Covid-19 Vaccine Acceptance in California State Prisons

(This letter to the editor was first published in The New England Journal of Medicine on May 12, 2021.)


David M. Studdert 2
Stanford Law Professor David Studdert

Prisons and jails are high-risk settings for Covid-19, with case and mortality rates far exceeding those in the general community.1 More incarcerated people have died from Covid-19 in U.S. correctional facilities in the past year than died by capital punishment in the past 70 years.2 Some states, including California, have prioritized incarcerated people for vaccination.

The California Department of Corrections and Rehabilitation (CDCR) provided anonymized data at the person-day level for all California prison residents from December 22, 2020, when the CDCR vaccination program began, through March 4, 2021. The data, which are described in the Supplementary Appendix (available with the full text of this letter at and elsewhere,3included variables that indicated which residents were offered doses of the BNT162b2 (Pfizer–BioNTech) or mRNA-1273 (Moderna) vaccine and which residents accepted. Our goal was to calculate the percentage of residents who accepted at least one dose among the residents who were offered doses and to use multivariable logistic regression analysis to estimate the probability of the acceptance of at least one dose according to the residents’ race or ethnic group, age group, medical vulnerability, and history of Covid-19. We also analyzed acceptance among residents who were reoffered vaccination after they had initially declined.

(Continue reading the letter to the editor on The New England Journal of Medicine’s page here.)