Gender differences in Covid-19 vaccine hesitancy

​​​As part of the Clayman Institute’s focus on gender and the pandemic, Margot Bellon joined the Institute as a researcher this summer. She worked on two projects related to Covid-19: one examining gender differences in Covid-19 contraction risk, and another analyzing demographic differences in Covid-19 vaccine hesitancy among Stanford healthcare workers. Working with information collected by researchers who surveyed health care workers, Bellon focused on data analysis. Bellon is a masters student in epidemiology and clinical research at Stanford and has aspirations of becoming a physician in order to directly address disparities in women's health. She is a graduate of Stanford University who majored in biology and minored in feminist, gender and sexuality studies. From San Mateo, California, Bellon is a French dual citizen with a passion for examining cross-cultural differences in healthcare. In her spare time, Margot enjoys long distance running and engaging in all things outdoors.

One of your projects looks at Covid-19 vaccine hesitancy. What are some of the major reasons you found that make people reluctant to get vaccinated?

The main reasons I found that make healthcare workers reluctant to get vaccinated are that they think the vaccine is too new, they are fearful of the vaccines’ potential side effects, they have philosophical or religious beliefs that prohibit vaccination, or they have medical contraindications to receiving a Covid-19 vaccine.

What role did gender play in your findings about vaccine hesitancy?

Women were significantly more likely to express a desire to delay or reject the Covid-19 vaccine than men were, which is consistent with the existing literature on vaccine hesitancy. Women were also more likely than men to state that the vaccine was too new, that they were fearful of side effects, and that they had a medical contraindication to the vaccine. Men and women were equally likely to state that their philosophical or religious beliefs prohibit vaccination. 

I was surprised to learn how much more likely than men women are to be vaccine hesitant, in addition to learning that younger healthcare workers are less likely to accept the Covid-19 vaccine than older healthcare workers, despite several studies pointing to the fact that younger people have higher agreeance on the importance of Covid-19 vaccination for community health than older people.

How about vaccine mandates? Were any mandates in place that would impact those who are vaccine hesitant?

Now that the Pfizer-BioNTech Covid-19 vaccine has received official FDA approval, public health campaigns should concentrate outreach initiatives on those who were fearful of the Covid-19 vaccine’s side effects or who thought the vaccine was too new. According to the Acting FDA Commissioner Janet Woodcock, because the Pfizer vaccine has received FDA approval, the public should feel confident that the vaccine meets “the high standards for safety, effectiveness, and manufacturing quality that the FDA requires of approved products.” This is to say that vaccine newness or fear of side effects should now become less commonly cited reasons for vaccine hesitancy among Americans. In my research, I found that women, Hispanic, African American, and Hawaiian/Pacific Islander healthcare workers and healthcare workers aged 18-27 were more likely than other demographic groups to think that the Covid-19 vaccine was too new or to be fearful of the vaccine’s side effects. Healthcare workers in housekeeping, IT, or nonclinical support were also more likely than expected to state the vaccine was too new. Therefore, I expect that more members of these demographic groups will now get their Covid-19 vaccine shots based on the perceived safety and security associated with official FDA approval of the Pfizer-BioNTech vaccine. 

What about this project surprised you? Did you find opportunities for additional future research?

I was surprised to learn how much more likely than men women are to be vaccine hesitant, in addition to learning that younger healthcare workers are less likely to accept the Covid-19 vaccine than older healthcare workers, despite several studies pointing to the fact that younger people have higher agreeance on the importance of Covid-19 vaccination for community health than older people. It was intriguing that healthcare workers who experience direct patient contact were more likely to accept the vaccine than those who work on the nonclinical side of healthcare, perhaps because healthcare workers who interface directly with patients consider themselves a risk to others without the vaccine. Furthermore, my research was consistent with the broader literature in demonstrating that healthcare workers who are racial minorities were more likely to be vaccine hesitant. Lack of trust in vaccines, particularly among Black populations, is common, likely stemming from systemic racism and previous under-representation of minorities in health research and vaccine trials. 

Now that the CDC has declared that the Covid-19 vaccine is safe for pregnant women, we are seeing more women of reproductive age accepting the vaccine. In my research, I did not separately analyze vaccine hesitancy among women of reproductive age (those who could be pregnant) and women who are not of reproductive age. I would like to account for reproductive age in future research and analysis in order to determine which women may be vaccine hesitant due to pregnancy and to better understand whether women of reproductive age face higher rates of vaccine hesitancy despite CDC guidelines on vaccine safety during pregnancy. 

Furthermore, in future research I will try to understand the demographic characteristics of healthcare workers who said they would not get the Covid-19 vaccine but got their shot anyway, in order to identify common demographic trends in changing perspectives on vaccine hesitancy among healthcare workers, perhaps due to effective public health campaigns. 

Was there a moment when you knew that gender research would be an important part of your career in medicine? What other opportunities for gender research in medicine do you hope to pursue?

I have been inspired throughout my undergrad by Marcia Stefanick’s pivotal work in promoting sex differences research, especially after taking six of her courses. [Stefanick is a Stanford professor of medicine and professor of obstetrics and gynecology, as well as former Clayman Institute faculty research fellow.] I believe that understanding the gender and racial differences in social acceptance of any vaccine will help public health officials create better vaccination campaigns. There may be a number of reasons why black, Hispanic, Pacific Islander, and female HCWs are less likely to receive the Covid-19 vaccine, including lack of transportation, childcare and time off work. It is important to consider all of these social and demographic factors when creating targeted vaccination campaigns, because different groups of people experience different barriers to vaccination. I am just beginning my master’s degree in epidemiology and clinical research this fall and hope to pursue my master’s thesis on gender, age, and racial differences in risk for Covid-19. I am fascinated by behavioral gender differences that influence susceptibility to Covid-19, and I am curious about how these findings will translate to the disease risk patterns of other contagious infectious diseases, like the flu. Beyond my master’s degree, I hope to continue pursuing research on sex and gender differences in disease risk and clinical manifestation throughout my career.