Fewer than half of inmates in jails and prisons surveyed in a new study said they would accept a COVID-19 vaccine.

The majority surveyed either said they wanted to wait before getting the vaccine or would refuse one.

“This is a population already at risk for COVID-19, and outbreaks among incarcerated people can worsen inequities in COVID-19 outcomes as well as contribute to spread in the surrounding community,” says lead author Marc Stern, affiliate assistant professor of health services in the University of Washington School of Public Health. “So culturally and health-literacy informed interventions are needed to help them feel more confident about getting vaccinated.”

For the study in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, researchers surveyed more than 5,000 inmates, men and women, in late 2020 from three prisons and 13 jails in Washington, California, Florida, and Texas.

Among those asked about their willingness to receive a vaccine, only 45% said they were willing. More than 45% said they would refuse, and nearly 10% said they might or weren’t sure they would receive it.

The most common reasons the participants gave for vaccine hesitancy fell into the response categories of waiting for more information or to see others take it first, and efficacy or safety concerns. The most common reason given for refusal was distrust of the health care system, correctional or government personnel, and institutions.

Researchers conducted the survey before vaccines became available, but at the time, Black and younger respondents were the least willing to get the vaccine. The researchers say a lower willingness to receive a vaccine among Black participants was “not unexpected given historical mistreatment and higher rates of distrust” of these institutions.

“People of color are subject to a ‘double whammy’—they are at higher risk of serious illness from COVID-19 and they are disproportionately incarcerated, living in facilities where they are more likely to become infected,” Stern says.

“I hope this study sheds light on the need to find ways of assuring high levels of vaccination of incarcerated individuals, not just for their own health, but for the health of the community.

Read the full article about vaccine hesitancy in prisons by Jake Ellison at Futurity.