Trust is hard-won in jail. The men and women incarcerated in King County’s two adult jails are generally wary of the people who monitor their movements or deliver their health care — a distrust that often stems from racial inequities in the legal and medical systems.

“These are people who are not voluntarily in these congregate settings and a lot of people there have a mistrust of the system,” said Dr. Shireesha Dhanireddy.

That’s part of the reason COVID-19 vaccination rates in the jail population lag behind King County overall, and why public health officials are making an extra push to reach the vulnerable population inside local jails with accurate information about vaccines.

Dhanireddy is one of three UW Medicine doctors who visited the Maleng Regional Justice Center in Kent on Thursday for a discussion about COVID-19 vaccines. A second session was Friday at the King County Correctional Facility in downtown Seattle. The doctors who visited the jails were all people of color — a deliberate choice so that the medical professionals looked like the very people they were most interested in reaching.

The doctors’ sessions were aimed at dispelling myths surrounding COVID-19 vaccines — no, they don’t cause infertility — providing science-based answers to vaccination questions and urging people who are in custody not only to get vaccinated themselves but to encourage their friends and family to get the shots, especially given the variants now circulating in the community.

“There was actually a lot of questions about, ‘How do I trust the government?’ And we really had to bring it back to trusting the science rather than it being a government or political issue,” Dhanireddy said.

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Danotra McBride, the director of Jail Health Services, a division of Public Health — Seattle & King County, said distrust of the system has always presented a challenge to providing health care in the county jails. Racial disproportionality in the jail population along with the acute vulnerabilities of her patients, including homelessness and substance abuse disorders, means many of the people seen by Jail Health Services staff don’t regularly receive medical care outside of jail.

In early May, McBride observed a patient education session UW Medicine doctors conducted at the SCORE jail in Des Moines, which houses people from six South King County cities arrested for non-felony offenses.

That experience prompted McBride to partner with UW Medicine to hold similar question-and-answer sessions in Seattle and Kent.

After the SCORE session in Des Moines, four of the 10 or so people in attendance asked to be vaccinated as soon as it wrapped up, said Dhanireddy.

McBride didn’t have numbers immediately available from the Thursday and Friday sessions but said she heard several people who attended also asked to be immunized against the coronavirus that has so far killed more than 600,000 Americans, nearly 6,000 of them in King County alone. She estimated that half of the current population of around 1,250 people total in the two jails has been vaccinated.

At the education sessions, doctors “emphasized that this virus gets transmitted really through the air,” said Dr. Santiago Neme of UW Medicine. “And it’s challenging in that in a closed environment, where you don’t necessarily have adequate ventilation in every space, you’re going to have a high risk of transmission.”

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“We also highlighted the fact that unlike other respiratory illnesses, with COVID, we have 30% of people who don’t have symptoms and yet transmit the infection,” in contrast, he said, “with other viral infections that we’ve had for a long time.”

He said most of the people who attended the 90-minute question-and-answer sessions were nonwhite. Neme observed people correctly wearing masks and noted new masks and hand sanitizer were readily available inside the facilities.

But vaccine hesitancy remains a concern, particularly among Black men — which is true both inside and outside the jails, McBride said. In recent months, a video — featuring a conversation between W. Kamau Bell, a Black comic and TV host, and Black doctors, nurses and scientists about the COVID-19 vaccines, which since March has been viewed more than 1.5 million times on YouTube — has played on a loop in both jails’ booking areas, said McBride. It was chosen because it speaks directly to Black people’s questions about the vaccines.

“OK. First question. The vaccine happened fast. Like super fast. Like Usain Bolt headed to the bathroom fast. Is that something we should be concerned about?” Bell asks at the beginning of the five-minute video.

The screen flashes among six Black doctors, who in turn discuss the vaccines’ emergency authorization while emphasizing that no critical steps were cut and vaccines were still subject to scientific rigor.

But inside the jails — which have high turnover in their daily populations, as people are arrested, booked and released — health officials are still seeing a 40% to 50% weekly vaccine-refusal rate, said McBride. And because transmission in group living environments can happen fast, as seen in a March outbreak that saw 46 people in custody and seven staff members test positive for the coronavirus, “it’s extremely important in jail for us to offer the vaccine and educate them about the importance of it,” she said.

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Those in jail can choose between the Moderna vaccine, which requires a two-dose regimen, or the single dose Johnson & Johnson shot, in-house. If a person opts for Moderna, McBride’s staff has a process to help set up appointments if a second dose will be administered outside of jail. And for those booked into jail who have already gotten a first shot of the Pfizer vaccine, which needs to be stored in ultra-cold freezers, Jail Health Services has partnered with Harborview Medical Center to ensure patients get their second doses, McBride said.

After first administering doses based on the state’s phased guidelines, Jail Health Services has offered vaccination to anyone entering the jail during an initial health screening and during voluntary health evaluations 14 days after booking, McBride said. People in custody can now request to be vaccinated at any time, either from their housing units or during clinical appointments with doctors and nurses, she said.

McBride said plans to host additional patient-education sessions with UW Medicine doctors are in the works and her staff is also incorporating information gleaned from last week’s discussions into their medical practice.

On Monday, there was one adult in custody with a confirmed case of the coronavirus but no confirmed cases among the 18 juveniles currently in detention, according to the King County Department of Adult and Juvenile Detention’s COVID-19 dashboard.

Noah Haglund, a spokesperson for Public Health — Seattle & King County, said DAJD has partnered with the Seattle Fire Department to administer the Pfizer vaccine to 16- and 17-year-olds in detention.

As of Monday, 1,194 doses have been administered to 1,101 men and 93 women inside the two adult jails, though the numbers did not include a breakdown between Moderna and J&J doses, Haglund said in an email. Of those who have received the shots, 615 are white, 405 are Black, 126 are Asian, and 22 are American Indian, according to data Haglund provided. The racial identity of 26 people is unknown.

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In the last 30 days, the state Department of Corrections has confirmed 18 cases of the coronavirus in seven of its 12 prisons, half of them among men incarcerated at the Coyote Ridge Corrections Center in Franklin County, according to DOC’s online COVID-19 data.

Coyote Ridge was the site of an outbreak last spring and summer that sickened 277 prisoners and 73 staff and led to the death of two inmates. A November report from the Office of Corrections Ombuds concluded that missteps by administrators likely worsened the outbreak, The Seattle Times reported.

As of Monday, DOC reported that 18,588 first and second doses of the Moderna vaccine had been administered to people housed in state prisons, and another 1,134 people have received the J&J vaccine, according to the online data.