10.P. Scientific session: Improving health security and preparedness: are we leaving someone behind?

Abstract Prisons are unique, high-risk, high-security, complex settings; however, the impact of emergencies on prisons is a concern not only to the prison but also to the functioning of, for example, the criminal justice system, policing and courts, as well as to the general public. Prison environments can amplify infectious diseases. In the context of emerging health threats, this risk could be made into an asset through early warning surveillance and epidemiological studies. Many global and public health actors advocated for the inclusion of prisons and custodial settings in a comprehensive response to emerging threats since the early days of the COVID-19 pandemic and again during the Mpox epidemic. The increase in risk in closed environments and the vulnerability of people living in prisons make prisons and other custodial settings potential hotspots for transmission of infectious diseases and for excess morbidity and mortality. Yet, as mentioned above, prisons have been included to only a limited extent in national preparedness and response plans. Similarly, prisons are not always explicitly mentioned in international guidance on the preparation of national plans or in measures taken in the absence of such guidance. Preventing, predicting and responding to threats to the health of prison populations require scientifically valid, evidence-based interventions and assessment of the positive and negative impact of control measures on the population, especially in view of the unequal distribution of harm and disease among people living in prison and unequal access to mitigation or therapeutic interventions. Because of a general lack of timely, good-quality, translatable evidence on prison health, guidance for the management of health threats in prisons is often based on adapting other sources to the prison setting (so-called “prisonification” of guidelines), rather than on evidence specific to prisons. Prisons and custodial settings may also be affected by other biological, chemical, radionuclear and environmental hazards, all of which must be catered for in comprehensive preparedness and response plans. Timely collection of information is essential for national preparedness and response capacity to ensure rapid identification and response to threats. Again, however, the prison population is often excluded from or not explicitly identified in national surveillance systems. As a result, cases or outbreaks may not be identified or not receive an effective response, due to lack of collaborative structures between prison and public health authorities. Inclusion of prisons in local, regional, national and international emergency planning is therefore essential to test plans and revise guidance on the basis of evidence, exercises and/or real events. This workshop aims at exploring the current landscape and deriving implications for preparedness and health security in Europe and beyond. Key messages • Prison authorities should be included as stakeholders in the development of national preparedness and contingency plans according to good governance approach. • Explicit inclusion of prisons and other custodial settings in international and national plans for preparedness and response to emerging health threats is needed.