Beyond the Vaccine: Addressing Gender Barriers in Immunization Efforts

As we reflect on World Polio Day, we consider the intersections that exist between gender equality and immunization efforts and explore what needs to be further addressed to ensure everyone has the same opportunities to access and benefit from immunization. 

Limited access to female healthcare providers, particularly in contexts with norms restricting physical contact between women and men, including male health workers; lack of women’s agency to make decisions around their health, including vaccination; the division of labor within the household that may detract from fathers’ involvement with childcare duties and restrict women’s opportunities for vaccination; gender norms that prioritize men and boys’ health; discriminating health services; and long distances from health facilities with the associated safety and mobility issues, are only some of the gender-related barriers that prevent women, girls and LGBTQ+ people from seeking vaccination. 

Efforts to integrate gender equality into the immunization agenda

Over the past few years, the health community has become increasingly aware of the need to integrate gender equality into immunization efforts. There has been greater recognition, at both global and national levels, of the impact of these gender barriers and gaps on immunization, especially when trying to reach zero-dose and under-immunized children and communities. 

The 2019 external evaluation of Gavi’s, the Vaccine Alliance, Gender Policy, and its subsequent revisions, as well as the Global Polio Eradication Initiative’s (GPEI) Gender Equality Strategy, have helped raise awareness around these issues and spur increased investment in identifying and addressing gender barriers to immunization. 

For example, Gavi emphasizes the importance of supporting female caregivers and healthcare workers, acknowledging their central roles in community health. Gavi’s Gender Policy also highlights the need to address the unique challenges faced by adolescent girls, ensuring equitable health access. Through these initiatives, Gavi aims to reach zero-dose and under-immunized children and communities by dismantling gender-related obstacles. 

Similarly, the GPEI’s strategy aims at promoting the integration of a gender perspective into various aspects of the GPEI’s programming and interventions. As part of the interventions, the GPEI facilitates gender training with government staff to ensure that gender is integrated into all stages of their polio outbreak response planning and supports countries in addressing gender-related barriers to polio vaccination.

Canada’s role in advocating for a gender-intentional approach to immunization

As per Canada’s Feminist International Assistance Policy, 95 percent of bilateral international development assistance initiatives target or integrate gender equality and the empowerment of women and girls. Through the funding of multilateral initiatives, Canada plays an important role in advocating for a gender-intentional approach to immunization: Canada was the GPEI’s first bilateral donor and has been a member of Gavi’s Board of Directors since the Alliance’s creation. Canada also sits on the GPEI’s Polio Oversight Board as one of its main donors. This position has enabled Canada to advocate for policy changes within these global health initiatives, namely with regard to gender mainstreaming. 

 In recent history, Canada has made contributions to advancing gender equality and reducing the burden of infectious diseases through vaccination. These include efforts to vaccinate women in their reproductive years against tetanus and to provide 1.1 million girls with HPV vaccines. Similarly, in response to global calls for support to enhance the COVID-19 vaccine roll-out in 2022, Canada partnered with UNICEF to strengthen gender-responsive primary healthcare services and with the World Health Organization (WHO) to increase equitable access to vaccines and reinforce health systems through the delivery of gender-equitable immunization and primary healthcare. 

What more needs to be done

• Building evidence of what works 

National health authorities are increasingly acknowledging that gender barriers, as well as broader diversity and inclusion challenges, play a significant role in the prevalence of zero-dose and under-immunized children and communities. However, we still need to build an evidence base of what works to tackle these barriers, considering the diverse experiences of all community members. Countries like Canada can support these efforts by investing in research collaborations between Canadian and local academic institutions. These collaborations should focus on developing and testing approaches that are not only gender-responsive and -transformative but also consider the intersectionality of factors such as age, race, socio-economic status, and disability. Recognizing and addressing these overlapping identities and experiences will ensure more comprehensive and context-specific solutions. 

• Advocate for commitments and investments

To address gender-related and intersectional barriers to immunization effectively, it’s imperative that national immunization strategies prioritize and allocate sufficient resources to pilot and scale up gender-responsive and gender-transformative immunization programming. This approach should consider the interplay of gender with other factors such as age, race, socio-economic status, and disability. Robust advocacy is pivotal in this endeavor. We must champion these issues at both global and national levels, pushing for unequivocal commitments and investments in intersectional and gender-responsive and -transformative approaches. This commitment entails the integration of gender and intersectionality-focused activities into national immunization strategies and programs and leveraging comprehensive gender analyses to shape informed and inclusive plans and budgets.

Moving from a gender-responsive strategy to adopting a gender-transformative approach to immunization

Gender-transformative approaches tackle the root of gender inequality, transform harmful gender roles, norms, and relations, and promote gender equality. Such approaches are essential for overcoming gender-related barriers to immunization.

• Promoting women’s agency and leadership

Promoting women’s agency and leadership, both as primary caregivers and as integral members of the health workforce, is vital for reaching zero-dose and under-immunized children and communities. Empowered women in the health sector bring unique insights and expertise and enhance the delivery and acceptance of vaccination services. As primary caregivers, they can effectively advocate for immunization, addressing specific barriers and fostering community trust. Furthermore, elevating women to leadership roles within health systems ensures more effective and sustainable vaccination efforts, accelerating progress toward universal coverage.

• Engaging men and boys as allies

At the community level, given the important role of men in decision-making around health and vaccination, engaging men and boys as well as traditional, cultural and religious leaders as allies is crucial. For example, the GPEI engages traditional and religious leaders, as trusted sources of information, to prevent misinformation and debunk rumors. WHO also recommends using male influencers to model gender equality behaviors or integrating themes such as gender equality, equal parenting and household decision-making, and men’s equal share of childcare and other domestic responsibilities, in all health promotion messaging. However, while it is essential to seek men and boys’ allyship, we must ensure that this involvement does not overshadow or diminish women’s voices, inadvertently reinforcing patriarchal norms or diminishing women’s pivotal roles in healthcare. 

• Empowering communities 

To effectively address gender barriers and shift detrimental gender norms in immunization programs, it is essential to prioritize the active involvement of diverse community groups, including women, men, youth, and grassroots organizations, throughout the program’s design, execution, monitoring, and evaluation. Utilizing approaches like Human-Centered Design (HCD) can be instrumental in ensuring these programs are tailored to the real needs and contexts of these communities. While such comprehensive approaches may require more time and resources initially, the long-term benefits in terms of program effectiveness and community engagement make the investment well worth the effort. In addition, we need to leverage local knowledge and invest in national capacity through training and economic empowerment initiatives.

As a champion of women’s health issues and feminist approaches to development, Canada has a crucial role to play and must continue to support gender-responsive and transformative approaches to immunization through supporting research and data collection, advocating for continued investment and commitments globally and nationally, and building capacity at national and sub-national levels for gender-responsive and transformative programming.

Dominique Denoncourt is a Policy and Advocacy Officer at Results Canada. Alison Riddle is a Gender Equality and Global Health Consultant. To learn more, contact Dominique at [email protected] and Alison at [email protected].