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was prepared, quite prepared, or extremely prepared for
vaccine rollout to HCWs, staff, and incarcerated individuals,
respectively. Although by a smaller margin, 49%,
67%, and 78% of corrections officers reported their facility
was prepared, quite prepared, or extremely prepared
for vaccine rollout to HCWs, staff, and incarcerated individuals.
''First come first served'' was the most used system
of vaccine rollout for HCWs at 52% and correctional
staff at 60%.
We assessed the use of three possible facilitation strategies
for COVID-19 vaccine rollout: (a) planning for
management of postvaccination symptoms (e.g., differentiate
COVID-19 from postvaccine illness, determine
which individuals need quarantining), (b) planning to
stagger vaccinations to avoid staff shortages, and (c) incentive
use to promote vaccine uptake. The use of planning
for management of postvaccination symptoms was
used most often (Table 1). Incentive use was limited
overall; the most common form of incentive identified
for HCWs and staff was ''paid time off.'' Many respondents
were unsure of their facilities' use of incentives,
with an average of 30% and 22% unsure of incentive
use for HCWs and staff, respectively.
There was a majority opposition to the initiation of
COVID-19 vaccine mandates. Of sheriff respondents
who provided a response, 56% and 63% responded
''no'' when asked if a vaccine approved by the Food
and Drug Administration (FDA) should be mandated
for HCWs and staff, respectively. Of corrections officer
respondents, 72% and 74% responded ''no'' when
asked if an FDA-approved vaccine should be mandated
for HCWs and staff (Table 1).
Respondents ranked willingness to receive the vaccine
as the No. 1 barrier to HCWs and correctional staff.
Respondents ranked concerns about adverse reactions,
absences related to vaccine side effects, and scheduling
multiple doses as the second, third, and fourth strongest
barriers, respectively, for HCWs and correctional staff
(Fig. 1).
Discussion
To our knowledge, this is the first study reporting on
opinions of sheriffs and corrections officers on initial
COVID-19 vaccine rollout in carceral settings. Overall,
stakeholder input from people who work in jails, especially
corrections officers and sheriffs, is rare in health
care literature. Having input from these stakeholders
helps inform how policy dictates practice in correctional
facilities and provides the insight that is critical to creating
strategies to overcome barriers to vaccine distribution
(Rosenbaum, 2021).
As of June 2021, prison staff vaccination rates were
lower than in the general population in almost every
state; in New Hampshire, only 58% of prison staff were
vaccinated as of October 2021 (Lewis & Sisak, 2021;
Rosenbluth, 2021; Tyagi & Rajeshwar, 2021). The persistence
of vaccine hesitancy, despite millions of Americans
having received the vaccine and faring well, informs
the need for continued communication within these settings
to overcome different reasons for refusal (Evans
& French, 2021).
One successful strategy used in Massachusetts has
been bringing medical students, community clinicians,
and faith leaders into jails for ''Ask Me Anything'' sessions
(unpublished data). Other successful strategies
have been vaccine education at morning ''roll call'' and
the use of educational videos (Berk et al., 2021). Notably,
reported use of incentives with HCWs and correctional
staff was limited (Table 1), despite widespread use in
other places of employment (Karni & Stolberg, 2021).
Carceral unions and leadership are hubs of social support
for corrections officers and sheriffs. As such, they
would be powerful tools as a mode of exploring reasons
for vaccine refusal with individuals. Building on these
discussions with use of aforementioned communication
models has the potential to decrease reactant behaviors
and serve to prevent workplace staff shortages (Rosenbaum,
2021; Volpp et al., 2021).
Despite the vaccine being approved in January 2021,
more than 50% of respondents reported that vaccines
were first distributed in March, April, or May (Table 2).
The prioritization of people who are incarcerated is a
strategy rooted in both epidemiological evidence to protect
the most vulnerable and the incarcerated people's
right to health care under the U.S. Constitution (Eber,
2009). The clear support from science and law did not
protect this policy from inciting some controversy and
may have been one factor leading to this delay in distribution
(Quandt, 2020).
Interestingly, there has also been public debate about
prioritization of people who work in jail. One survey
found Americans were less willing to prioritize people incarcerated
in jails and prisons and people who work in
prisons than other National Academies of Science, Engineering,
and Medicine's (NASEM) phase 2 groups such
as teachers, grocery store workers, and healthy older
adults (Persad et al., 2021).
Collective empathy building and education on the interconnectedness
between carceral settings and communities
may be necessary to communicate the elevated
risks that jail staff and carceral communities face. Repairing
the public perceptions of separation from carceral
communities, and subsequent public support for adequate
health care and disease prevention for such groups, will
undoubtedly improve health care outcomes for all
(Aviram, 2021).
The first hospital in the United States to mandate
COVID-19 vaccination did so in April 2021 and several
other institutions have followed (Boyle, 2021). President
Journal of Correctional Health Care - April 2023

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