Build it Right or They Won’t Come: Being Gender Responsive for COVID-19 Mass Vaccination

To date, less than 4% of people in low-income countries have had at least one dose of a coronavirus vaccine, as opposed to almost 62% in high-income countries. As part of USAID’s commitment to the purchase and delivery of safe and effective COVID-19 vaccines for the world’s most vulnerable and at-risk populations, USAID MTaPS is assisting COVID-19 vaccine introduction in low- and middle-income countries on multiple technical fronts.

COVID-19 vaccination strategies and policies must be gender-responsive and include tailored and context-specific, gender-sensitive approaches to ensure vaccine equity. Due to the limited shelf life, supply chain issues, and cold chain challenges of COVID-19 vaccines, the time to think practically about engaging women and other vulnerable groups is before vaccines arrive and not after, when the logistics of getting the doses into arms may preclude equitable distribution and outreach to marginalized populations.

Mass Vaccination Sites

Conventional health facility-based vaccination sites are not sufficient to meet the need for rapid vaccination to stop the spread of COVID-19. Mass vaccination sites are effective, efficient, and allow for complete use of multidose vials without waste. These sites also allow for controlled infection control and social distancing, but they need to be gender-responsive. Three important considerations are necessary:

• Privacy screens for women to partially disrobe that allow vaccinators access to the upper arm for the vaccine
• Female vaccinators, especially in conservative societies
• Adherence to water, sanitation, and hygiene principles to ensure access for disabled persons and lactating and pregnant individuals (since some COVID-19 vaccines have been deemed safe for pregnant individuals) at mass vaccination sites, remembering that many people have walked long distances to the sites

Demand Generation

To read or not to read

A country’s literacy rate is an important consideration for the channels used for vaccine information. Women are less likely to receive relevant COVID-19 vaccination information due gender gaps in education, literacy, and technology access and use. Although literacy rates have improved globally, females still lag behind males in literacy, and there are stark differences in rates by country. Therefore, printed brochures, patient information, or flyers in any language would not be effective tools for vaccine information. After understanding household rates of TV and radio ownership, concentrating COVID-19 vaccine messages on mass media via these modalities and pairing mass media campaigns with community engagement will effectively reach most of the population. Messages may need to be in local or familiar languages to reach all communities, especially women.

What to say in the messages

We know that males and females respond differently to vaccines, so it is important to let the community know it is expected that 80% of females will experience most of the vaccine side-effects. To limit hesitancy among women, messages need to specifically state that mass vaccination sites are female-friendly, such as having privacy screens and female vaccinators if these campaigns are in conservative societies. Television spots that utilize drama or cartoons need to show female vaccinators and privacy screens at vaccination sites, and radio messages must explicitly state this. Pretesting messages is necessary, and focus groups need to have a mix of men and women.

Community Engagement

Community acceptance, accessibility, and equity must be addressed from the outset. In coordination with mass media, trusted community leaders can be leveraged to increase demand for these life-saving vaccines and dispel myths. Creating vaccine champions to serve as trusted voices to get entire communities vaccinated and dispel myths, in addition to identifying those most at risk and those who are not able to get to mass vaccination sites, is an effective way to bolster mass media campaigns. Using social behavior change communication, these champions will help overcome vaccine hesitancy and increase vaccine confidence.

What Does All This Mean for Vaccine Introduction?

To vaccinate the world, outreach needs to target women and other vulnerable groups to improve health outcomes. Identifying and resolving gender-based barriers to vaccination is critical because women care for family members and play a central role in health and immunization decisions. These roles should be leveraged to benefit the equitable distribution of vaccines and overall uptake within communities. Gender equity in vaccinations will not only improve public health outcomes but also mitigate gender-based violence and protection risks, including sexual exploitation.

Practical Suggestions for Gender-Responsive Mass Vaccination

Vaccination Sites

• Both men and women need to be at vaccination planning meetings.
•  Mass vaccination sites may need privacy screens for women to receive injections in some countries, and these should be included in the budget.
• Separate male and female toilets is a must, especially if people need to come from long distances in rural areas.
• Female vaccinators are a must in conservative societies.

Messaging

• Keep literacy rates in mind—focus on mass media (e.g., TV, radio, voice messages, billboards) and use all common languages to broadcast at prime viewing and listening times.
• Be sure to pretest messages with both women and men.
• Make sure messages specifically state that vaccine sites are female-friendly.
• SMS messages need to include a statement that the messages should be shared with women in the household, given that phone ownership favors men and literacy rates are low among women.

Community Engagement

• Use the community to identify those who cannot get to mass vaccination sites to allow mobile vaccinators to reach the most vulnerable (ill, bed bound, elderly).
• Use community mobilization approaches that increase vaccine demand and decrease vaccine hesitancy, utilizing local leaders and public figures as champions and leveraging faith-based organizations to encourage people to protect themselves, their family, and their community.

Providing women easy access to COVID-19 vaccines at sites that take cultural realities into account is paramount for ensuring that communities achieve herd immunity while limiting the social and economic impacts that have disproportionately affected women during the pandemic.

Lynn Lieberman Lawry is the Senior Gender Advisor for the USAID MTaPS