COVID-19 vaccine prioritization of incarcerated people relative to other vulnerable groups: An analysis of state plans

Health disparities among incarcerated populations: a crucial laboratory and pathology review

BACKGROUND

The United States notoriously has one of the highest rates of incarceration in the world, yet scant attention to the health care needs of those incarcerated exists within laboratory medicine and pathology training and education. This article explores health disparities among incarcerated and released individuals regarding diagnostic laboratory testing and pathology services.

METHODS

A literature search was conducted for articles published between 2002 and 2023 using keywords including "healthcare," "incarcerated," "laboratory services," "pathology services," and "health insurance for prisoners." Central themes were extracted and discussed to reveal the realities of health care during and after release from incarceration. Excluded from the analysis were articles about the immediate or extended family of incarcerated persons.

RESULTS

Incarcerated individuals have an increased risk for the development and exacerbation of communicable and noncommunicable diseases and mental health disorders, which results in exceedingly high morbidity and mortality rates.

CONCLUSION

Policy changes are needed to mitigate disparities and improve health outcomes for incarcerated and released persons. Central to these disparities is decreased access to laboratory and pathology services, impeded by inadequate health care funding for these carceral institutions. Providing additional funding to the carceral system's health care budget is necessary to improve access to pathology and laboratory services.

Cooperating Graph Neural Networks With Deep Reinforcement Learning for Vaccine Prioritization

This study explores the vaccine prioritization strategy to reduce the overall burden of the pandemic when the supply is limited. Existing vaccine distribution methods focus on macro-level or simplified micro-level assuming homogeneous behavior within populations without considering mobility patterns. Directly applying these models for micro-level vaccine allocation leads to sub-optimal solutions. To address the issue, we first proposed a Trans-vaccine-SEIR model to incorporate mobility heterogeneity in disease propagation. Then we develop a novel deep reinforcement learning to seek the optimal vaccine allocation strategy for the disease evolution system. The graph neural network is used to effectively capture the structural properties of the mobility network and extract disease features. In our evaluation, the proposed framework reduces 7%-10% of infections and deaths compared to the baseline strategies. Extensive evaluation shows that the proposed framework is robust to seek the optimal vaccine allocation with diverse mobility patterns. In particular, we find transit usage restriction is significantly more effective than restricting cross-zone mobility for the top 10% age-based and income-based zones under optimal vaccine allocation strategy. These results provide valuable insights for areas with limited vaccines and low logistic efficacy.

Dynamic contact networks of residents of an urban jail in the era of SARS-CoV-2

BACKGROUND

In custodial settings such as jails and prisons, infectious disease transmission is heightened by factors such as overcrowding and limited healthcare access. Specific features of social contact networks within these settings have not been sufficiently characterized, especially in the context of a large-scale respiratory infectious disease outbreak. The study aims to quantify contact network dynamics within the Fulton County Jail in Atlanta, Georgia.

METHODS

Jail roster data were utilized to construct social contact networks. Rosters included resident details, cell locations, and demographic information. This analysis involved 6702 male residents over 140,901 person days. Network statistics, including degree, mixing, and dissolution (movement within and out of the jail) rates, were assessed. We compared outcomes for two distinct periods (January 2022 and April 2022) to understand potential responses in network structures during and after the SARS-CoV-2 Omicron variant peak.

RESULTS

We found high cross-sectional network degree at both cell and block levels. While mean degree increased with age, older residents exhibited lower degree during the Omicron peak. Block-level networks demonstrated higher mean degrees than cell-level networks. Cumulative degree distributions increased from January to April, indicating heightened contacts after the outbreak. Assortative age mixing was strong, especially for younger residents. Dynamic network statistics illustrated increased degrees over time, emphasizing the potential for disease spread.

CONCLUSIONS

Despite some reduction in network characteristics during the Omicron peak, the contact networks within the Fulton County Jail presented ideal conditions for infectious disease transmission. Age-specific mixing patterns suggested unintentional age segregation, potentially limiting disease spread to older residents. This study underscores the necessity for ongoing monitoring of contact networks in carceral settings and provides valuable insights for epidemic modeling and intervention strategies, including quarantine, depopulation, and vaccination, laying a foundation for understanding disease dynamics in such environments.Top of Form.

Respect for bioethical principles and human rights in prisons: a systematic review on the state of the art

BACKGROUND

Respect for human rights and bioethical principles in prisons is a crucial aspect of society and is proportional to the well-being of the general population. To date, these ethical principles have been lacking in prisons and prisoners are victims of abuse with strong repercussions on their physical and mental health.

