Acceptability of a proposed new tuberculosis vaccine among people deprived of liberty in Brazil.

BACKGROUND

Tuberculosis (TB) persists as a global threat, with unequal burden across populations. New TB vaccines are in development, and people deprived of liberty (PDL) represent a vulnerable group that may benefit from vaccination. This study evaluated acceptability of a hypothetical new TB vaccine and factors associated with hesitancy among PDL in Brazil.

METHODS

We performed a cross-sectional study among PDL in six male and two female prison units from April 2025 to October 2025. From each unit,130 PDL were randomized to be evaluated through a structured questionnaire about sociodemographic status, TB knowledge, acceptability of a hypothetical vaccine and attitudes towards TB vaccination, including Likert-scale statements. We compared characteristics and vaccine attitudes by prison type and by vaccine acceptance status.

RESULTS

Of the 1040 individuals randomized, 945 provided consent to study procedures and were interviewed. Four were excluded due to missing questionnaire answers, with 941 included for main analysis. In total, 95.2% of individuals reported that they would take the TB vaccine if available for them, with 94.1% and 98.7% of acceptance in male and female prisons, respectively. Compared to females, male individuals reported more distrust in vaccine safety (28.9% vs 14.5%, p < 0.001), more community coercion to vaccine uptake (15.4% vs 5.6%, p < 0.001) and worse TB knowledge (44.6% vs 31.2%, p < 0.001). Overall, among individuals that would not accept vaccination, 77.8% and 55.6% of them did not trust vaccine safety and efficacy, respectively, 60.0% did not trust healthcare workers and 20.0% reported community coercion.

CONCLUSION

We found that acceptability of a new TB vaccine in prisons was high. Despite differences in intent to vaccinate regarding gender, individuals that refused vaccination more often reported distrust in vaccine products and healthcare. A significant proportion of them reported community coercion for vaccine uptake. Our findings suggest that a new TB vaccine would be accepted among PDL.