The impact of COVID-19 vaccination in prisons in England and Wales : a metapopulation model

McCarthy, Ciara V. and O’Mara, Oscar and van Leeuwen, Edwin and Sherratt, Katharine and Abbas, Kaja and Wong, Kerry Lm and Atkins, Katherine E. and Lowe, Rachel and Meakin, Sophie R. and Davies, Nicholas G. and Russell, Timothy W. and O’Reilly, Kathleen and Hué, Stéphane and Finch, Emilie and Villabona-Arenas, C. Julian and Edmunds, W. John and Jafari, Yalda and Tully, Damien C. and Bosse, Nikos I. and Pearson, Carl A.B. and Hodgson, David and Kucharski, Adam J. and Medley, Graham and Liu, Yang and Procter, Simon R. and Waites, William and Abbott, Sam and Barnard, Rosanna C. and Sun, Fiona Yueqian and Gibbs, Hamish P. and Eggo, Rosalind M. and Chapman, Lloyd A.C. and Flasche, Stefan and Endo, Akira and Mee, Paul and Munday, James D. and Koltai, Mihaly and Gimma, Amy and Jarvis, Christopher I. and Quaife, Matthew and Clifford, Samuel and Funk, Sebastian and Prem, Kiesha and Knight, Gwenan M. and Pung, Rachael and Brady, Oliver and Quilty, Billy J. and Jit, Mark and Sandmann, Frank, CMMID COVID-19 Working Group (2022) The impact of COVID-19 vaccination in prisons in England and Wales : a metapopulation model. BMC Public Health, 22 (1). 1003. ISSN 1471-2458 (

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Background: High incidence of cases and deaths due to coronavirus disease 2019 (COVID-19) have been reported in prisons worldwide. This study aimed to evaluate the impact of different COVID-19 vaccination strategies in epidemiologically semi-enclosed settings such as prisons, where staff interact regularly with those incarcerated and the wider community. Methods: We used a metapopulation transmission-dynamic model of a local prison in England and Wales. Two-dose vaccination strategies included no vaccination, vaccination of all individuals who are incarcerated and/or staff, and an age-based approach. Outcomes were quantified in terms of COVID-19-related symptomatic cases, losses in quality-adjusted life-years (QALYs), and deaths. Results: Compared to no vaccination, vaccinating all people living and working in prison reduced cases, QALY loss and deaths over a one-year period by 41%, 32% and 36% respectively. However, if vaccine introduction was delayed until the start of an outbreak, the impact was negligible. Vaccinating individuals who are incarcerated and staff over 50 years old averted one death for every 104 vaccination courses administered. All-staff-only strategies reduced cases by up to 5%. Increasing coverage from 30 to 90% among those who are incarcerated reduced cases by around 30 percentage points. Conclusions: The impact of vaccination in prison settings was highly dependent on early and rapid vaccine delivery. If administered to both those living and working in prison prior to an outbreak occurring, vaccines could substantially reduce COVID-19-related morbidity and mortality in prison settings.