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.