The gender gap on vaccination: women are more likely to be shot than men

Holly Elgison and Len Schillaci are a mixed couple, and they are far from being alone.

"I always wanted to get 100 percent of the vaccine," said Ms. Elgison, a medical claims investigator in Valrico, Florida.

Her husband, a disaster insurance expert, said he would pass. "To be honest, I think the worst of Covid is behind us," said Mr Schillaci. "I'm fine."

With the Biden administration trying to immunize 80 percent of adult Americans by the summer, the continued reluctance of men to get a shot could hamper that goal.

Women are vaccinated at a far higher rate – around 10 percentage points – than men, although the gap between men and women is roughly the same across the country's population. The trend is worrying for many, especially as vaccination rates have dropped somewhat recently.

The reasons for the gender gap in the US are diverse, reflecting the roles of women in certain occupations who received vaccination priority early, political and cultural differences, and longstanding patterns of women using preventive care more often than men.

The gap also exists when worldwide deaths from Covid-19 were around 2.4 times higher in men than women. And the department explains the reality of the disproportionate role women play in caring for others in American society.

"It might be important to pinpoint herd immunity," said Alison Buttenheim, an associate professor of nursing at the University of Pennsylvania and an expert on vaccine reluctance. "While most experts are annoyed by larger gaps by race, political party, religion and occupation," she said, many of which overlap with gender differences, "I have not yet heard any specific initiatives to combat men."

In Los Angeles County, where 44 percent of women over 16 got their first shot – compared to 30 percent of men – officials are trying hard to figure out exactly how to do that.

"We are very concerned about this and plan to establish targeted contact with men," said Dr. Paul Simon, science director for the Los Angeles county's health department, said the differences are of particular concern to Black and Latino men. Only 19 percent of black men in Los Angeles County and 17 percent of Latino men have received at least one dose of vaccine, compared with 35 percent of Asian men and 32 percent of white men. This is based on the latest data available earlier this month.

"We don't quite get it," said Dr. Simon. "One of our messaging strategies will be that the vaccine is not only important to you, but also a means of protecting others in your family."

The early breakdown of vaccination rates by gender could largely be explained by demographics. Americans over 70 got their first doses, and women make up a greater proportion of this age group. Healthcare workers and teachers have also been given precedence over vaccines in many states: three-quarters of full-time healthcare workers are women, and over 75 percent of public school teachers in the United States are women.

The differences show both where women do the paid and unpaid work of life. For example, women lost the majority of their earliest jobs in the food, retail, healthcare, and government professions. The mothers among them have done most of the work in moving to distance learning and caring for parents and sick relatives.

The combination may have boosted their vaccine motivation in two ways: they are trying to protect the rest of their family, and they are desperate to get back into work. Just as women caused job losses last year, they are now leading the economic recovery. Around half a million women entered the world of work in March, partly because personal schooling was resumed in large parts of the country.

Updated

April 22, 2021, 9:03 a.m. ET

"In addition to the disproportionate representation of women in various key occupations," said Pilar Gonalons-Pons, University of Pennsylvania assistant professor of sociology who specializes in gender issues, "they are also disproportionately represented as unpaid caregivers for older adults. " Families and communities, and this can be additional motivation for the vaccine as well. "

In many ways, the pattern in vaccines reflects longstanding gender differences in terms of health care. Women, on average, are more likely to receive annual exercise than men, even when adapted to pre-existing health conditions and other factors, and are more likely to receive preventive treatment than men.

Men are more likely than women to engage in harmful behaviors such as heavy drinking, smoking and illegal drug use, and are more overweight than women. According to federal data, men are less likely to see doctors regularly, go to the emergency room, and receive basic dental care in a crisis. Vaccines are no exception: historically, influenza vaccination is much higher in women – about 63 percent versus 53 percent – although the gap is narrowing among Americans over 75 years of age.

The coronavirus vaccine "is the latest expression of the proven gender gap we have long observed in the search for preventive health practices," said Lindsey Leininger, health policy researcher and clinical professor at the Tuck School of Business at Dartmouth College.

However, experts say that even related to the general dissatisfaction with male health care, there may be some factors specific to this vaccine that prevent more male shots in the arms. Because signing up was cumbersome and confusing, men may have had less patience navigating the system, which was largely online. This process may be easier for women as they tend to get more information about their health care online.

"We have to find out whether there are differences in access, whether men have greater difficulty finding their way through the appointment systems," said Simon from Los Angeles.

When it comes to the coronavirus, which has been the subject of rampant misinformation, evolving medical advice, and politicization, another dynamic may be at work.

"Some men feel that they are not necessarily vulnerable," Simon told health care workers. "You have survived this for more than a year and have a sense of omnipotence."

Public health and science experts have long been concerned about the "macho" effect that prevents men from receiving all types of health care and fear that this vaccine will make it worse. (Particularly in the military's most masculine service division, the Marines, about 40 percent of those offered the vaccine by the Department of Defense have turned it down.)

"This avoidance has been linked to ideals of masculinity, where men are strong and invincible and don't ask for help," said Kristen W. Springer, associate professor at Rutgers University, New Jersey's sociology institute who studied this trait.

"In other words, these cultural ideals lead men to avoid essential health services in order to act masculine," she said. “Now that the vaccine is available to everyone, it will be interesting to see the differences between men and women in vaccine intake, as these reflect more social and cultural ideas about gender and health, such as the cultural idea being the 'real' Men 'don't have preventive health care. "

At this point in time, U.S. health officials have not released data on non-binary adults and vaccinations.

There can also be political connections. Women are far more likely than men to register as Democrats, and polls show that Republicans across the country are far less likely than Democrats to take the vaccine.

Who will people listen to? Apparently not their wives and friends or doctors. Leah Witus and Erik Larson, professors at Macalester College in Saint Paul, Minnesota, watched videos of men and women with identical information about the vaccine for their recent preprint study. Of the 1,184 Americans who observed them, most were positively influenced by the male narrator, while the female narrator received a far more mixed response.

"The male-narrated version of the video increased viewers' vaccination intent," Ms. Witus said, "but the female-narrated version had mixed associations with vaccination propensity and, for some viewers, those identified as conservative actually decreased vaccination intent . ”

This could mean a victory for Mr Schillaci as he and his wife subtly fight to influence the vaccination decision of their 20 year old son. Mr Schillaci shared his views with his son, whom his wife nudges to get a shot.

"I'd prefer him to get the shot and I hope he thinks about it," said Ms. Elgison.

But Ms. Elgison's own decision can benefit her son even if he chooses not to have the vaccine.

As is so often the case in life, men can find that their gaps are being filled by women. "To the extent that most people live and socialize in a mixed environment," said Ms. Buttenheim, men will benefit from higher coverage among women.

However, Ms. Elgison still has one trump card that she hopes could work. "I want my son to have it so we can all travel together," she said. "I explained to him that it was possible that we could protect his father."