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Uptake of Covid-19 vaccines among frontline workers in California state prisons

Background Prisons are high-risk environments for Covid-19. Vaccination levels among prison staff remain troublingly low - lower than levels among residents and members of the surrounding community. 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- and community-level factors associated with being unvaccinated. Design We calculated fractions of prison staff and incarcerated residents in California state prisons who remained unvaccinated. Adjusted analyses identified demographic, community, and peer factors associated with vaccination uptake among staff. Setting California Department of Corrections and Rehabilitation prisons. Participants Custody and healthcare staff who worked in direct contact with residents. Main Outcomes and Measures Remaining unvaccinated through June 30, 2021. Results A total of 26 percent of custody staff and 52 percent of healthcare staff took [≥] 1 dose in the first two months of vaccine offer; uptake stagnated thereafter. By June 30, 2021, 61 percent of custody and 37 percent of healthcare staff remained unvaccinated. Remaining unvaccinated was positively associated with younger age, prior Covid-19, residing in a community with relatively low vaccination rates, and sharing shifts with co-workers who had relatively low vaccination rates. Conclusions and Relevance Vaccine uptake among prison staff in California in regular contact with incarcerated residents has plateaued at levels that pose ongoing risks - both of further outbreaks in the prisons and transmission into surrounding communities. Staff decisions to forego vaccination appear to be complex and multifactorial. Achieving safe levels of vaccine protection among frontline staff may necessitate requiring vaccination as condition of employment.