Uptake of COVID-19 Vaccination Among Frontline Workers in California State Prisons

Importance Prisons and jails are high-risk environments for COVID-19. Vaccination levels among workers in many such settings remain markedly lower than those of residents and members of surrounding communities. The situation is troubling because prison staff are a key vector for COVID-19 transmission. Objective To assess patterns and timing of staff vaccination in California state prisons and identify individual-level and community-level factors associated with remaining unvaccinated. Design, Setting, and Participants This cohort study used data from December 22, 2020, through June 30, 2021, to quantify the fractions of staff and incarcerated residents who remained unvaccinated among 23 472 custody and 7617 health care staff who worked in roles requiring direct contact with residents at 33 of the 35 prisons operated by the California Department of Corrections and Rehabilitation. Multivariable probit regressions assessed demographic, community, and peer factors associated with staff vaccination uptake. Main Outcomes and Measures Remaining unvaccinated throughout the study period. Results Of 23 472 custody staff, 3751 (16%) were women, and 1454 (6%) were Asian/Pacific Islander individuals, 1571 (7%) Black individuals, 9008 (38%) Hispanic individuals, and 6666 (28%) White individuals. Of 7617 health care staff, 5434 (71%) were women, and 2148 (28%) were Asian/Pacific Islander individuals, 1201 (16%) Black individuals, 1409 (18%) Hispanic individuals, and 1771 (23%) White individuals. A total of 6103 custody staff (26%) and 3961 health care staff (52%) received 1 or more doses of a COVID-19 vaccine during the first 2 months vaccines were offered, but vaccination rates stagnated thereafter. By June 30, 2021, 14 317 custody staff (61%) and 2819 health care staff (37%) remained unvaccinated. In adjusted analyses, remaining unvaccinated was positively associated with younger age (custody staff: age, 18-29 years vs >= 60 years, 75% [95% CI, 73%-76%] vs 45% [95% CI, 42%-48%]; health care staff: 52% [95% CI, 48%-56%] vs 29% [95% CI, 27%-32%]), prior COVID-19 infection (custody staff: 67% [95% CI, 66%-68%] vs 59% [95% CI, 59%-60%]; health care staff: 44% [95% CI, 42%-47%] vs 36% [95% CI, 36%-36%]), residing in a community with relatively low rates of vaccination (custody staff: 75th vs 25th percentile:, 63% [95% CI, 62%-63%] vs 60% [95% CI, 59%-60%]; health care staff: 40% [95% CI, 39%-41%] vs 34% [95% CI, 33%-35%]), and sharing shifts with coworkers who had relatively low rates of vaccination (custody staff: 75th vs 25th percentile, 64% [95% CI, 62%-66%] vs 59% [95% CI, 57%-61%]; health care staff: 38% [95% CI, 36%-41%] vs 35% [95% CI, 31%-39%]). Conclusions and Relevance This cohort study of California state prison custody and health care staff found that vaccination uptake plateaued at levels that posed ongoing risks of further outbreaks in the prisons and continuing transmission from prisons to surrounding communities. Prison staff decisions to forgo vaccination appear to be multifactorial, and vaccine mandates may be necessary to achieve adequate levels of immunity in this high-risk setting. Question In California prisons, what proportion of prison staff who have direct contact with residents are unvaccinated, and what are their characteristics? Findings In this cohort study of 23 472 custody staff and 7617 health care staff in California state prisons, 14 317 custody staff (61%) and 2819 (36%) health care staff remained unvaccinated through June 30, 2021, despite widespread vaccine availability. Unvaccinated staff were younger and more likely to have had COVID-19; they were also more likely to work alongside other unvaccinated staff and live in communities with relatively low rates of vaccination. Meaning The study results suggest that low vaccination rates among prison staff pose continuing risks. This cohort study examines rates of COVID-19 vaccination among custody staff and health care staff in California state prisons.

Automated summary

This cohort study examines rates of COVID-19 vaccination among custody staff and health care staff in California state prisons. The study found that despite widespread vaccine availability, 61% of custody staff and 36% of health care staff remained unvaccinated through June 30, 2021. Unvaccinated staff were younger, more likely to have had COVID-19, and more likely to work alongside other unvaccinated staff and live in communities with relatively low rates of vaccination.