California prison staff have significantly lower COVID-19 vaccination rates compared to the incarcerated residents they oversee. And increasing vaccination rates among this high-risk workforce is a challenge that persists nationwide even as new variants overseas threaten to unleash yet another surge here in the United States.
Prisons and jails are high-risk environments for COVID-19 transmission, Stanford Health Policy researchers noted in an original investigation recently published in JAMA Health Forum. The situation is troubling, they said, because prison staff are the route of transmission—both for the start of outbreaks in prisons and for disease flowing back into surrounding communities.
There have been more than 550,000 COVID-19 cases among prison residents and staff nationwide and nearly 3,000 deaths since the pandemic began two years ago. Infection rates among residents are four-to-five times higher than those in the general community. Beginning in December 2020, California prioritized prison residents and employees for vaccination. By mid-October 2021, 77% of the state’s incarcerated residents were vaccinated — whereas vaccination levels among prison staff had reached little more than 60%.
“Correctional staff who socially mix in the communities where they live and also have direct contact with prison residents are likely to be a significant source of introduction of SARS-CoV-2 infection into prisons,” the researchers wrote. The federal government along with several states, including California, tried to address this by implementing vaccine mandates for correctional workers on the frontlines. That in turn prompted prison staff resignations nationwide and lawsuits that have s blocked implementation of these mandates.
The cohort study found that 61% of 23,472 custody staff in California state prisons and 36% of 7,617 health-care staff remained unvaccinated through June 2021, despite six months of widespread vaccine availability. Unvaccinated staff were generally younger and more likely to have previously tested positive for COVID-19 — and they were more likely to work alongside other unvaccinated staff and live in communities with relatively low rates of vaccination.
“Achieving high rates of vaccination and boosting remain a critical public health tool as we are sadly not out of the woods just yet,” said senior author Jeremy Goldhaber-Fiebert, PhD, professor of health policy and one of the founders of the SC-COSMO Consortium based at Stanford Health Policy. “While the surge of Omicron cases in January and February has largely subsided in both communities and prisons, recent increases in case rates caused by the new BA.2 variant in Europe foreshadow future risks in the United States, especially in high transmission settings like prisons and jails.”
The lead author of the study was research data analyst Lea Prince, another member of the consortium whose members have been producing data for the state — among other entities and organizations — to prevent and mitigate the coronavirus in communities throughout California and in the state’s 35 prisons.
The researchers found vaccination hesitancy among the prison staff is complex.
The decision to remain unvaccinated likely involves both assessment of individual risk-benefit and social considerations,” said Goldhaber-Fiebert. “Younger people and those with history of prior infections are probably less likely to get vaccinated as they perceive that they are individually at lower risk of infection or serious health consequences. This is consistent with prior studies.”
The social dimensions can run counter to individual risk protection.
“If a person is living or working with a group of people who are unvaccinated, getting vaccinated is particularly important,” Goldhaber-Fiebert said. “But we see the opposite in our results — people in such groups are less likely to get vaccinated themselves. This is consistent with people being swayed by those around them and seeking out those whose beliefs align with their own.”
This vicious cycle — custody staff more likely to forego vaccines if the people around them remain unvaccinated — could potentially be broken if delivery of staff vaccination were designed with peer effects in mind, the researchers concluded. For example, ensuring that individual staff members have access to vaccination in venues and at times when they can avoid being observed by their coworkers may help to lift vaccination rates. Likewise, as vaccination coverage increases in the prison and in particular among staff groups, communicating the current status of the cohort as a whole may help to shift a staff member’s perception of their peers’ actions.
“The challenge of achieving high coverage of COVID-19 vaccination among workers in high-risk settings across the nation will remain an important public health issue for the foreseeable future,” Goldhaber-Fiebert said. “And SHP researchers will continue to use cutting-edge research to understand and address this challenge.”
The other co-authors of the study were Elizabeth Long, MS; David M. Studdert, LLB, ScD; David Leidner, PhD, Elizabeth T. Chin, BS; Jason R. Andrews, MD, MS; and Joshua A. Salomon, PhD.