METHODS

A systematic review was performed, through a MESH of the following words (bioethics) AND (prison), (ethics) AND (prison), (bioethics) AND (jail), (ethics) AND (jail), (bioethics) AND (penitentiary), (ethics) AND (penitentiary), (prison) AND (human rights). Inclusion and exclusion criteria were defined and after PRISMA, 17 articles were included in the systematic review.

RESULTS

Of the 17 articles, most were prevalence studies (n.5) or surveys (n.4), followed by cross-sectional studies (n.3), qualitative studies (n.1), retrospective (n.1) and an explanatory sequential mixed-methods study design (n.1). In most cases, the studies associated bioethics with prisoners' access to treatment for various pathologies such as vaccinations, tuberculosis, hepatitis, HIV, it was also found that bioethics in prisons was related to the mental health of prisoners, disability, ageing, the condition of women, the risk of suicide or with the request for end-of-life by prisoners. The results showed shortcomings in the system of maintaining bioethical principles and respect for human rights.

CONCLUSIONS

Prisoners, in fact, find it difficult to access care, and have an increased risk of suicide and disability. Furthermore, they are often used as improper organ donors and have constrained autonomy that also compromises their willingness to have end-of-life treatments. In conclusion, prison staff (doctors, nurses, warders, managers) must undergo continuous refresher courses to ensure compliance with ethical principles and human rights in prisons.

Controlling COVID-19 outbreaks in the correctional setting: A mathematical modelling study

Correctional centres (termed here 'prisons') are at high risk of COVID-19 and have featured major outbreaks worldwide. Inevitable close contacts, frequent inmate movements, and a disproportionate burden of co-morbidities mean these environments need to be prioritised in any public health response to respiratory pathogens such as COVID-19. We developed an individual-based SARS-CoV-2 transmission model for the prison system in New South Wales, Australia - incorporating all 33 correctional centres, 13,458 inmates, 578 healthcare and 6,909 custodial staff. Potential COVID-19 disease outbreaks were assessed under various mitigation strategies, including quarantine on entry, isolation of cases, rapid antigen testing of staff, as well as immunisation.Without control measures, the model projected a peak of 472 new infections daily by day 35 across the prison system, with all inmates infected by day 120. The most effective individual mitigation strategies were high immunisation coverage and prompt lockdown of centres with infected inmates which reduced outbreak size by 62-73%. Other than immunisation, the combination of quarantine of inmates at entry, isolation of proven or suspected cases, and widespread use of personal protective equipment by staff and inmates was the most effective strategy. High immunisation coverage mitigates the spread of COVID-19 within and between correctional settings but is insufficient alone. Maintaining quarantine and isolation, along with high immunisation levels, will allow correctional systems to function with a low risk of outbreaks. These results have informed public health policy for respiratory pathogens in Australian correctional systems.

Effects of the COVID-19 pandemic on people experiencing incarceration: a systematic review

OBJECTIVE

To assess the effect of the COVID-19 pandemic on people experiencing incarceration (PEI), focusing particularly on clinical outcomes compared with the general population.

DESIGN

Systematic review with narrative synthesis in accordance with the Centre for Reviews and Dissemination's good practice guidelines.

DATA SOURCES

Medline, Social Policy and Practice, Criminology Connection, ASSIA, EMBASE, SCOPUS, Web Of Science, CINAHL, Cochrane Library, Cochrane COVID-19 reviews, COVID-19 Evidence Reviews and L*OVE COVID-19 Evidence databases were searched up to 21 October 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included studies presenting data specific to adults ≥18 years experiencing incarceration, with exposure to SARS-CoV-2 infection. All studies with a comparison group, regardless of study design and country were included. Studies with no comparison group data or not measuring clinical outcomes/health inequalities were excluded. Studies focussing on detained migrants, forensic hospitals, prison staff and those not in English were also excluded.

DATA EXTRACTION AND SYNTHESIS

Two reviewers extracted data and assessed risk of bias. Data underwent narrative synthesis using a framework analysis based on the objectives, for infection rates, testing, hospitalisation, mortality, vaccine uptake rates and mental health outcomes. There was no scope for meta-analysis, due to the heterogeneity of evidence available.

