What is the international policy context relating to the provision of hepatitis services for people in prison?

In addition to the broader public health benefits of eliminating viral hepatitis in the prison setting, there is also a strong human rights argument for implementing and scaling up elimination programs, evidenced across international principles, recognised standards and case law.  

The enjoyment of the highest attainable standard of physical and mental health is an internationally recognised and fundamental human right of every person. 

The most commonly cited principle of equivalence of care in the context of the prison population is the 2015 Nelson Mandela Rules (cited at the 2015 United Nations General Assembly (United Nations, 2015b)) which states that ‘prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary healthcare services free of charge without discrimination on the grounds of their legal status’ (Rule 24).  

The Sustainable Development Goals (SDGs) make a strong commitment to end the epidemics of AIDS, tuberculosis, malaria and other communicable diseases by 2030. Universal access to healthcare and health services are described under UN SDG 3: Ensure healthy lives and promote well-being for all at all ages.  

Other UN resolutions for specific ​populations such as the 2010 Bangkok Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders specify the health screening of prisoners to include comprehensive screening for sexually transmitted diseases or blood-borne viruses.  

Predating this further still, the 1990 Havana rules articulate that juveniles who are deprived of liberty should also have the right to facilities and services that meet all the requirements of health and human dignity.  

As indicated in the Optional Protocol to the Convention against Torture (OPCAT), ‘a human rights perspective should be adopted in providing health treatment in view of the need to prevent inhuman or degrading treatment or punishment for people deprived of their liberty’ (United Nations, 2002).  

The 2023 guidance document on the European Prison Rules, developed by the Council of Europe, outlines a comprehensive set of rules and guidelines on the management of prisons and the treatment of people living in prison.  

Healthcare is covered through a series of fundamental principles that cut across the delivery of prison healthcare services, including continuity of care, equivalence of care, non-discrimination and independence (PRI, 2023). As a result, the attainment of the equivalent standards of healthcare has been well documented across international human rights law and international guidance documents for decades. 

The 2022 European Union Council Recommendations related to people in prison, state that EU Member States should provide regular medical supervision and should encourage vaccination and health screening programmes for communicable (HIV, viral hepatitis B and C, tuberculosis and sexually transmitted diseases) and non-communicable diseases (especially cancer screening), followed up by diagnosis and initiation of treatment where required (EU, 2022).  

​​​​​​Access to​ viral hepatitis care in the prison setting is also reflected in international human rights case law. Testing in prisons can be seen as opportunity to identify infectious diseases in underserved groups: ‘[…] the spread of transmissible diseases should be a major public-health concern, especially in prisons […] it would be desirable if, with their consent, [people] could benefit, within a reasonable time after being committed to prison settings, from free screening’ for different types of viral hepatitis, HIV and TB (European Court of Human Rights, Council of Europe, 2017).  

In the European Commission’s 2024 Council Recommendation on vaccine-preventable cancers, it is recommended that special attention should be paid to people who inject drugs, ‘and making HBV vaccination routine in drug treatment, prison and harm-reduction services, in a stigma-free environment, on a voluntary basis, without costs for the person being vaccinated, and with the possibility for accessing an accelerated dosing schedule’ (EU, 2024).

WHY ADDRESS HEPATITIS IN PRISONS?

Addressing viral hepatitis in prisons is an opportunity to substantially reduce the associated morbidity and mortality in Europe and advance viral hepatitis elimination. It also provides the opportunity to help tackle the often complex and multiple health needs of an underserved population and to help reduce health inequalities.