Study highlights structural barriers in covid-19 vaccine access for marginalised communities in India

A new study has brought attention to the significant challenges faced by transgender, gender-diverse (TGD), and disability communities in accessing COVID-19 vaccines in India. Despite the intent to get vaccinated among most participants, various structural barriers have hindered vaccine access for these marginalised groups, exacerbating existing health inequities.

The study, titled “Understanding Structural Inequities in COVID-19 Vaccine Access and Uptake among Disability, Transgender, and Gender-Diverse Communities in India,” was published in Vaccine by Elsevier. Conducted between September 2021 and February 2023, it involved interviews with 24 community representatives who identify as transgender, gender diverse, or persons with disabilities, and 21 key informants, including vaccine program managers, providers, and community advocates. The study was co-led and co-designed by trans and disability community members, offering unique insights into the barriers these communities face.

The research identified several key obstacles, starting with information and communication gaps. Participants highlighted the lack of targeted information addressing the specific health needs of transgender and disability communities. Concerns were raised about the adverse effects of vaccines on individuals undergoing hormone replacement therapy, antiretroviral therapy, or those with specific disabilities such as hemophilia and visual impairment.

Procedural barriers also played a significant role. The CoWIN digital vaccination registration system was found to be largely inaccessible to people with disabilities. Issues like mandatory ID card requirements and a lack of guidelines for gender discordant ID card holders led to reluctance among trans and gender-diverse individuals to get vaccinated or resulted in them being denied the vaccine altogether.

Infrastructural challenges further compounded the issue. Participants reported difficulties such as long distances to vaccination centers, a lack of accessible transport, and non-inclusive infrastructure at the centers, including gendered washrooms and non-disability-friendly facilities.

Mistreatment and discrimination at vaccination centers were also significant deterrents. The study observed frequent instances of staff mistreating individuals, with transgender people and those with disabilities reporting stigmatising and discriminatory experiences.

The study offers several recommendations to address these challenges. It suggests the development and dissemination of detailed information on vaccines that address the specific health needs of transgender and disability communities. Additionally, the study calls for accessible digital platforms like CoWIN, with user-friendly interfaces for people with disabilities, and protocols for providing vaccinations to those without ID cards.

The research also advocates for infrastructure improvements at vaccination centers, including the provision of disability-friendly facilities and non-binary gender options to ensure comfort and safety for the trans community. It emphasises the need for comprehensive sensitisation training for vaccination center staff to prevent discrimination and stigmatisation, promoting an inclusive and respectful environment. The study further recommends equity-focused partnerships between government bodies, NGOs, and community leaders to provide accessible and stigma-free vaccination services tailored to marginalised communities.