RESULTS

4516 references were exported from the databases and grey literature searched, of which 55 met the inclusion criteria. Most were from the USA and were retrospective analyses. Compared with the general population, PEI were usually found to have higher rates of SARS-CoV-2 infection and poorer clinical outcomes. Conflicting data were found regarding vaccine uptake and testing rates compared with the general population. The mental health of PEI declined during the pandemic. Certain subgroups were more adversely affected by the COVID-19 pandemic, such as ethnic minorities and older PEI.

CONCLUSION

PEI have poorer COVID-19 clinical outcomes than the general public, as shown by largely low-quality heterogenous evidence. Further high-quality research of continuing clinical outcomes and appropriate mitigating interventions is required to assess downstream effects of the pandemic on PEI. However, performing such research in the context of incarceration facilities is highly complex and potentially challenging. Prioritisation of resources for this vulnerable group should be a focus of national policy in the event of future pandemics.

PROSPERO REGISTRATION NUMBER

CRD42022296968.

Allocating health care resources in jails and prisons during COVID-19: a qualitative study of carceral decision-makers

COVID-19 created acute demands on health resources in jails and prisons, burdening health care providers and straining capacity. However, little is known about how carceral decision-makers balanced the allocation of scarce resources to optimize access to and quality of care for incarcerated individuals. This study analyzes a national sample of semi-structured interviews with health care and custody officials (n = 32) with decision-making authority in 1 or more carceral facilities during the COVID-19 pandemic. Interviews took place between May and October 2021. We coded transcripts using a directed content analysis approach and analyzed data for emergent themes. Participants reported that facilities distributed personal protective equipment to staff before incarcerated populations due to staff's unique role as potential vectors of COVID-19. The use of testing reflected not only an initial imperative to preserve limited supplies but also more complex decision-making about the value of test results to facility operations. Participants also emphasized the difficulties caused by limited physical space, insufficient staff, and stress from modifying job roles. The rapid onset of COVID-19 confronted decision-makers with unprecedented resource allocation decisions, often with life-or-death consequences. Planning for future resource allocation decisions now may promote more equitable decisions when confronted with a future pandemic event.

Self-rated health impact of COVID 19 confinement on inmates in Southeastern of Europe: a qualitative study

INTRODUCTION

The COVID-19 pandemic necessitated the implementation of various measures within closed institutions like prisons to control the spread of the virus. Analyzing the impact of these measures on the health of inmates is crucial from a public health perspective. This study aimed to explore inmates' subjective perception of the COVID-19 lockdown, the implemented measures, their physical self-perception, and their views on the vaccination process.

METHOD

Between April 2021 and January 2022, 27 semi-structured individual interviews and 1 focus group were conducted with inmates in a prison located in northwest Spain. The interviews were conducted in person and audio-recorded. Thematic content analysis was employed, utilizing methodological triangulation to enhance the coherence and rigor of the results.

RESULTS

The analysis revealed two main themes and nine subthemes. The first theme focused on inmates' perception of the implementation of protective measures against COVID-19 within the prison and its impact on their well-being. The second theme explored the pandemic's emotional impact on inmates. All participants reported negative consequences on their health resulting from the measures implemented by the institution to contain the pandemic. However, they acknowledged that measures like lockdowns and mass vaccination helped mitigate the spread of the virus within the prison, contrary to initial expectations.

CONCLUSION

COVID-19 and related measures have directly affected the health of inmates. To improve their health and minimize the impact of pandemic-induced changes, community participation and empowerment of individuals are essential tools, particularly within closed institutions such as prisons.

Trends in COVID-19 and influenza vaccine ordering and distribution in Massachusetts jails

Incarcerated populations are highly vulnerable to respiratory illnesses such as COVID-19 and influenza. We evaluated COVID-19 and influenza vaccine ordering and administration rates among 13 of 14 Massachusetts county jails and compared them with rates in the general population. Results showed heterogeneity in the number of vaccines ordered per incarcerated individual across institutions, with small to medium-sized jails ordering more vaccines per person. Vaccine administration in jails utilized approximately 41% of the total vaccines ordered by jails. Additionally, the study revealed disparities in vaccine brand distribution between incarcerated and non-incarcerated populations, potentially perpetuating historical health inequities in carceral settings. Considering that vaccine hesitancy among incarcerated individuals and jail staff has been identified as a significant barrier to vaccination, these findings underscore the need for equitable and comprehensive vaccine distribution strategies in carceral settings, necessitating collaboration between public health and correctional systems to ensure the health and well-being of incarcerated individuals.

