Reaching the hard-to-reach: Increasing access and vaccine uptake among prison population in Europe (RISE-Vac)

Background and aims of the project

Vaccination has proven to be among the most efficient and cost-effective public health interventions to reduce mortality and morbidity from infectious diseases worldwide. Although expanded programs of immunization are well established in the European Union/European Economic Area (EU/EEA), significant immunity gaps and suboptimal vaccination coverage (VC) in a number of countries still exist. According to 2019 State of Health in the EU, tackling the decline in vaccination confidence is one of the key areas for action. Across Europe, vaccine hesitancy (VH) has contributed to declining immunization rates, due to various factors including, lack of knowledge and vaccine literacy (VL), as well as barriers to access. In particular, lower vaccination coverage is registered among specific population groups, including individuals belonging to socially deprived communities, who may in fact benefit from comprehensive life-course vaccination the most.

Among the groups with low vaccination coverage, a key group is represented by people in prison for a number of reasons. In Europe, as globally, most people in prisons belong to socially deprived communities, with an increasing proportion of migrants and persons with minority ethnic backgrounds. Although evidence is scarce, low vaccination coverage among people entering prison is likely due to the combined effect of sub-optimal access to healthcare services and inadequate health and vaccine literacy. The low vaccination coverage, together with the cumulative effect of socio-behavioral risks and additional risk factors intrinsic to the prison environment have as result that, compared with the general population, people in prison have a higher prevalence of infection for a number of diseases for which data are available, such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), syphilis, gonorrhea, chlamydia and tuberculosis (TB). People in prison are also at increased vulnerability to vaccine-preventable diseases (VPD) with outbreak potential in custodial settings, e.g. flu, meningococcal disease, diphtheria, as well as other VPDs such as hepatitis B virus HBV, due e.g. to practices such as tattooing or injecting habits. People who inject drugs (PWID) form a large part of the imprisoned population, with studies showing that the prevalence of substance abuse and dependence, although highly variable, is typically many orders of magnitude higher in prisoners than the general population, particularly for women. The increased prevalence of communicable diseases among people in prisons is recognized as a major risk for the health of both people living and working in prisons and also for the general population, as the vast majority of people in prisons return to their communities after short periods of incarceration (median incarceration time, 8 months). Therefore, for all the above reasons, this population group may benefit from expanded adult vaccination programs.

The RISE-Vac will develop individual-centered and evidence-based models to increase vaccine literacy, access and vaccine uptake among prison population and will support decision-makers, experts and citizens to value and foster quality prison health care in order to tackle health inequalities and health gaps in the European population at large. The project has also four specific objectives (SO) discusses below:

• To provide a comprehensive assessment of vaccine strategies and vaccine uptake in European prison settings: SO1 consists in providing a comprehensive assessment of vaccine strategies and services in place, including vaccine offer and of barriers to vaccine uptake in prison settings in selected European countries;
• To increase vaccine literacy among prison population and prison staff: SO2 will be achieved by designing, developing and implementing education and information tools to increase VU and VL among prison population and prison staff;
• To increase access to vaccine services and vaccine uptake in prison settings: SO3 be achieved by designing, developing and implementing models of care to effectively deliver vaccination services in prison settings;
• To foster quality preventive care in prison settings: SO4 will consist of developing a combination of tools (i.e. training and education materials; vaccine registration tools; scalable models of vaccine delivery; evidencebased recommendations) on how to improve vaccine uptake among prison population in Europe with the scope of supporting decision-makers, experts and European citizens to value and foster quality prison health care in order to tackle health inequalities and health gaps in the European population at large.

The project will be conducted by 9 institutions from 6 European including University of Pisa, (Italy, the project coordinator), Frankfurt University of Applied Sciences (Germany), ASST Santi Paolo e Carlo Presidio Ospedale San Carlo Borromeo - San Paolo Hospital (Italy), Department of Health - Public Health England (United Kingdom), National Administration of Penitentiaries (Moldova), Centre Hospitalier Universitaire Montpellier (France), Health Without Barriers (Italy), Cyprus National Addictions Authority (Cyprus), and the Ministry of Justice and Public Order - Cyprus Prison Department (Cyprus). 

Description of the work packages

Of all seven work packages Frankfurt University of Applied Sciences will be engaged in two work packages: work package 4 and work package 6.

Work package 4: Promoting evidence-informed policies for prison health systems

Actions undertaken: to assess current vaccination program in prison settings and to collect and synthetize evidence on intervention to increase vaccination uptake in order to develop evidence-based guidelines to guide countries in designing, implementing and assessing vaccination services in prison settings in Europe.

Work package 6: Increasing vaccine literacy among prison staff and patients people in prison

Actions undertaken: to develop an e-learning course on Future Learn on vaccination in prisons targeting prison staff, and; information material on vaccinations targeting people in prison using people with lived experience to develop the product/s.

Frankfurt UAS representatives

In this project Prof. Heino Stöver (Chair of the Institute of Addiction Research (ISFF) and leader of the work packages), Mr. Babak Moazen (Research collaborator) will represent Frankfurt University of Applied Sciences.

Laufzeit: 01.01.2021 – 31.12.2023

Förderer: EU-Kommission

Projektleitung: Prof. Dr. Heino Stöver; Frankfurt University of Applied Sciences, Fachbereich “Soziale Arbeit und Gesundheit“ 

Projektmitarbeiter: Babak Moazen