Over 3,000 incarcerated and detained people in the United States have died of COVID-19 in the past two years, with over 588,000 cumulative cases behind bars. With little sign of COVID-19 quietly fading away, public health officials have been clear, consistent, and accurate that vaccinations are our strongest defense against existing and future variants of COVID-19. But despite widespread vaccine availability across the country, many people continue to be hesitant about the COVID-19 vaccination.

While the vaccine refusal rates are not generally worse in prisons than in the general population, vaccination is even more critical in prisons. Incarcerated people can’t employ other strategies to avoid getting COVID-19, they have higher rates of medical conditions that make them more vulnerable to severe illness and death, and if they do fall ill, they don’t have the same access to prompt, effective medical care as people outside of prison do. Behind bars, the risks of non-vaccination can be even more deadly, with a COVID-19 death rate of more than double that of the general U.S. population.

An insightful new report from the Correctional Association of New York offers the only survey data we know of that explains why incarcerated people are hesitant to accept the COVID-19 vaccination. A report focusing on New York is particularly valuable nationally because New York State was one of the least successful states at vaccinating incarcerated people. The report finds that vaccine hesitancy in prison is rooted in general distrust and suspicion of healthcare in prison, and that the solutions to overcome vaccine hesitancy behind bars are more complicated than in non-carceral settings.

Researchers have determined that the best practice for addressing vaccine hesitancy – in general and in the context of COVID-19 – is to promote transparency, equity, and trust between individuals, communities, and healthcare providers. In addition, we know that community engagement, messaging and education, and timely and accurate information about vaccines are critical for responses to vaccine hesitancy.

The reality is that the prison context inherently undermines almost all of the best practices for responding to vaccine hesitancy.

Read the full article about the prison system and public health by Emily Widra at Prison Policy Initiative.