Perceptions of Vaccine Safety and Hesitancy Among Incarcerated Adults and Correctional Staff in the Rural Midwest

Background & Significance. The COVID-19 pandemic raised awareness about the vulnerabilities that people living and working in prisons face during public health crises. With shared living spaces and an aging incarcerated population, prisons were hit especially hard during the height of the pandemic with incidence and mortality rates exceeding that of the general population. Public health crises are not new to prisons, however; each year, prison administrators and staff combat the potential spread of the flu, airborne pathogens, and other communicable diseases. People living in prisons often cycle in and out of different facilities while staff move between their home communities and prisons. This transient context contributes to the high potential for risk of viral spread and disease transmission. Vaccination is the most protective strategy to reduce the risks of infectious diseases among people living and working in prisons yet vaccine hesitancy has increased, particularly in rural regions of the U.S. This project assessed vaccine hesitancy among staff and incarcerated adults in one rural medium-security prison in the Midwestern U.S. and identified differences in hesitancy across sociodemographic and work-related variables.

Methods. 610 prison staff and people incarcerated completed a cross-sectional survey in May 2021. The vaccine hesitancy scale (VHS) identified perceived risk and confidence in vaccination. The VHS is not specific to one vaccine; it assesses general perceptions of vaccination. A single item measured whether people typically follow public health protocols in the prison. Background and demographic variables were also collected. A combination of analyses was utilized including ANOVA, Chi-Square, and Pearson’s correlation.

Results. Vaccine hesitancy was moderate to high for both populations. Incarcerated people had more confidence in vaccination than staff; differences did not reach statistical significance, F(1, 540) = 1.30, p = .26. Incarcerated people had statistically significantly higher perceptions of risk compared to staff, F(1, 544) = 3.84, p = .05. Both populations reported doing their best to follow public health protocols. For both populations, vaccine hesitancy varied by education and veteran status. Among staff, hesitancy varied by gender and political beliefs. For people incarcerated, it varied by pre-incarceration income and visit frequency.

Conclusions. Studies show vaccine hesitancy is associated with a person’s choice to vaccinate themselves and family members. This study finds moderate vaccine hesitancy among staff living in primarily rural areas and people incarcerated. General hesitancy and distrust may, in part, stem from distrust in the criminal-legal system among incarcerated people. Developing partnerships with local public health agencies may be a promising strategy for some; however, official partnerships with government agencies may actually deter some people from undergoing vaccination due to perceived risk of current or future surveillance. Partnering with people who are currently and formerly incarcerated and with correctional staff to develop effective plans for these unique populations is key to integrating local and group norms into health and safety planning. Targeted intervention is needed to reduce hesitancy within the staff and incarcerated populations so implemented public health protocols like vaccination for influenza or booster shots for COVID-19 are accepted.