Dynamic Contact Networks of Residents of an Urban Jail in the Era of SARS-CoV-2

Background

In custodial settings such as jails and prisons, infectious disease transmission is heightened by factors such as overcrowding and limited healthcare access. Specific features of social contact networks within these settings have not been sufficiently characterized, especially in the context of a large-scale respiratory infectious disease outbreak. The study aims to quantify contact network dynamics within the Fulton County Jail in Atlanta, Georgia, to improve our understanding respiratory disease spread to informs public health interventions.

Methods

As part of the Surveillance by Wastewater and Nasal Self-collection of Specimens (SWANSS) study, jail roster data were utilized to construct social contact networks. Rosters included resident details, cell locations, and demographic information. This analysis involved 6,702 residents over 140,901 person days. Network statistics, including degree, mixing, and turnover rates, were assessed across age groups, race/ethnicities, and jail floors. We compared outcomes for two distinct periods (January 2022 and April 2022) to understand potential responses in network structures during and after the SARS-CoV-2 Omicron variant peak.

Results

We found high cross-sectional network degree at both cell and block levels, indicative of substantial daily contacts. While mean degree increased with age, older residents exhibited lower degree during the Omicron peak, suggesting potential quarantine measures. Block-level networks demonstrated higher mean degrees than cell-level networks. Cumulative degree distributions for both levels increased from January to April, indicating heightened contacts after the outbreak. Assortative age mixing was strong, especially for residents aged 20-29. Dynamic network statistics illustrated increased degrees over time, emphasizing the potential for disease spread, albeit with a lower growth rate during the Omicron peak.

Conclusions

The contact networks within the Fulton County Jail presented ideal conditions for infectious disease transmission. Despite some reduction in network characteristics during the Omicron peak, the potential for disease spread remained high. Age-specific mixing patterns suggested unintentional age segregation, potentially limiting disease spread to older residents. The study underscores the need for ongoing monitoring of contact networks in carceral settings and provides valuable insights for epidemic modeling and intervention strategies, including quarantine, depopulation, and vaccination. This network analysis offers a foundation for understanding disease dynamics in carceral environments.

Incarcerated in a Pandemic: How COVID-19 Exacerbated the “Pains of Imprisonment”

Although the exact toll of COVID-19 in U.S. prisons and jails is relatively undetermined, estimates show that deaths due to the virus in the nation's correctional facilities are approximately six times higher than deaths in the general population. During the pandemic, jail and prison structures as well as significant overcrowding made it virtually impossible to institute protective measures against infection in correctional settings. Jail and prison administrators suspended in-person visitation, leaving those incarcerated even further isolated, and their friends and family in fear for the health and safety of their loved ones. The present study examines narratives of individuals who spoke about their experiences while incarcerated during the pandemic. The data for the study were gathered from prison reform advocacy organizations that featured individuals’ stories. The narrative findings provide insight into the traumatic experiences that incarcerated people endured, how institutional failures exacerbated their mistrust of the criminal legal system, and their efforts to cope.

Perceptions of vaccine safety and hesitancy among incarcerated adults and correctional staff in the rural midwest

Objectives

This project assessed vaccine hesitancy among staff and incarcerated adults in one rural medium-security prison in the Midwestern United States and identified differences in hesitancy across sociodemographic and work-related variables.

Methods

610 prison staff and people incarcerated completed a cross-sectional survey in May 2021. The vaccine hesitancy scale (VHS) identified perceived risk and confidence in vaccination. A single item assessed whether people typically follow public health protocols in the prison. A combination of analyses was utilized, including ANOVA, Chi-Square, and Pearson's correlation.

Results

Vaccine hesitancy was moderate to high for both populations. Incarcerated people had more confidence in vaccination than staff; differences did not reach statistical significance. Incarcerated people had statistically significantly higher perceptions of risk compared to staff. Both populations reported doing their best to follow public health protocols. For both populations, vaccine hesitancy varied by education and veteran status. Among staff, hesitancy varied by gender and political beliefs. For people incarcerated, it varied by pre-incarceration income and visit frequency.

Conclusions

Results support the need for public health policy and procedural interventions to reduce hesitancy towards vaccination in correctional settings.

