Dismantling Barriers to Transgender People Getting Vaccinated Against COVID-19
Surveys conducted in Colorado and Pennsylvania revealed that the LGBTQ+ population has lower rates of COVID-19 vaccinations and higher rates of vaccine hesitancy than the American public at large. Most public health models rely exclusively on a binary model of sex/gender, which erases non-conforming identities and makes relevant data on COVID-19’s impact on intersex, transgender, nonbinary, and other gender-diverse populations difficult to come by. However, what we do know is that transgender people face higher vulnerabilities to COVID-19.
Transgender people in the United States, specifically, have low rates of COVID-19 vaccinations and face discrimination, mistreatment, and stigma in the American healthcare system, so it is vital to enact new trans-inclusive policies to break down barriers to access and provide culturally competent care and health information specific to the transgender community.
Barriers to the transgender community getting vaccinated against the virus include a lack of transgender participants in clinical trials for the vaccines and state policies that restrict transgender access to healthcare and necessary accommodations. Transgender people face further barriers, including fear of being misgendered, deadnamed, and/or not having an ID match their name or gender and lower rates of health insurance, all of which translate into vaccine hesitancy. One study from the Kaiser Family Foundation found that transgender adults are more likely to be uninsured (19% vs. 12%) and report cost-related barriers to care (19% vs. 13%) than cisgender counterparts, incurring yet another barrier to access.
Clinical trials, including those for the COVID-19 vaccine, do not always include gender identities other than cisgender men and women and are not mindful of inclusive trial design, such as asking for participants’ gender identity, pronouns, and sex assigned at birth. Harvard University Research Assistant Rachel Hemond shared, “For example, it can be traumatic to go through things like urine pregnancy tests if you fully identify as male.” Furthermore, they may be unable to participate in clinical trials given their medical history. Transgender youth are also more likely to have a history of substance use and are at higher risk of conditions such as HIV, sometimes preventing them from participating in research studies. Given these barriers to clinical trial access, there is limited research on the effects of the COVID-19 vaccine on transgender individuals.
Certain states do not have laws in place to prohibit discrimination on the basis of gender identity or sexual orientation, with some states going as far to explicitly allow insurers to refuse to cover gender-affirming care. These healthcare laws and policies are yet another barrier to healthcare access and sow greater mistrust in the healthcare system for transgender individuals.
Transgender people may also be anxious about being misgendered, deadnamed, or otherwise disrespected as well as not having identification that matches their identity (e.g. name, pronouns, and gender), which further discourages them from getting vaccinated against SARS-CoV-2. They are also less likely to have health insurance.
We need to enact new trans-inclusive policies around vaccine delivery and generate health information specific to this community. Similar to voter registration, workers delivering vaccines should be trained on how to serve people whose ID does not match their gender identity or preferred name for instance.
There needs to be further research into the effects of the COVID-19 vaccine on transgender patients and data to validate it will not interfere with people transitioning if they so choose. In general, we need more research on gender-diverse populations to create equitable public health solutions. More inclusive policies, thorough research, and culturally competent care are important steps to building trust in the healthcare system and ensuring transgender people are protected against COVID-19.
Written for the Vaccine Student Working Group on Ethics and Policy.
References
Perret, Meg, et al., “COVID-19 Data On Trans And Gender-Expansive People, Stat!,” Health Affairs, 2021, https://www.healthaffairs.org/do/10.1377/hblog20210510.756668/full
“Why It’s Harder For Many Transgender People To Access (And Trust) COVID-19 Vaccines.” Discover Magazine, 2021, https://www.discovermagazine.com/health/why-its-harder-for-many-transgender-people-to-access-and-trust-covid-19
“Movement Advancement Project | Healthcare Laws And Policies”. Movement Advancement Project, 2021, https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
Cerretani, Jessica. “Transgender Discrimination In Health Care: What Families Should Know — Boston Children’s Answers”. Boston Children’s Answers, 2020, https://answers.childrenshospital.org/transgender-discrimination
Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). “Barriers to healthcare for transgender individuals.” Current opinion in endocrinology, diabetes, and obesity, 23(2), 168–171. https://doi.org/10.1097/MED.0000000000000227
