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

BackgroundGlobally tuberculosis (TB) persists as a public health threat, with an unequal burden of disease among populations. Targeting disease control, new vaccine candidates for adults and adolescents are currently in the development pipeline. If available, these products can be directed in vaccination campaigns for vulnerable populations, such as people deprived of liberty (PDL). This study aims to assess acceptability towards a proposed new TB vaccine and factors associated with hesitancy in a carceral settings at eight prison units in Brazil. MethodsWe performed a cross-sectional study among PDL in six male and two female prison units within 6 Brazilian cities from April 2025 to October 2025. Eligible participants included adults (over 18 years old) who could provide consent. Through prison census, we randomly selected 130 individuals for initial evaluation with structured questionnaire about sociodemographic status, TB disease beliefs, willingness to receive a hypothetical new TB vaccine, sources of information trusted and select reasons that could make them not take a vaccine. We also requested that individuals rated affirmations regarding TB vaccines in the Likert scale. We compared participants characteristics and answers to vaccine questionnaire within prison gender and reported vaccine acceptance groups. ResultsOf the 945 individuals evaluated, 4 were excluded due to missing questionnaire results, 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% acceptance in male prisons and 98.7% in female prisons. 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. ConclusionWe found that acceptability of a new TB vaccine in Brazilian prisons was very high. Despite few differences in intent to vaccinate regarding gender, individuals that refused vaccination more often reported problems with vaccine and healthcare trust, as well as a significant proportion of them reported possible community coercion for vaccine uptake. Our findings suggest that a new TB vaccine would be well accepted among PDL.