal costs of a measles outbreak","volume":"147","author":"Pike","year":"2021","journal-title":"Pediatrics"},{"issue":"3","key":"2026032301073093100_ref032","doi-asserted-by":"crossref","first-page":"475","DOI":"10.2105\/AJPH.2011.300374","article-title":"Dual loyalty in prison health care","volume":"102","author":"Pont","year":"2012","journal-title":"American Journal of Public Health"},{"key":"2026032301073093100_ref033","unstructured":"RISE-Vac Consortium\n (2024), \u201cStrengthening vaccination services in prison settings: public health guidance\u201d, available at:Link to the cited article."},{"issue":"12","key":"2026032301073093100_ref034","first-page":"4475","article-title":"Prevalence of chronic noncommunicable diseases in the prison system: a public health challenge","volume":"27","author":"Serra","year":"2022","journal-title":"Ci\u00eancia & Sa\u00fade Coletiva"},{"issue":"7","key":"2026032301073093100_ref035","doi-asserted-by":"publisher","first-page":"e026806","DOI":"10.1136\/bmjopen-2018-026806","article-title":"Prison cell spatial density and infectious and communicable diseases: a systematic review","volume":"9","author":"Simpson","year":"2019","journal-title":"BMJ Open"},{"issue":"13","key":"2026032301073093100_ref036","doi-asserted-by":"crossref","first-page":"473","DOI":"10.15585\/mmwr.mm7013a3","article-title":"Willingness to receive a COVID-19 vaccination among incarcerated or detained persons in correctional and detention facilities \u2013 four states, september\u2013december 2020","volume":"70","author":"Stern","year":"2021","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"issue":"Supplement_3","key":"2026032301073093100_ref037","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/eurpub\/ckac129.388","article-title":"COVID-19 vaccination in prison settings: a model to design tailored vaccine delivery strategies","volume":"32","author":"Tavoschi","year":"2022","journal-title":"European Journal of Public Health"},{"key":"2026032301073093100_ref038","unstructured":"United Nations Office on Drugs and Crime (UNODC)\n (2015), \u201cThe united nations standard minimum rules for the treatment of prisoners (the Nelson mandela rules)\u201d, available at:Link to the cited article"},{"key":"2026032301073093100_ref039","unstructured":"United Nations Office on Drugs and Crime (UNODC)\n (2024), \u201cGlobal prison population and trends: a focus on rehabilitation\u201d, available at:Link to the cited article"},{"issue":"20","key":"2026032301073093100_ref040","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17207589","article-title":"Vaccination coverage among prisoners: a systematic review","volume":"17","author":"Vicente-Alcalde","year":"2020","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"21","key":"2026032301073093100_ref041","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17218045","article-title":"Immunization coverage of inmates in Spanish prisons","volume":"17","author":"Vicente-Alcalde","year":"2020","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"2026032301073093100_ref042","unstructured":"World Health Organization (WHO)\n (2007), \u201cHealth in prisons: a WHO guide to the essentials of prison health care\u201d, available at:Link to the cited article"},{"key":"2026032301073093100_ref043","unstructured":"World Health Organization (WHO)\n (2014), \u201cPrisons and health\u201d, available at:Link to the cited article"},{"key":"2026032301073093100_ref044","unstructured":"World Health Organization (WHO)\n (2023), \u201cStatus report on prison health in the WHO European region 2022\u201d, available at:Link to the cited article"},{"key":"2026032301073093100_ref045","unstructured":"World Health Organization, Regional Office for Europe\n (2023), \u201cCreating supportive conditions to reduce infectious diseases in prisons\u201d, available at:Link to the cited article"}],"container-title":["International Journal of Prison Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.emerald.com\/ijoph\/article-pdf\/doi\/10.1108\/IJOPH-11-2025-0089\/11356038\/ijoph-11-2025-0089en.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.emerald.com\/ijoph\/article-pdf\/doi\/10.1108\/IJOPH-11-2025-0089\/11356038\/ijoph-11-2025-0089en.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T05:07:41Z","timestamp":1774242461000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.emerald.com\/ijoph\/article\/doi\/10.1108\/IJOPH-11-2025-0089\/1351362\/Behind-bars-beyond-barriers-a-viewpoint-on"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":45,"URL":"https:\/\/doi.org\/10.1108\/ijoph-11-2025-0089","relation":{},"ISSN":["2977-0254","2977-0262"],"issn-type":[{"value":"2977-0254","type":"print"},{"value":"2977-0262","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]}}}