Unpacking the impact of gender on access to COVID-19 vaccines

The COVID-19 pandemic was marked by vaccines, therapeutics, and diagnostics apartheid, as well as the decimation of health systems. Within the rollout of medical technologies and crisis response, several gendered impacts of COVID-related measures emerged. As countries instituted lockdowns, countries began reporting an increase in gender-based violence, with countries like Cyprus and Singapore reporting an increase in helpline calls by 30% and 33% respectively, and another study noting an increase of up to 131% of domestic violence complaints in districts in India with most stringent lockdown measures. However gender-related barriers to accessing COVID-19 vaccines reach wider than these – and an intersectional documentation of these barriers had not yet been conducted.

We interviewed 25 individuals from global health agencies, UN agencies, civil society organisations (including feminist and LGBTQIA+ organisations, and academic/research institutions). Interviews were transcribed using Otter.ai and analysed using Jhpiego’s gender analysis framework.

Case studies were selected through a snowball sample, following leads from desk research and qualitative interviews for documented practices that had the potential to highlight neglected areas of a global gender-sensitive COVID-19 response. Potential case studies were assessed for availability of data, consent of program implementers, and correlation to research findings.

Several barriers to accessing COVID-19 services were documented including:

  • Gendered Social Norms/Traditional Roles. Gendered norms often result in women taking a disproportionate burden of domestic work, care for children, seek permission from male relatives to access healthcare, or present at vaccination centres with a male guardian.
  • Transportation and a Lack of Finances. With gendered roles comes limited access to transportation, with male partners more likely to have full-time use of owned vehicles, and a lack of access to financial means for public transport to travel to COVID-19 vaccination or treatment centres.
  • Health Systems Factors, including Digitalisation of COVID-19 Tools. Many governments rolled out digital-first tools for vaccine registration, leaving out elderly populations, disabled populations, and populations with less digital literacy. In LMICs, 165 million less women have access to mobile phones compared to men. In addition, the COVID-19 response did not take into account the need to deploy vaccines and treatments in safe environments for LGBTQIA+ people.
  • Exclusion from Clinical Trials. Pregnant and lactating people were left out of clinical trials for vaccines and for the novel antivirals, despite pregnant people having higher COVID-19 risk. This resulted in delays of lifesaving interventions, and increased misinformation.
  • Limited Gender-Disaggregated Data. Countries did not initially collect sex- and gender- disaggregated data on COVID-19 deaths, hospitalisation rates, and infections. In addition, there was poor sex- and gender-based analyses of clinical trial results.

The research also distilled recommendations for governments, global health agencies/donors, and scientists/biomedical researchers.