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

CMMID COVID-19 Working Group, Ciara V. McCarthy*, Oscar O’Mara, Edwin van Leeuwen, Mark Jit, Frank Sandmann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


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.

Original languageEnglish
Article number1003
JournalBMC Public Health
Publication statusPublished - 18 May 2022

Bibliographical note

Funding Information: CVM was supported by the National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, a partnership between UKHSA Health Security Agency and the London School of Hygiene and Tropical Medicine (grant code HPRU-2019-NIHR200929). The views expressed are those of the authors and not necessarily those of the NIHR, UK Health Security Agency or the Department of Health and Social Care. EvL was supported by the National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Modelling and Health Economics, a partnership between UK HSA, Imperial College London, and LSHTM (grant number NIHR200908) and by the European Union's Horizon 2020 research and innovation programme - project EpiPose (101003688).

Funding for the CMMID COVID-19 Working Group is as follows: KS: Wellcome Trust (210,758/Z/18/Z); KA: BMGF (INV-016832; OPP1157270); KLM: European Commission (EpiPose 101,003,688); KEA: European Research Council Starting Grant (Action number 757688); RL: Royal Society Dorothy Hodgkin Fellowship; SRM: Wellcome Trust (grant: 210,758/Z/18/Z); NGD: NIHR Health Protection Research Unit in Immunisation (NIHR200929); UK MRC (MC_PC_19065); TWR: Wellcome Trust (grant: 206,250/Z/17/Z); KO’R: B&MGF (OPP1191821); EF: MRC (grant number MR/N013638/1); CJVA: European Research Council Starting Grant (Action number 757688); WJE: European Commission (EpiPose 101,003,688), NIHR (NIHR200908, MRC: MC_PC_19065,); YJ: NIHR/UKRI COVID-19 Rapid Response Initiative; NIB: Health Protection Research Unit (grant code NIHR200908); CABP: B&MGF NTD Modelling Consortium (OPP1184344), FCDO/Wellcome Trust: Epidemic Preparedness Coronavirus research programme (221,303/Z/20/Z); DH: National Institutes of Health (Grant: 1R01AI141534-01A1); AJK: Wellcome Trust (grant: 206,250/Z/17/Z), NIHR (NIHR200908); GFM: B&MGF NTD Modelling Consortium (OPP1184344); YL: B&MGF (INV-003174), NIHR (16/137/109), European Commission (101,003,688), UK MRC (MC_PC_19065); SRP: B&MGF (INV-016832); WW: MRC (grant: MR/V027956/1); SA: Wellcome Trust (grant: 210,758/Z/18/Z); RCB: European Commission (EpiPose 101,003,688); FYS: NIHR EPIC grant (16/137/109); HPG: EDCTP2: RIA2020EF-2983-CSIGN, UK DHSC/UK Aid/NIHR: PR-OD-1017–20,001; RME: HDR UK (grant;: MR/S003975/1, UK MRC (grant: MC_PC_19065), NIHR (grant: NIHR200908); LACC: NIHR (NIHR200908); SFlasche: Wellcome Trust (grant: 208,812/Z/17/Z); AE: The Nakajima Foundation; PM: CADDE (MR/S0195/1 & FAPESP 18/14389–0); JDM: Wellcome Trust (grant: 210,758/Z/18/Z); MK: Wellcome Trust (grant: 221,303/Z/20/Z); AG: European Commission (EpiPose 101,003,688); CIJ: Global Challenges Research Fund (ES/P010873/1); MQ: ERC Starting Grant (Action Number #757,699), B&MGF (INV-001754); SC: Wellcome Trust (grant: 208,812/Z/17/Z), UK MRC (grant: MC_PC_19065); SFunk: Wellcome Trust (grant: 210,758/Z/18/Z); KP: B&MGF (INV-003174), European Commission (101,003,688); GMK: UK MRC (grant: MR/P014658/1); RP: Singapore Ministry of Health; OJB: Wellcome Trust (grant: 206,471/Z/17/Z); BJQ: NIHR (16/137/109), NIHR (16/136/46), B&MGF (OPP1139859).

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Publisher Copyright:© The Author(s) 2022.

Citation: McCarthy, C.V., O’Mara, O., van Leeuwen, E. et al. The impact of COVID-19 vaccination in prisons in England and Wales: a metapopulation model. BMC Public Health 22, 1003 (2022).



  • COVID-19
  • Mathematical model
  • Prisons
  • Public health
  • Vaccination


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