Reasons for COVID-19 vaccine refusal among people incarcerated in Canadian federal prisons.

David Ortiz-Paredes,Joseph Cox,Shainoor J Ismail,Bertrand Lebouché,Nadine Kronfli,Nicole E Basta,Hyejin Park,Shannon E Macdonald,Olivia Varsaneux,James Worthington,Andrea Knittel

doi:10.1371/journal.pone.0264145

Abstract

BackgroundVaccine uptake rates have been historically low in correctional settings. To better understand vaccine hesitancy in these high-risk settings, we explored reasons for COVID-19 vaccine refusal among people in federal prisons.MethodsThree maximum security all-male federal prisons in British Columbia, Alberta, and Ontario (Canada) were chosen, representing prisons with the highest proportions of COVID-19 vaccine refusal. Using a qualitative descriptive design and purposive sampling, individual semi-structured interviews were conducted with incarcerated people who had previously refused at least one COVID-19 vaccine until data saturation was achieved. An inductive–deductive thematic analysis of audio-recorded interview transcripts was conducted using the Conceptual Model of Vaccine Hesitancy.ResultsBetween May 19-July 8, 2021, 14 participants were interviewed (median age: 30 years; n = 7 Indigenous, n = 4 visible minority, n = 3 White). Individual-, interpersonal-, and system-level factors were identified. Three were particularly relevant to the correctional setting: 1) Risk perception: participants perceived that they were at lower risk of COVID-19 due to restricted visits and interactions; 2) Health care services in prison: participants reported feeling “punished” and stigmatized due to strict COVID-19 restrictions, and failed to identify personal benefits of vaccination due to the lack of incentives; 3) Universal distrust: participants expressed distrust in prison employees, including health care providers.InterpretationReasons for vaccine refusal among people in prison are multifaceted. Educational interventions could seek to address COVID-19 risk misconceptions in prison settings. However, impact may be limited if trust is not fostered and if incentives are not considered in vaccine promotion.

Highlights

Canadian correctional settings have witnessed several large SARS-CoV-2 outbreaks since the start of the pandemic [1]
Three were relevant to the correctional setting: 1) Risk perception: participants perceived that they were at lower risk of COVID-19 due to restricted visits and interactions; 2) Health care services in prison: participants reported feeling “punished” and stigmatized due to strict COVID-19 restrictions, and failed to identify
Participants were recruited from Kent Institution (KI; British Columbia), Edmonton Institution (EI; Alberta), and Millhaven Institution (MI; Ontario)

Summary

Introduction

Canadian correctional settings have witnessed several large SARS-CoV-2 outbreaks since the start of the pandemic [1]. This is likely due to close living conditions, overcrowding, an aging and comorbid population, and the challenges in accessing and implementing effective infection prevention measures [2, 3]. Vaccine uptake rates have remained historically low in Canadian prisons despite the availability and promotion of routine vaccination since the 1990s [5]. This might be due to the disproportionate incarceration of people experiencing social and health inequities and the overrepresentation of hard-to-reach populations, who tend to be less engaged in health promotion and prevention programs [5]. To better understand vaccine hesitancy in these high-risk settings, we explored reasons for COVID-19 vaccine refusal among people in federal prisons

Objectives

Methods

Results

Discussion

Conclusion