“To Be Honest, You Probably Would Have to Read It 50 Times”: Stakeholders Views on Using the Opt-Out Approach for Vaccination in Jails

Abstract

Background Despite national guidelines on infectious disease testing and vaccination in prisons, there is heterogeneity on the implementation of these practices in jails. We sought to better understand perspectives on the implementation of opt-out vaccination for infectious diseases in jails by interviewing a broad group of stakeholders involved in infectious diseases vaccination, testing, and treatment in Massachusetts jails. Methods The research team conducted semi-structured interviews with people incarcerated in Hampden County Jail (Ludlow, MA), clinicians working in jail and community settings, corrections administrators, and representatives from public health, government, and industry between July 2021—March 2022. Results Forty-eight people were interviewed, including 13 people incarcerated at the time of interview. Themes that emerged included: misunderstandings of what opt-out means, indifference to the way vaccines are offered, belief that using the opt-out approach will increase the number of individuals who receive vaccination, and that opt-out provides an easy way for vaccine rejection and reluctance to accept vaccination. Conclusion There was a clear divide in stakeholders’ support of the opt-out approach, which was more universally supported by those who work outside of jails compared to those who work within or are incarcerated in jails. Compiling the perspectives of stakeholders inside and outside of jail settings on the opt-out approach to vaccination is the first step to develop feasible and effective strategies for implementing new health policies in jail settings.