Choosing to challenge gender inequity in the COVID-19 vaccine rollout

Relief. An unfamiliar emotion after this turbulent and trying year. But that’s how I felt as friends and family working for the NHS (UK National Health Service) started receiving their first dose of the COVID-19 vaccine. It felt like the beginning of the end, as if a light had appeared at the end of the tunnel.

Although those I know working for the NHS span numerous departments and roles, they have one thing in common. They are all women. This isn’t surprising: 77% of the NHS workforce (2018) are women.

The same is true all around the world as women make up approximately 70% of the global health workforce. This high representation is not evenly spread across the different levels within the workforce though. In most countries, male workers take up the majority of physician, pharmacist, and leadership positions, whilst female workers comprise the majority of the nursing and midwifery workforce. In other words, women are predominantly in the lower paid and patient-facing roles that are more exposed to the virus.

In addition, women perform 75% of unpaid care work globally. On average, they spend four hours and 25 minutes daily on unpaid care work such as childcare, collecting water, and cleaning – more than three times men’s average of one hour and 23 minutes.

Despite being unpaid and often strenuous, all around the world, this work is essential to managing households, sustaining the economy, and indeed, supporting the COVID-19 response.

So, around the world, women’s (low) paid and unpaid work in this pandemic has been essential.

Paid and unpaid carers must therefore be prioritised in the vaccine rollout. However, for many, especially in low income countries that are facing broad challenges in accessing the vaccine, this must still feel like a distant dream. In their positions as carers, it will be women who bear the brunt of the inequitable distribution of vaccines around the world.

Throughout this pandemic there have been repeated calls to acknowledge the gendered aspects of the pandemic, in particular, how women have been impacted. Now, we need to anticipate how the delivery of the vaccines will further affect them.

A number of potential issues can already be identified, although women will likely face many other challenges and risks across different contexts and stages of the vaccine roll-out:

• For many, vaccine access will rely on the unpaid labour of women who will likely be responsible for taking elderly or cared-for relatives to be immunised once or twice, depending on the type of vaccine. This may incur out of pocket expenses or lost income as a result of time away from their paid work.
• The administration of the vaccines itself may result in increased workloads of healthcare workers. There is already a shortfall of 18 million health care workers particularly in low- and middle-income countries, meaning that pressure on the health systems will further increase.
• Unpaid community health workers are also predominantly women and will be expected to mobilise and educate communities, and even accompany clients to facilities. In Nepal, for example, 50,000 community health workers were included in the priority list for the vaccine. All countries should do the same.
• In rural areas particularly, some women have limited access to information and news sources, and therefore know very little about the vaccine. This can give rise to misinformation, myths and misconceptions that may make them hesitant to get vaccinated when/if they can.
• Amid scarce supplies, healthcare workers may face violence and abuse by those that want to secure the limited number of vaccine doses. Additionally, as has been seen in Polio and Ebola vaccination campaigns, they may also be attacked by those who are against the vaccination programme.
• There are also fears, linked to the rise in domestic gender-based violence during the pandemic, that a woman that gets vaccinated before a male ‘head of house’ may face abusive repercussions.
• We can also not ignore the potential risk for sexual exploitation arising from the imbalance of power between those who are involved with vaccine delivery and those who are in need. This happened during the Ebola vaccination programme in the Democratic Republic of Congo in 2018, where some male health-care workers offered vaccines in exchange for sexual favours from women and girls.

On this International Women’s Day, let’s choose to challenge vaccine inequity by including women’s voices, as healthcare workers and unpaid carers, in the conversations around vaccine delivery, acceptability and hesitancy. We, the international community, governments, and development organisations such as Options, must recognise women’s caregiving roles as a risk factor and prioritise them.

Options is working with vaccine taskforces in Kenya and Nigeria to ensure that healthcare workers are prioritised and that vaccines will be rolled out smoothly and efficiently. We are also engaging civil society organisations and religious bodies on COVID-19 vaccine introduction, advocacy, rumor management and sensitisation, which will address some of the challenges that exacerbate vaccine inequity. But more is needed.

We must ensure that the roll out of the vaccine does not become another way in which women are unfairly disadvantaged in this pandemic, despite their leading role.