COVID-19 vaccine hesitancy and gender

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Christina WalcherbergerUniversity of Vienna, Austria

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Jakob-Moritz EberlUniversity of Vienna, Austria

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Julia PartheymüllerUniversity of Vienna, Austria

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Katharina T. PaulMedical University of Vienna, Austria

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Tanja A. StammMedical University of Vienna, Austria

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In the context of the COVID-19 pandemic, activists and clinicians have raised concerns about male bias in vaccine development and public health responses. The health crisis has become gendered, both on the level of decision-making and on the level of associated health risks and other downstream attitudes and vulnerabilities – including, but not restricted to, vaccine hesitancy (Harman et al, 2021). Three failings in this regard need to be highlighted. First, women’s reports of menstrual changes following COVID-19 vaccination could not initially be backed up by scientific analysis, as these data were not collected in the clinical trials (Male, 2021). Instead, women’s experiences were dismissed as ‘psychosomatic’ phenomena of low priority. Second, despite early warnings by the World Health Organisation (WHO) of a concurrent ‘infodemic’, official vaccination campaigns were slow in addressing blatant misinformation and conspiracy theories surrounding fertility in young women (Abbasi, 2022). Third, the slow and incoherent messaging regarding the vaccination of pregnant women, who were excluded from pre-marketing clinical trials, might have contributed to the low uptake in that group (see, for example, Stock et al, 2022).

In this ‘gender update’, we use data from the Austrian National Vaccination Registry (Statistik Austria, 2022), as well as the Austrian Corona Panel Project (ACPP) (Kittel et al, 2020; 2021), to provide tentative evidence of the potential impact of the three aforementioned failings on gender-based differences in vaccine hesitancy. Austria has seen one of the lowest COVID-19 vaccination uptakes in Western Europe. Previous research points towards moderate gender-based differences in COVID-19 vaccine hesitancy in the country: before the first vaccines became available, a survey found that women in Austria were about six percentage points less likely to report an intention to get vaccinated (Paul et al, 2021). Another study found a cluster among unvaccinated Austrians, including a heightened share of female participants, showing relatively low levels of trust in science but high levels of belief in ‘alternative medical methods’, such as homoeopathy (Stamm et al, 2022). One year into the vaccine rollout, however, official statistics in March 2022 show that the gap in vaccination rates between Austrian men and women has largely vanished at the aggregate level (69.9 per cent versus 70.3 per cent, respectively). Hence, it is not self-evident how and whether gender and COVID-19 vaccine hesitancy are still related.

Taking a closer look at the recent data from the Austrian National Vaccination Registry (see Figure 1), we can see that gender-based differences in vaccine uptake are still present but mostly limited to the subgroup of the young and unemployed. To be more precise, unemployed 25-year-old males, for example, have a vaccine uptake that is five percentage points higher than that of their female counterparts. This pattern might reflect the differential concerns of women of child-bearing age and that some women with childcare responsibilities tend not to be in the active workforce. While the aggregate gap in vaccine uptake has levelled out, an intersectional pattern persists.

Figure 1:
Figure 1:

COVID-19 vaccination rate by gender and employment status

Citation: European Journal of Politics and Gender 5, 2; 10.1332/251510821X16498676658252

Source: Statistik Austria (2022).

Based on the ACPP survey data, Figure 2 shows the dynamics of concerns regarding vaccine safety between December 2020 and January 2022. Generally speaking, anxiety regarding side effects caused by the COVID-19 vaccination was higher among women compared to men throughout the pandemic. For example, in December 2020, when vaccines first became available, 50 per cent of the male, but 68 per cent of the female, respondents said that they were worried about adverse effects of vaccination (‘strongly agree’/‘somewhat agree’). Over time, however, the gender-based differences in concerns about side effects shrink to five percentage points by January 2022.

Figure 2:
Figure 2:

Concern about side effects of COVID-19 vaccination by gender and over time

Citation: European Journal of Politics and Gender 5, 2; 10.1332/251510821X16498676658252

Notes: N ≈ 1,500 per wave. The target population was Austrian residents aged 14+ years.Source: ACPP.

While gender-based differences are moderate and have decreased over the course of the vaccine rollout, registry data, as well as survey data, confirm that some of the gendered nature of COVID-19 vaccine hesitancy has endured. These findings are, in fact, in line with the majority of the research on COVID-19 vaccine hesitancy and vaccination refusal so far (for a review of the literature, see Troiano and Nardi, 2021). Although a strict causal assessment is beyond the scope of this ‘gender update’, it seems plausible that the three failings – first, the dismissal of women’s reports of menstrual changes; second, the infodemic of fertility-related misinformation; and, third, the exclusion and confusing messaging regarding pregnant women – may have contributed to the patterns observed. More research would be necessary in this regard, which could also aim at assessing the underlying narratives and values connected to women’s vaccine hesitancy in more detail.

