Covid-19 Vaccine Acceptance in California State Prisons


To the Editor:

Prisons and jails are high-risk settings for Covid-19, with case and mortality charges far exceeding these within the common neighborhood.1 Extra incarcerated folks have died from Covid-19 in U.S. correctional amenities previously yr than died by capital punishment previously 70 years.2 Some states, together with California, have prioritized incarcerated folks for vaccination.

The California Division of Corrections and Rehabilitation (CDCR) supplied anonymized information on the person-day stage for all California jail residents from December 22, 2020, when the CDCR vaccination program started, by March 4, 2021. The info, that are described within the Supplementary Appendix (obtainable with the complete textual content of this letter at and elsewhere,3 included variables that indicated which residents had been supplied doses of the BNT162b2 (Pfizer–BioNTech) or mRNA-1273 (Moderna) vaccine and which residents accepted. Our objective was to calculate the proportion of residents who accepted not less than one dose among the many residents who had been supplied doses and to make use of multivariable logistic regression evaluation to estimate the chance of the acceptance of not less than one dose in accordance with the residents’ race or ethnic group, age group, medical vulnerability, and historical past of Covid-19. We additionally analyzed acceptance amongst residents who had been reoffered vaccination after they’d initially declined.

Share of Residents Provided Covid-19 Vaccination Who Accepted at Least One Dose.

Proven are the anticipated margins estimated from the outcomes of multivariable logistic-regression analyses of the pattern of 64,387 incarcerated residents who had been supplied not less than one dose of the BNT162b2 or mRNA-1273 vaccine, with changes for room sort (outlined in accordance with the variety of residents housed in a room), participation in penal labor, safety stage, and jail. Particulars of the mannequin specification and a whole set of outcomes are supplied in Desk S3 within the Supplementary Appendix. All of the classes of race or ethnic group apart from Hispanic point out non-Hispanic residents. The California Division of Corrections and Rehabilitation (CDCR) developed a danger rating to grade residents’ chance of extreme Covid-19–associated illness. The chance rating sums weighted values for 17 objects recognized within the scientific literature as danger components for extreme outcomes after SARS-CoV-2 an infection (Desk S1). We categorized scores into low danger (rating of 0 or 1), medium danger (2 or 3), and excessive danger (≥4). Residents had been thought-about to have had a historical past of Covid-19 if they’d had a optimistic check outcome whereas in CDCR custody, earlier than the date of the primary provide of a vaccine.

Two thirds of the 97,779 incarcerated residents had been supplied vaccines; amongst these supplied a vaccine, 66.5% (42,952 of 64,633) accepted not less than one dose. The outcomes of adjusted analyses of the info for residents who had been supplied vaccination indicated that acceptance was highest amongst Hispanic residents (72.6%; 99.6% confidence interval [CI], 72.1 to 73.1) and White residents (72.1%; 99.6% CI, 71.3 to 72.9), barely decrease amongst American Indian or Alaska Native residents (67.7%; 99.6% CI, 64.4 to 71.0) and Asian or Pacific Islander residents (67.7%; 99.6% CI, 64.8 to 70.6), and considerably decrease amongst Black residents (54.9%; 99.6% CI, 54.3 to 55.5) (Determine 1). Youthful and more healthy residents had been much less prone to settle for vaccines than older and medically susceptible residents. The chances of residents who accepted didn’t differ appreciably in accordance with residents’ historical past of Covid-19. Among the many residents who had initially declined and had been subsequently reoffered vaccination, 45.9% (901 of 1962) accepted not less than one dose.

Many of the residents who had been supplied vaccines within the first 10 weeks of this program accepted, and the chances of older and extra medically susceptible residents who accepted are much like these reported in long-term care amenities.4 Nevertheless, acceptance was markedly decrease amongst residents at low danger for extreme sickness from Covid-19 and amongst non-Hispanic minorities, particularly Black residents. Fewer than half of younger, Black residents accepted not less than one dose (Fig. S2), a discovering that will replicate distrust in correctional authorities and clinicians or a scarcity of entry to dependable info on vaccine security and efficacy.5 Nevertheless, an encouraging discovering was {that a} substantial proportion of residents who had initially declined a primary dose later accepted a reoffer — an vital indication that hesitancy isn’t essentially fastened.

Even when Covid-19 vaccines change into broadly obtainable in correctional establishments, achievement and upkeep of ample population-level immunity to keep away from massive outbreaks shall be difficult. Excessive and equitable vaccination uptake is essential; attaining it might depend upon profitable efforts to construct belief and vaccine confidence and on common reoffers to those that decline initially.

Elizabeth T. Chin, B.S.
Stanford College College of Drugs, Stanford, CA
[email protected]

David Leidner, Ph.D.
San Luis Obispo, CA

Theresa Ryckman, B.A.
Yiran E. Liu, B.S.
Lea Prince, Ph.D.
Stanford College College of Drugs, Stanford, CA

Fernando Alarid-Escudero, Ph.D.
Heart for Analysis and Instructing in Economics, Aguascalientes, Mexico

Jason R. Andrews, M.D.
Joshua A. Salomon, Ph.D.
Jeremy D. Goldhaber-Fiebert, Ph.D.
David M. Studdert, LL.B., Sc.D.
Stanford College College of Drugs, Stanford, CA

Supported partly by the Covid-19 Emergency Response Fund at Stanford, established with a present from the Horowitz Household Basis; a grant (R37-DA15612), awarded to Dr. Salomon, from the Nationwide Institute on Drug Abuse; a grant (NU38OT000297-02), awarded to Dr. Salomon, from the Facilities for Illness Management and Prevention although the Council of State and Territorial Epidemiologists; a grant (DGE-1656518), awarded to Ms. Chin, from the Nationwide Science Basis Graduate Analysis Fellowship Program; and a grant (OR2020-69521), awarded to Dr. Alarid-Escudero, from Open Society Foundations.

This letter was printed on Might 12, 2021, at

  1. 1. Hawks L, Woolhandler S, McCormick D. COVID-19 in prisons and jails in the USA. JAMA Intern Med 2020;180:10411042.

  2. 2. Snell TL. Capital punishment, 2018 — statistical tables. Washington, DC: Division of Justice, Bureau of Justice Statistics, September 2020 ( material/pub/pdf/cp18st.pdf).

  3. 3. Chin ET, Ryckman T, Prince L, et al. Covid-19 within the California state jail system: an observational research of decarceration, ongoing dangers, and danger components. March 8, 2021 ( material/10.1101/2021.03.04.21252942v1). preprint.

  4. 4. Gharpure R, Patel A, Hyperlink-Gelles R. First-dose COVID-19 vaccination protection amongst expert nursing facility residents and employees. JAMA 2021;325:16701671.

  5. 5. Momplaisir F, Haynes N, Nkwihoreze H, Nelson M, Werner RM, Jemmott J. Understanding drivers of COVID-19 vaccine hesitancy amongst Blacks. Clin Infect Dis 2021 February 9 (Epub forward of print).


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