Behind bars, beyond barriers: a viewpoint on vaccination challenges and opportunities in prison settings

Purpose 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. Design/methodology/approach 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. Findings 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. Research limitations/implications 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. Practical implications 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. Social implications 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. Originality/value 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.