Scaling up vaccination for people living in prisons: a global person-centred need for public health.

BACKGROUND: People living in prison (PLP) are at increased risk of vaccine-preventable diseases due to overcrowding, high turnover, and limited healthcare access. Vaccination is a cost-effective preventive intervention, yet coverage in prisons remains inconsistent and frequently absent from national immunisation strategies. OBJECTIVE: To develop evidence-based guidance to strengthen vaccination services in prisons, ensuring equity, continuity of care, and alignment with international public health standards. METHODS: The EU-funded RISE-Vac project employed a multistage approach, including two systematic reviews, a cross-country survey in 20 European states, stakeholder interviews, and focus groups. Evidence from these sources was triangulated within a dedicated database and synthesised into five domain-specific working documents, structured by public health objective, target population and modality of vaccine offer. Draft guidance was validated through a structured consensus process with a multidisciplinary expert panel (n = 27) and refined through two rounds of remote revisions. RESULTS: Key facilitators identified include integration of vaccination within prison health services, staff training, peer-led approaches, clear governance and financing, and interoperable health information systems. An incremental model of service delivery was proposed, ranging from a minimum package aligned with community standards to an expanded offer addressing the heightened health needs of PLP. This model encompasses catch-up and seasonal vaccination, cancer-preventing vaccines, and tailored interventions for specific risk groups, with continuity of care post-release as a central component. CONCLUSIONS: Strengthening prison vaccination requires an incremental, person-centred model that integrates vaccination into routine prison healthcare, is supported by trained staff, peer-led initiatives, dedicated governance, and interoperable health information systems, and that addresses five priority domains, from catch-up and cancer-preventing vaccination to continuity of care after release. Embedding this model within national immunisation strategies can prevent outbreaks, reduce health inequities, and protect both PLP and the wider community.