As time may very well be of the essence during a health crisis, we believe that both medical research and pharmacovigilance systems need to be gender sensitive by design, taking into account, instead of invalidating, the experiences of women. Medical research still tends to focus on the male patient as the blueprint for any patient, which can result in women not receiving appropriate treatment or doing so only with significant delay. Only by adopting a gender-sensitive approach to medicine can public health campaigns quickly and effectively counteract the possible fear of side effects before it can spread through social media and other channels and becomes entrenched in large parts of the population. We conclude that COVID-19 may serve as a case to reflect upon the implications of the institutionalised marginalisation of women – including issues related to menstrual and reproductive health – in clinical trials and communication efforts. Taken together, the lessons learned from the COVID-19 pandemic may serve to strengthen trust in the healthcare system among women and in society as a whole.

Acknowledgements

The data collection of the Austrian Corona Panel Project was supported by COVID-19 Rapid Response Grant EI-COV20-006 of the Wiener Wissenschafts- und Technologiefonds, financial support by the rectorate of the University of Vienna, and funding by the FWF Austrian Science Fund (P33907). Further funding by the Austrian Social Survey, the Vienna Chamber of Labour and the Federation of Austrian Industries is gratefully acknowledged.

Author biographies

Christina Walcherberger is a student assistant at the Vienna Center for Electoral Research at the University of Vienna and a member of the Austrian Corona Panel Project (ACPP).

Jakob-Moritz Eberl is a senior scientist at the Department of Communication at the University of Vienna and a member of the project team of the Austrian Corona Panel Project (ACPP).

Julia Partheymüller is a senior scientist at the Department of Government at the University of Vienna and a member of the project team of the Austrian Corona Panel Project (ACPP).

Katharina T. Paul is Elise Richter Research Fellow (FWF - Austrian Science Fund) at the Department of Political Science at the University of Vienna.

Tanja Stamm is Full Professor of Outcomes Research at the Medical University of Vienna and Head of the Ludwig Boltzmann Institute for Arthritis and Rehabilitation.

Conflict of interest

The authors declare that there is no conflict of interest.

References

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  • View in gallery
    Figure 1:

    COVID-19 vaccination rate by gender and employment status

  • View in gallery
    Figure 2:

    Concern about side effects of COVID-19 vaccination by gender and over time

  • Abbasi, J. (2022) Widespread misinformation about infertility continues to create COVID-19 vaccine hesitancy, JAMA, 327(11): 101315. doi: 10.1001/jama.2022.2404

    • Search Google Scholar
    • Export Citation
  • Harman, S., Herten-Crabb, A., Morgan, R., Smith, J. and Wenham, C. (2021) COVID-19 vaccines and women’s security, The Lancet, 397(10272): 3578. doi: 10.1016/S0140-6736(20)32727-6

    • Search Google Scholar
    • Export Citation
  • Kittel, B. et al. (2020) Austrian corona panel project (SUF edn), AUSSDA, 4, doi: 10.11587/28KQNS.

  • Kittel, B. et al. (2021) The Austrian Corona Panel Project: monitoring individual and societal dynamics amidst the COVID-19 crisis, European Political Science, 20(2): 31844. doi: 10.1057/s41304-020-00294-7

    • Search Google Scholar
    • Export Citation
  • Male, V. (2021) Menstrual changes after COVID-19 vaccination, BMJ, 374.

  • Paul, K.T., Eberl, J.M. and Partheymüller, J. (2021) Policy-relevant attitudes toward COVID-19 vaccination: associations with demography, health risk, and social and political factors, Frontiers in Public Health, 9. doi: 10.3389/fpubh.2021.671896

    • Search Google Scholar
    • Export Citation
  • Stamm, T., Partheymüller, J., Mosor, E., Ritschl, V., Kritzinger, S. and Eberl, J.M. (2022) Coronavirus vaccine hesitancy among unvaccinated Austrians: assessing underlying motivations and the effectiveness of interventions based on a cross-sectional survey with two embedded conjoint experiments, The Lancet Regional Health – Europe. doi: https://doi.org/10.1016/j.lanepe.2022.100389

    • Search Google Scholar
    • Export Citation
  • Statistik Austria (2022) COVID-19-Impfstatus, https://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/gesundheit/covid19/covid19_impfstatus/index.html.

    • Search Google Scholar
    • Export Citation
  • Stock, S.J. et al. (2022) SARS-CoV-2 infection and COVID-19 vaccination rates in pregnant women in Scotland, Nature Medicine, 28(3): 50412. doi: https://doi.org/10.1038/s41591-021-01666-2.

    • Search Google Scholar
    • Export Citation
  • Troiano, G. and Nardi, A. (2021) Vaccine hesitancy in the era of COVID-19, Public Health, 194: 24551. doi: 10.1016/j.puhe.2021.02.025

    • Search Google Scholar
    • Export Citation
Christina WalcherbergerUniversity of Vienna, Austria

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Jakob-Moritz EberlUniversity of Vienna, Austria

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Julia PartheymüllerUniversity of Vienna, Austria

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Katharina T. PaulMedical University of Vienna, Austria

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Tanja A. StammMedical University of Vienna, Austria

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