Coronavirus Disease-2019 Vaccine Hesitancy

Early in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, before coronavirus disease-2019 (COVID-19) vaccines were authorized, surveys began tracking public acceptance of a hypothetical COVID-19 vaccine. As vaccines became more widely available, the focus shifted from evaluating premeditative thoughts about COVID-19 vaccines to observing behaviors, measuring uptake, and characterizing factors associated with acceptance. A wealth of peer-reviewed literature examining the complexities of COVID-19 vaccine acceptance has emerged, but our understanding of COVID-19 vaccine acceptance is constantly evolving. In this article, we review the current state of knowledge regarding COVID-19 vaccine hesitancy, with an emphasis on pediatric vaccination.

Developing a Roadmap for Mass Vaccination of COVID-19 in Iran: A Qualitative Study

BACKGROUND

Nowadays, the Covid-19 pandemic is 1 of the most important challenges worldwide, especially in terms of health. The most important strategy to prevent and control the Covid-19 pandemic is mass vaccination. This study aimed at developing a roadmap for the mass vaccination of COVID-19 in Iran.

METHODS

The current study was conducted using a qualitative approach with a content analysis method. In the first step, the review of literature and documents was carried out by a search in scientific databases. In the next step, the data were amassed via in-depth and semi-structured interviews with experts who were selected purposefully, including policymakers, health care workers, and managers. After this, 3 multidisciplinary expert panels for roadmap development were held.

RESULTS

Based on the literature review, interviews, and 3 stages of an expert panel, the final roadmap was developed with 5 dimensions. These included outcomes, planning and preparation, strategies, and preparation, implementation, monitoring, and evaluation.

CONCLUSIONS

This roadmap was developed to improve mass vaccination during the COVID-19 pandemic. According to our findings, it is strongly recommended that the vaccination roadmap with all the above-mentioned features and comprehensive structure should be applied to mitigate the consequences of the COVID-19 pandemic.

COVID-19 vaccine for people who live and work in prisons worldwide: A scoping review

Overcrowding, poor conditions, and high population turnover make prisons highly susceptible to COVID-19. Vaccination is key to controlling COVID-19, yet there is disagreement regarding whether people who live and work in prisons should be prioritised in national vaccination programmes. To help resolve this, we critically examine the extent, nature, and quality of extant literature regarding prioritisation of COVID-19 vaccinations for people who live and work in prisons. Using a scoping review as our methodological framework, we conducted a systematic literature search of 17 databases. From 2,307 potentially eligible articles, we removed duplicates and screened titles and abstracts to retain 45 articles for review and quality appraisal. Findings indicated that while most countries recognise that prisons are at risk of high levels of COVID-19 transmission, only a minority have explicitly prioritised people who live and work in prisons for COVID-19 vaccination. Even among those that have, prioritisation criteria vary considerably. This is set against a backdrop of political barriers, such as politicians questioning the moral deservingness of people in prison; policy barriers, such as the absence of a unified international framework of how vaccine prioritisation should proceed in prisons; logistical barriers regarding vaccine administration in prisons; and behavioural barriers including vaccine hesitancy. We outline five strategies to prioritise people who live and work in prisons in COVID-19 vaccination plans: (1) improving data collection on COVID-19 vaccination, (2) reducing the number of people imprisoned, (3) tackling vaccine populism through advocacy, (4) challenging arbitrary prioritisation processes via legal processes, and (5) conducting more empirical research on COVID-19 vaccination planning, delivery, and acceptability. Implementing these strategies would help to reduce the impact of COVID-19 on the prison population, prevent community transmission, improve vaccine uptake in prisons beyond the current pandemic, foster political accountability, and inform future decision-making.

The COVID-19 pandemic behind bars: Experimental evidence showing higher support for decarceration when framed as risk to correctional staff

This study examined the effect of framing COVID-19 spread in correctional facilities as impacting imprisoned individuals or impacting correctional staff on public support for decarceration. I employed an experiment in the 2021 Empire State Poll (n = 765) in which participants were randomly assigned to a treatment condition, which highlighted information about the number of COVID-19 cases among imprisoned individuals, or a control condition, which highlighted correctional staff instead. Participants reported how supportive or unsupportive they are of releasing imprisoned individuals to curb the spread of COVID-19. Overall, 35% of New Yorkers supported decarceration. A higher percentage of respondents supported decarceration when the impact on correctional staff was highlighted (40%) relative to imprisoned individuals (31%). There was also higher support among non-Hispanic Black (54%) and Hispanic (51%) participants relative to non-Hispanic White (28%) participants. Within racial/ethnic groups support for decarceration was higher when the impact on correctional staff was highlighted among non-Hispanic Whites, Hispanics, and those of another race, but not among non-Hispanic Blacks where support for decarceration was higher when the impact on imprisoned individuals was highlighted. Inferential analysis using log binomial regression found that the association between treatment condition assignment and support for decarceration was not significant. Public health practitioners and policy makers should consider leveraging the higher support associated with concerns over the health and wellbeing of correction staff found among some racial/ethnic groups to fight the COVID-19 pandemic.

