In the past year, Covid has penetrated Bristol County’s jails on several occasions, spreading from staff members free to mingle in the outside world to inmates who sleep in bunk beds spaced only a few feet apart and transmit the disease behind bars.

An initial outbreak in May infected nearly 40 inmates and 30 staff members. Fear and confusion over quarantine protocols led to a violent conflict between the jail’s staff and a group of immigrants awaiting deportation. Infections spiked again during the winter holidays, when more than 100 staff members tested positive.

But the latest data show three in four inmates in Bristol County are now refusing vaccination. Hesitancy is especially prevalent at New Bedford’s Ash Street Jail, where 73 of the 82 inmates awaiting trial have refused their first dose. That’s the highest refusal rate of any jail or prison in Massachusetts that complied with data reporting requirements last week.

Lizz Matos, an advocate who leads Prisoners’ Legal Services of Massachusetts, said a prisoner’s decision to accept the vaccine often comes down to trust. 

“Oftentimes, the health care is pretty poor, and people who have chronic care issues and other issues oftentimes feel they have been consistently either undertreated or mistreated in the jail and prison context,” Matos said. “And that, of course, is playing a huge role here as well, because those are the same providers that are administering the vaccine.”

That dynamic may be especially fraught in Bristol County, where Sheriff Thomas Hodgson has cultivated a reputation for spartan conditions in his facilities.

Matos said it’s also important to remember that many inmates in county jail expect to be released soon. Unlike inmates in prison, where vaccination rates are much higher, many county inmates are still awaiting trial. The rest are serving sentences shorter than a year and a half.

“County folks might be weighing their risks and saying, I really don't trust this health care provider to give me the vaccine appropriately, or I just don't don't feel comfortable getting the vaccine here,” said Matos. 

Sheriff Hodgson claims there’s another factor at play in his jails.

“You know, we've had a lot of judges letting a lot of people out with this argument that, ‘Oh, they could potentially get COVID,’” said Hodgson. “That doesn't help, because then there are those inside the prisons who would say, ‘Well, you know what, I'm going to hang in there. I'm not going to take it, because if I take it, then I don't really have an argument to say that I could potentially get COVID.’”

But no inmates have been released from the sheriff’s jails under coronavirus precautions since August, and critics point out that vaccine hesitancy is as prevalent among the sheriff’s staff as it is among inmates.

State data shows more than 70 percent of jail employees have declined the vaccine at work. Sheriff Hodgson can’t force his employees to disclose whether they were vaccinated offsite — but he also doesn’t ask.

“You could ask the entire staff and if, say, 100 of them got vaccinated off site and only two of them tell you something, there's not much benefit to it,” Hodgson said.

Adding to the hesitancy, stories of the vaccine’s side effects have spread quickly among inmates and staff. A spokesman for the sheriff said 12 staff members missed work last Thursday because they felt sick after receiving their second dose.

In neighboring Rhode Island, prisoners and guards have been far more likely to accept the vaccine. 

Dr. Justin Berk, the acting medical director for Rhode Island’s prisons, said just one in four inmates there have refused the vaccine.

“One of the big reasons for success for us is the pretty aggressive education that we’ve offered,” Berk said. “We’ve done videos and flyers and I think that information has helped but we also have two public health nurses who are well known to individuals who are incarcerated who have been going cell to cell for the past two months to sit and talk with people about the vaccine.”

Sheriff Hodgson said inmates in his jails have read flyers, seen posters and watched videos translated into English, Spanish and Portuguese. 

But in an effort to boost the vaccination rate, an association of sheriffs from outside the county suggested more education programming.

An infectious disease doctor is scheduled to make a presentation to inmates next week. 

Sofia Rudin contributed reporting.

Ben Berke is the South Coast Bureau Reporter for The Public’s Radio. He can be reached at bberke@thepublicsradio.org.