About two-thirds of Oklahoma prison workers and just under half of the inmates have opted not to receive the COVID-19 vaccine from the state Department of Corrections, a sign that vaccine hesitancy remains high and some facilities may not reach the immunity threshold necessary to prevent future outbreaks.

a meeting, corrections director Scott Crow said that the agency expects to distribute vaccine doses to 1,500 corrections staff and 12,000 prisoners through the end of April. The corrections department employs about 4,500 and houses just under 22,000 inmates.

Prison medical staff began vaccinating corrections workers in late January, while inmates have been eligible to receive the vaccine since March 8.

Corrections department spokesman Justin Wolf said the staff vaccination total does not include employees who decided to get inoculated at off-site pharmacies or vaccine pods. Wolf said the agency has encouraged its staff to get vaccinated wherever it’s available and most convenient, but it cannot compel staff to provide proof of off-site vaccination.

Most state corrections systems are not mandating the vaccine for staff or inmates. Some states have used incentives, like reinstating in-person visitation if a certain percentage of prisoners get vaccinated, as a way to encourage vaccination.

Some of Oklahoma’s largest COVID-19 outbreaks have spread from state prisons, where many inmates live in dormitory-style housing units not conducive to social distancing. When an outbreak hit the Eddie Warrior Correctional Center in Taft in early September, Muskogee County ranked firstamong U.S. metropolitan areas with the most new COVID-19 cases.

Since April, more than 1,000 staff and 7,300 inmates have tested positive for COVID-19. At least 44 have died.

At least 15 states, including Oklahoma, have prioritized vaccination for corrections staff ahead of inmates, arguing that they may introduce the virus to both inmate populations and nearby communities. But prison workers nationwide are showing resistance to the vaccine. In North Carolina, 65% of prison staff said in a February survey that they would not be getting vaccinated. A group of Nevada corrections officers told a legislative committeein December that they would rather quit than inoculated.

The problem isn’t unique to prisons. Police officers, firefighters and emergency responders in several states have rejected the vaccine at a greater rate than the general public. Polling indicates that Republicans without college degrees, a group often drawn to law enforcement and corrections work, are among the most likely to decline vaccination. Experts say misinformation and conspiracy theories about the vaccine could be contributing to the hesitancy.

For inmates, mistrust of prison medical staff and a history of medical experimentation on prisoners has caused some to be skeptical. Because inmates don’t have the same access to information as the general public,advocates say educational outreach to incarcerated populations about the vaccine is critical.

Speaking on the condition of anonymity due to fear of retaliation, an inmate at the Dick Conner Correctional Facility in Hominy said he’s talked to several guards and prisoners who reject the idea of getting vaccinated. According to the inmate, one guard said that he believed there could be a “tracking device” in the vaccine and there was no way he could get it. The inmate, who said he previously tested positive for COVID-19, says he decided to get the vaccine because of new variants spreading through the U.S.

Judy Worsham Fox, a moderator of a Facebook group for Oklahoma inmate family members, said she has heard similar stories of conspiracy theories spreading among staff and inmates. Among them: the vaccine is the “mark of the beast,” a reference to a New Testament passage foreshadowing that the Antichrist will test Christians by asking them to put a mark on their body.

Worsham Fox said her son Michael, an inmate at the Oklahoma State Penitentiary in McAlester, received his first dose of the vaccine last week.

“He believes in science.” she said. “He’s been far from hesitant.”

Wolf said the agency has worked to educate inmates and staff on the science behind the vaccine and the importance of getting vaccinated. He declined to comment on if corrections officials had encountered any widespread vaccine hesitancy among staff.

While some corrections unions in other states have urged their members to get vaccinated, Oklahoma Corrections Professionals, an independent statewide association for Department of Corrections employees, has promised to protect employees who don’t get the shot.

Bobby Cleveland, the group’s executive director, said he expects that more than half of state corrections staff won’t get vaccinated.

“They’re very apprehensive about it,” Cleveland said. “I got my shot, but we feel like we don’t know anything about the side effects at this time.”

The Centers for Disease Control and Prevention says vaccinated individuals can expect mild side effects for a few days, including pain around the arm where the dose was administered, fatigue and fever. With the two-shot Pfizer and Moderna vaccines, side effects are generally more severe after the second dose. Serious side effects, including allergic reactions, are very rare for all three vaccines.