Effectiveness of Coronavirus Disease 2019 (COVID-19) Vaccines Among Incarcerated People in California State Prisons: Retrospective Cohort Study

BACKGROUND

Prisons and jails are high-risk settings for coronavirus disease 2019 (COVID-19). Vaccines may substantially reduce these risks, but evidence is needed on COVID-19 vaccine effectiveness for incarcerated people, who are confined in large, risky congregate settings.

METHODS

We conducted a retrospective cohort study to estimate effectiveness of messenger RNA (mRNA) vaccines, BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna), against confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among incarcerated people in California prisons from 22 December 2020 through 1 March 2021. The California Department of Corrections and Rehabilitation provided daily data for all prison residents including demographic, clinical, and carceral characteristics, as well as COVID-19 testing, vaccination, and outcomes. We estimated vaccine effectiveness using multivariable Cox models with time-varying covariates, adjusted for resident characteristics and infection rates across prisons.

RESULTS

Among 60 707 cohort members, 49% received at least 1 BNT162b2 or mRNA-1273 dose during the study period. Estimated vaccine effectiveness was 74% (95% confidence interval [CI], 64%-82%) from day 14 after first dose until receipt of second dose and 97% (95% CI, 88%-99%) from day 14 after second dose. Effectiveness was similar among the subset of residents who were medically vulnerable: 74% (95% CI, 62%-82%) and 92% (95% CI, 74%-98%) from 14 days after first and second doses, respectively.

CONCLUSIONS

Consistent with results from randomized trials and observational studies in other populations, mRNA vaccines were highly effective in preventing SARS-CoV-2 infections among incarcerated people. Prioritizing incarcerated people for vaccination, redoubling efforts to boost vaccination, and continuing other ongoing mitigation practices are essential in preventing COVID-19 in this disproportionately affected population.

COVID-19 Outbreak and BNT162b2 mRNA Vaccination Coverage in a Correctional Facility during Circulation of the SARS-CoV-2 Omicron BA.1 Variant in Italy

Background. The recent spread of the highly mutated SARS-CoV-2 Omicron variant (B.1.1.529) has raised concerns about protection against COVID-19 in congregate settings such as prisons, characterized by a high risk of transmission and possible difficulties in obtaining adequate vaccination coverage. The present study aims to investigate the spread of an outbreak of COVID-19 in an Italian correctional facility during the dominant circulation of the Omicron BA.1 variant, and also considers BNT162b2 mRNA vaccination coverage among inmates. A COVID-19 screening campaign by RT-PCR was performed on 515 detainees from 4−30 January 2022, in response to an outbreak that began in the correctional facility. Furthermore, 101 serum samples collected from healthy inmates 21 days after having received the second dose of the BNT162b2 vaccine were tested for neutralizing antibodies against both the wild-type SARS-CoV-2 strain and the Omicron BA.1 variant. The global attack rate during the study period was 43.6% (RR 0.8), progressively reducing from unvaccinated inmates (62.7%, RR 1.8) to those who had one dose (52.3%, RR 1.5), two doses (full cycle) (45.0%, RR 1.3), and the third dose (booster) vaccinated group (31.4%, RR 0.7). The percentage of SARS-CoV-2 positive subjects among unvaccinated inmates was significantly higher than in the other groups (p < 0.001), while no significant difference was observed between inmates with one or two vaccine doses. Only two of the positive inmates were hospitalized for COVID-19. The geometric mean titer of neutralizing antibodies in the tested sub-group after two doses of vaccine was lower than in previous studies against the wild-type virus, and showed a complete lack of neutralization against the Omicron variant in 92.1% of individuals. The findings support the need to prioritize vaccination in correctional facilities, as a public health measure to increase the protection of inmates and consequently of prison workers and the community against COVID-19, in coordination with the other prevention strategies.

