Determinants of SARS-CoV-2 vaccine willingness among people incarcerated in 3 Canadian federal prisons: a cross-sectional study

Abstract

Canadian correctional settings have witnessed several large SARS-CoV-2 outbreaks since the start of the COVID-19 pandemic. [1][2][3] Many of the risk factors that predispose correctional settings to SARS-CoV-2 outbreaksclose living conditions, 4,5 an aging and comorbid population, 5,6 and limited autonomy that affects access to health care 7,8 -are nonmodifiable, underscoring the importance of SARS-CoV-2 vaccination. 9 The Canadian National Advisory Committee on Immunization prioritized residents and staff of congregate settings, such as correctional settings, for early SARS-CoV-2 vaccination in December 2020. 10 However, rates of vaccine uptake have remained historically low in Canadian prisons despite the routine availability and promotion of vaccination since the 1990s. 11 Given the disproportionate incarceration of people experiencing social and health inequities, [12][13][14][15][16] maximizing vaccine acceptance is essential in preventing morbidity and death from vaccine-preventable diseases among the 30 000 adults currently incarcerated in Canadian federal and provincial or territorial prisons.

Preparing correctional settings for the next pandemic: a modeling study of COVID-19 outbreaks in two high-income countries

“…Prisons are therefore high-priority settings for coordinated public health responses to the COVID-19 pandemic and future outbreaks of other respiratory infections (3,(12)(13)(14)(15). However, the response to COVID-19 in prisons has been hampered due to limited access and use of personal protective equipment (PPE) in resource-limited settings, poorer access and delay the vaccination and vaccine hesitancy, security and logistical constraints, frequent movement of people between correctional settings, and the continuous entry and exit of people into the prison (16)(17)(18)(19)(20). Correctional settings, therefore, require system-level and evidence-based responses (21,22).…”

Education increases COVID-19 vaccine uptake among people in Canadian federal prisons in a prospective randomized controlled trial: The EDUCATE study

“…The first questionnaire (the pre-intervention questionnaire (Supplementary Appendix C); ∼20 minutes) assessed socio-demographic and clinical characteristics, as well as knowledge, attitudes, and beliefs towards COVID-19 vaccines. We developed the survey questions by adapting questions from the World Health Organization Strategic Advisory Group of Experts Working Group on Vaccine Hesitancy [20] , Leger’s North American Tracker – Concerns about COVID-19 [21] , Statistics Canada’s Canadian Perspectives Survey Series 3 [8] , the National Advisory Committee on Immunization Acceptability Matrix [22] , an online survey of vaccine acceptability among the Canadian general public [23] , and the 5C vaccine confidence scale [24] . We pilot-tested the questionnaire with 15 people in prison to ensure clarity before study inception.…”

“…As incarcerated individuals disproportionately experience social determinants of health associated with increased risk of COVID-19 due to a higher prevalence of chronic diseases such as hypertension and diabetes and, additionally, live in congregate settings with a high risk of transmission, efforts to maximize COVID-19 vaccine uptake, one of the most effective tools for reducing COVID-19 morbidity and mortality, are paramount. However, vaccine hesitancy is not uncommon among people in prison [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] . Studies investigating reasons for vaccine refusal among people incarcerated in Canadian federal prisons found that a lack of information and misinformation were important barriers to COVID-19 vaccine acceptability [9] , [12] , underscoring the potential for educational interventions to improve COVID-19 vaccine uptake.…”

Understanding the determinants of vaccine hesitancy in the United States: A comparison of social surveys and social media

“…Previous work by [ 56 ] using China and the US as case studies, for example, showed that acquiescence bias can inflate estimated incidence of conspiratorial beliefs and political perceptions by as much as 50%. Related to this is the dissent bias where people tend to express a negative agreement in a more frequent manner [ 57 ]. Survey results can also be affected by social desirability bias wherein respondents choose responses that they believe will make them be viewed favorably by others [ 57 ].…”