Prison Vaccination in a pandemic: Geographic disparities and policy insights

Abstract

Introduction: During the COVID-19 pandemic, carceral communities suffered disproportionate impacts across multiple health indicators despite numerous protective measures. As the COVID-19 vaccination campaign began in 2021, many states introduced plans and policies, including prioritization, decarceration, and incentivization, that could increase the vaccination coverage of these vulnerable communities and protect them from further spread. Here, we analyze the geographic distribution of COVID-19 vaccination coverage among incarcerated populations and assess the impact of implemented policies on this coverage.

Methods: We used jurisdiction-level data collected by the UCLA COVID Behind Bars project to characterize vaccination coverage, initial vaccination rate, and days to saturation of coverages in the incarcerated population by state. We also used a regression model to understand the association between implemented policy (incentivization, prioritization, and decarceration) and incarcerated vaccine coverage.

Results: Our study found significant geographic heterogeneity in incarcerated vaccination coverage, initial vaccination rate, and days to saturation of coverage. Our regression analysis revealed that the timing of vaccine prioritization for incarcerated populations, measured as the duration they were prioritized before vaccines became available to the general public, was significantly associated with higher vaccination rates in these facilities. In contrast, decarceration and incentivization had weaker associations with vaccination coverage among the incarcerated.

Conclusion: Our work provides a quantitative analysis of vaccination in confined communities during a public health emergency. We highlight striking geographic disparities in incarcerated vaccination metrics across states, highlighting how decentralized correctional healthcare systems produced uneven protection for this vulnerable population. Our findings also inform optimal allocation of limited resources by demonstrating the effectiveness of early vaccine access policies relative to other policies.

Keywords: carceral; decarceration; incarceration; incentive; prison; vaccination.