Vaccine Effectiveness during Outbreak of COVID-19 Alpha (B.1.1.7) Variant in Men's Correctional Facility, United States

In April 2021, a COVID-19 outbreak occurred at a correctional facility in rural Virginia, USA. Eighty-four infections were identified among 854 incarcerated persons by facilitywide testing with reverse transcription quantitative PCR (qRT-PCR). We used whole-genome sequencing to link all infections to 2 employees infected with the B.1.1.7α (UK) variant. The relative risk comparing unvaccinated to fully vaccinated persons (mRNA-1273 [Moderna, https://www.modernatx.com]) was 7.8 (95% CI 4.8–12.7), corresponding to a vaccine effectiveness of 87.1% (95% CI 79.0%–92.1%). Average qRT-PCR cycle threshold values were lower, suggesting higher viral loads, among unvaccinated infected than vaccinated cases for the nucleocapsid, envelope, and spike genes. Vaccination was highly effective at preventing SARS-CoV-2 infection in this high-risk setting. This approach can be applied to similar settings to estimate vaccine effectiveness as variants emerge to guide public health strategies during the ongoing pandemic.

A pilot study on COVID-19 vaccine hesitancy among healthcare workers in the US

To explore the attitude towards COVID-19 vaccination among healthcare workers in the US, we surveyed three groups of individuals (essential non-healthcare workers, general healthcare workers, and correctional healthcare workers). We found surprisingly high portions of healthcare workers with COVID-19 vaccine hesitancy/resistance, with 23% of correctional healthcare workers and 17% general healthcare workers (as compared to 12%) refusing to be vaccinated against COVID-19. Multivariate regression models suggest that current season flu vaccination (aOR = 3.34), relying on employer for COVID-19 information (aOR = 3.69), and living in the Midwest (aOR = 5.04) to be strongly associated with COVID-19 vaccine acceptance among essential workers and general healthcare workers. Current season flu vaccination (aOR = 7.52) is also strongly associated with COVID-19 vaccine acceptance among correctional healthcare workers. Potential mechanisms of vaccine hesitancy/resistance among healthcare workers involves low health literacy and employer mistrust. Our findings are highly relevant as we try to reach COVID-19 vaccination goals in the US.

Prioritizing COVID-19 vaccination. Part 1: Final size comparison between a single dose and double dose

In response to the coronavirus disease 2019 (COVID-19) pandemic, Japan conducted mass vaccination. Seventy-two million doses of vaccine (i.e., for 36 million people if a double dose is planned per person) were obtained, with initial vaccination of the older population (≡ 65 years). Because of the limited number of vaccines, the government discussed shifting the plan to administering only a single dose so that younger individuals (<65 years) could also be vaccinated with one shot. This study aimed to determine the optimal vaccine distribution strategy using a simple mathematical method. After accounting for age-dependent relative susceptibility after single- and double-dose vaccination (vs and vd, respectively, compared with unvaccinated), we used the age-dependent transmission model to compute the final size for various patterns of vaccine distributions. Depending on the values of vs, the cumulative risk of death would be lower if all 72 million doses were used as a double dose for older people than if a single-dose program was conducted in which half is administered to older people and the other half is administered to adults (i.e., 1,856,000 deaths in the former program and 1,833,000-2,355,000 deaths [depending on the values of vs] in the latter). Even if 90% of older people were vaccinated twice and 100% of adults were vaccinated once, the effective reproduction number would be reduced from 2.50 to1.14. Additionally, the cumulative risk of infection would range from 12.0% to 54.6% and there would be 421,000-1,588,000deaths (depending on the values of vs). If an epidemic appears only after completing vaccination, vaccination coverage using a single-dose program with widespread vaccination among adults will not outperform a double-dose strategy.

The Risk of COVID-19 Infection in Prisons and Prevention Strategies: A Systematic Review and a New Strategic Protocol of Prevention

