A National Geographic and Morning Consult poll released earlier this week filled many with consternation when it revealed that fully one quarter of respondents identifying as women indicated that they were unlikely to take a coronavirus vaccine when one came available.[i] This news shook the optimism of those triumphantly celebrating the Pfizer and Moderna vaccines as unprecedented breakthroughs in the world of vaccinology. So why, when another poll released on the same day indicates an increase in vaccine confidence over the past several months, do vaccine-resistant women outnumber men by an almost 19% margin?
The easiest explanation is that women are well-represented in the anti-vaccination (and related wellness blogging) movement that has been hard at work reinforcing its infrastructure in North America since the outset of the pandemic. However, visual evidence points to the fact that men are just as entrenched in this and adjacent movements opposed to locks downs and mandatory mask wearing. And most of the respondents to the Pew poll likely do not align themselves with these conspiracy-theory propagating, Qanon boosting enthusiasts. So for now, I would like to consider the more complex factors that may be at work in gender-based vaccine skepticism.
If we turn to the science, vaccine trial data released to date reflects the tendency of medical science to take the male body as its default subject of study. Members of the UK-based Sex/Gender COVID-19 project have raised concerns over the lack of sex-disaggregrated data on vaccine efficacy. We just don’t know enough about whether women respond differently to the vaccine than men, whether they actually require the booster (studies support that women produce anti-bodies more efficiently than men), and whether they will suffer more adverse reactions than men (as is often the case). I’m not sure how closely the public is reading any of these studies, but what sometimes refers to as “gender blindness” in scientific studies could very well not be helping in terms of boosting vaccine confidence among women.
And yet more needs to be done on the information front than simply disaggregrating data on the basis of sex. As Olena Hankivsky and Anuj Kapilashrami point out, “ When attempting to capture differing rates of infection and outcomes, data …Biological explanations need to be integrated with other social factors, including but not limited to gender norms and roles and behaviours (e.g., smoking tobacco and drinking alcohol). Burden of disease is not only gendered, but rather, overlaid with other factors, such as age, health status, disability, occupation, socioeconomic status, migratory status and geographic location.” A poll such as that released this week simply perpetuates the gender binary and does not take into account the fact that any collection/presentation of data needs to be contextualized and take into account the diversity of experience that can in fact inform gender identity (as Hankivsky and Kapilashrami note). One important factor that often gets overlooked has to do with the fact that women are not a monolithic group, and that there are other social determinants at play that may render women of colour less likely to trust medical authorities, and these range from the historical to the structural. Racialized women may feel they are not well represented in clinical studies, or because they have been historically overlooked in public health messaging and left out of the conversation owing to a lack of outreach, their specific concerns could very well remain unaddressed.
I do think that having lost more in this pandemic, women have more to gain from a vaccine which could help restore to the workforce those who have had to step back for care work reasons. So if there are in fact serious reservations informing responses to vaccine confidence polling, we need to look at these closely through an intersectional lens that takes into account the role that a range of social determinants (including race, age, disability, sexual orientation, etc.) play in informing responses to immunization.
We should be wary of assuming that the usual reasons (or players) informing vaccine hesitancy are at work in the current situation. On the contrary, it would be useful to keep in mind that a novel virus brings novel hesitancy that is expanded beyond what we typically encounter, extending to all demographics, age groups, generations, genders, etc. Even the science accepting are not so sure about this one because it is also a novel vaccine that in its unfamiliarity is likely to feed pre-existing skepticism. So now we have a new reason for hesitancy, and again the ranks of the hesitant expand (or shift).
At this point I would offer an analogy and note that just like the mRNA vaccines are playing with the structure of the virus,[ii] so too is the complexion of our hesitancy changing in the face of the unfamiliar. Although more traditional vector and protein sub-unit vaccines are also in the trial phase, these new, rapidly produced mRNA vaccines (as a biotechnology that has been played with for years but which remains relatively unknown to the public), are the face of the coronavirus vaccine. That unfamiliarity, coupled with the bravado of “Operation Warp Speed,” further exacerbates concerns that science fiction rather than science is being sold by a desperate American government eager to paper over its failures with a so-called “miracle vaccine.” A segment of society already inclined to distrust the science of immunization will be less likely to follow the coronavirus task force onto the Starship Enterprise if they feel it is fueled by partisan politics (although I personally would follow Jean-Luc Picard to the nether reaches of the galaxy if invited, and would take a vaccine approved in my country by Health Canada).
[i] According to the National Geographic poll, “Men who were polled were more likely (69 percent) to say they would take the vaccine than women (51 percent), with nearly 1 in 4 women responding ‘very unlikely.’”
[ii] According to my limited understanding, the mRNA vaccine basically teaches our cells to produce a protein (the spike protein unique to the coronavirus) that our bodies then identify and produce antibodies in the form of a response that are subsequently stored as memory to help identify the actual coronavirus should one be exposed to it.