The COVID-19 vaccine
This is the first in a series of occasional posts on the work that EP:IC Consultants have undertaken consulting with people in prison on a series of health-related issues.
Donna Gipson And Dr Lucy Wainwright from EP:IC Consultants consulted 805 people in prison on their likelihood of accepting the coronavirus vaccine, any concerns they may have, how these concerns could be alleviated, what information would help improve understanding of the vaccine and views on priority groups. The consultation was undertaken using surveys in nine prisons in the South-East of England.
The people consulted
Just over 90% people consulted were men, with survey respondents aged from young adults to people over 80 years of age. The cohort was ethnically diverse with less than two thirds (62%) from a White background. Importantly, given the disproportionate impact of coronavirus on BAME communities, Black, Asian and Minority Ethnic groups made up 31% of the overall sample.
The views of people in prison
Overall nearly four out of five (78%) people in prison said they intended to accept a vaccine if offered with 19% saying they would decline and 3% unsure or hesitant. The main factors associated with people who said they would decline the virus were age and ethnic background.
Ethnicity
White people are the most likely to take the vaccine, with just over three quarters of White survey respondents across all prisons saying they would accept a vaccine if offered. Those who identified as belonging to the ‘Other’ ethnic group and those who preferred not to share their ethnicity were the next most likely group to accept a vaccine, with 73% and 72% respectively stating they would accept a vaccine. People from Mixed Heritage communities and Black people were least likely to accept vaccine with just over half, 58% and 57% of respectively stating they would accept a vaccine. Black people were over a third more likely to reject any offer of a vaccine than their White counterparts. In contrast Asian people were the most likely to be unsure, with 14% feeling hesitant about the vaccine.
Age
Attitudes towards accepting the vaccination were even more correlated with age. Younger people under 21 years old are the group least likely to accept a vaccine, with more than half refusing. In general, those under 30 years old are more hesitant. As we move up through the age groups, the proportion who would accept a vaccine grows, with the exception of those aged 60-69 years, where we see a small dip in intended uptake, as shown in the graphic below. The oldest people consulted – 80 years and older – report a 100% intended uptake. The most uncertain age group is 21-29 year olds and those who did not state their age, where nearly one tenth of patients report being unsure about the vaccine. Younger people were also less confident in their understanding of public health messages about COVID-19 and the vaccine.
Causes for concern
It is interesting to note that, even amongst those who were happy to take a vaccine, there remained concerns and hesitancy. As many as 40% of respondents in one prison who said they would accept the vaccine were nevertheless concerned about it.
Across the board, the greatest concern and barrier was a lack of understanding of the side effects or long-term risks the vaccine posed. Individuals wanted to understand how the vaccine would make them feel in the short term and in the future.
“No one knows the long-term effects, and no one can convince me it’s safe.”
Some patients expressed concern about the side effects and the interaction of the vaccine with current medications and existing health conditions.
“I have to see a specialist about my health, and I worry this might make it worse.”
“Does anyone know how this is safe for people with heart conditions?”
For women, there was concern around any potential impact on fertility.
“What do we know about what it does to fertility? I want to be sure this is safe for the future.”
Trust
One of most significant barriers related to trust. It is apparent a sense of distrust exists of many institutions and systems. Some respondents reported a distrust of government, the prison and medical professionals, or a general distrust in vaccine programmes, which increased hesitancy across the prison communities.
“No, I don’t trust the vaccine or who made it. We don’t have vaccines and I don’t believe in them.”
“I don’t trust the government. It’s all a hoax. You can’t trust any of them.”
Additionally, there was a minority of patients in all prisons whose distrust ran deeper and had developed into more serious conspiracy theories and thinking.
“I feel it is a pre-planned virus and is a way of the government trying to make money and populate the human race; don’t trust vaccines, do not want it, it’s corrupt.”
We received numerous comments from people in prison who felt they were being used as guinea pigs. This too connected with trust related concerns.
“I don’t think it’s ok for me to be treated as a lab rat. No one knows the side effects, so no thank you.”
Understanding COVID-19, transmission and the role of the vaccine
There remains a lack of understanding around COVID-19, particularly from younger people and minority groups. It was striking how, despite COVID-19 dominating people’s lives for a number of months and individuals being bombarded with information through internal and external news and updates, there remains a significant lack of understanding around how the virus is transmitted. Furthermore, there was a lack of understanding of the purpose of the vaccination.
Some saw the vaccine as a healthcare response to contracting the virus, rather than a preventative measure. As such, some people said they would only accept the vaccine if they caught COVID-19 while others expressed the opinion they had no need for it as they experienced good health.
“If I get COVID, I’ll have the vaccine, but right now I am fit and healthy and don’t need any jab to make me well.”
Some people were put off by their belief the vaccine involved injecting COVID-19 into their system.
“Nah, they wanna inject you with COVID and I don’t wanna be ill.”
Lack of information
The most dominant theme in this research was the lack of information available to people in prison who asked the researchers a wide range of questions (the most common are all cited in the report). Approximately one in five of everyone who responded to the survey wanted additional help and support in making their decision on whether to take-up the offer of the vaccination. Although people in prison said that newsletters and information leaflets would be useful, there was a strong desire for more direct responses to individual questions with “Q&A” sessions with staff and healthcare professionals. Unsurprisingly, people were also keen to know how the roll out of the vaccine would affect the prison regime. Many thought that if people in prison had the vaccination, the regime would quickly return to normal and face-to-face social visits would be restored. The researchers from EP:IC cautioned that this expectation needs to be carefully managed by prison authorities.
Recommendations
The researchers make a range of recommendations to improve the information available to people in prison and address the concerns of younger prisoners and those from BAME communities in particular. Perhaps the most important recommendation is for HMPPS to: “Consider whole prison community roll out, including staff, to alleviate suspicion and increase chances of recovering the regime”.
If you would like to read the full report click here and navigate to the bottom of the page.
Thanks to Andy Aitchison for kind permission to use the header image in this post. You can see Andy’s work here.