Health risks within prisons are well known and have worsened with the 2019 coronavirus pandemic (COVID-19), becoming a public health emergency. To date, there are more than 10 million inmates in the world; in most cases, conditions are bad and health care is scarce. A SARS-CoV-2 outbreak inside a prison is extremely rapid. The aim of this systematic review was to analyze all possible prevention techniques to reduce the risk of COVID-19 related infection within prisons. A systematic review of the literature was performed according to the PRISMA guidelines. Scopus, Web of Science, PubMed, and Google Scholar were used as search engines from 1 January 2020 to 1 November 2021 to evaluate the prevention of COVID-19 in prisoners. A total of 1757 articles were collected. Of them, 486 duplicates were removed. A total of 1250 articles did not meet the inclusion criteria. In conclusion, 21 articles were included in the present systematic review. From this analysis, it emerged that the most common COVID-19 prevention methods were the screening of the entire population (prisoners and workers) inside the prison through swab analysis and the reduction in overcrowding in prisons. Few studies concerned the prevention of COVID-19 infection through vaccination and the implementation of quarantine. To our knowledge, this is the first systematic review that evaluates the prevention of COVID-19 within jails and the real effectiveness of all possible methods used and published in the literature. Finally, a very useful strategic protocol is provided to reduce the incidence of infection and to control and manage COVID-19 in prisons.

Experience and Discussion: Safeguards for People With Disabilities During the COVID-19 Pandemic in China

The special vulnerability of people with disability (PWD) in the COIVD-19 pandemic has been confirmed by many studies, but data shows that the infection rate of PWD in China is lower than for non-disabled people. We believe that this difference can be attributed to the Chinese government's targeted safeguards for the disabled community during the pandemic, including support for disability empowerment, the establishment of a remote interactive decision-making system, fair vaccine distribution and economic protection for PWD. The professionalism of decision-makers and the maintenance of channels of interaction with PWD are also important. All of these changes have benefitted China's public health policy and legal framework. This system, which has six components (governance, prevention, response, knowledge, coordination, and people), enables the country to quickly formulate a series of safeguards for PWD that have a sufficient legal basis. We believe that China's rapidly improving public health policy and legal framework will make a hugely significant impact by alleviating the impact of the COVID-19 pandemic on the PWD community. Countries should pay more attention to discovering the special needs and obstacles of PWD in the COIVD-19 pandemic: in referring to China's experience, they should explore the protection framework for persons with disabilities and adjust it to their own needs on the basis of national conditions.

Health care disparities during the COVID-19 pandemic

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is a pandemic with more than 32 million cases and more than 500,000 deaths nationwide. With the significant health consequences seen secondary to COVID-19, health care disparities have been further exacerbated. Mechanisms that have been proposed to account for the increased disparity seen during the COVID-19 pandemic are multifactorial. This review of the literature outlines the unique barriers to health and disparities that are associated with vulnerable communities who have been most impacted by the COVID-19 pandemic in the United States.

Effectiveness of COVID-19 Vaccines among Incarcerated People in California State Prisons: A Retrospective Cohort Study

Background

Prisons and jails are high-risk settings for COVID-19 transmission, morbidity, and mortality. COVID-19 vaccines may substantially reduce these risks, but evidence is needed of their effectiveness for incarcerated people, who are confined in large, risky congregate settings.

Methods

We conducted a retrospective cohort study to estimate effectiveness of mRNA vaccines, BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna), against confirmed SARS-CoV-2 infections among incarcerated people in California prisons from December 22, 2020 through March 1, 2021. The California Department of Corrections and Rehabilitation provided daily data for all prison residents including demographic, clinical, and carceral characteristics, as well as COVID-19 testing, vaccination status, and outcomes. We estimated vaccine effectiveness using multivariable Cox models with time-varying covariates that adjusted for resident characteristics and infection rates across prisons.

Findings

Among 60,707 residents in the cohort, 49% received at least one BNT162b2 or mRNA-1273 dose during the study period. Estimated vaccine effectiveness was 74% (95% confidence interval [CI], 64-82%) from day 14 after first dose until receipt of second dose and 97% (95% CI, 88-99%) from day 14 after second dose. Effectiveness was similar among the subset of residents who were medically vulnerable (74% [95% CI, 62-82%] and 92% [95% CI, 74-98%] from 14 days after first and second doses, respectively), as well as among the subset of residents who received the mRNA-1273 vaccine (71% [95% CI, 58-80%] and 96% [95% CI, 67-99%]).

Conclusions

Consistent with results from randomized trials and observational studies in other populations, mRNA vaccines were highly effective in preventing SARS-CoV-2 infections among incarcerated people. Prioritizing incarcerated people for vaccination, redoubling efforts to boost vaccination and continuing other ongoing mitigation practices are essential in preventing COVID-19 in this disproportionately affected population.

Funding

Horowitz Family Foundation, National Institute on Drug Abuse, Centers for Disease Control and Prevention, National Science Foundation, Open Society Foundation, Advanced Micro Devices.