COVID-19 vaccines and women's security.

Pandemics such as COVID-19 are gendered with regard to who is infected, who dies, who provides care, who is secured against violence and economic change, and who leads and makes decisions. Vaccines are no different and there is a need to address male bias in vaccine development to make women safe from deadly diseases. For example, clinical trials that are not done in both men and women can raise adverse outcomes during implementation due to sex-based differences in immunological response. The excitement and awe at the speed of COVID-19 vaccine development and delivery needs to be attentive to the social and political dynamics in which the vaccine is delivered—women's work and their security are at the heart of this.

The delivery and facilitation of COVID-19 vaccines will disproportionately depend on the unpaid labour of women. Vaccine uptake partly depends on the free labour of women within the household, impacting women's economic and personal security. Unpaid labour will generally fall to women as parents or family carers; women will typically have the responsibility for arranging when and how children and wider family members, such as older relatives, get immunised. This process is likely to be more onerous with vaccines requiring two doses, such as the Pfizer–BioNTech, Moderna, and Oxford–AstraZeneca options.4, 5, 6 This effort to practically access COVID-19 vaccines will add to the already exploitive care burden placed on women during the COVID-19 pandemic. Women in care roles may have to give up time otherwise spent on paid work or education, and incur out-of-pocket expenses related to travel and other costs of accessing vaccines for those they care for and themselves, which could require multiple different trips depending on national vaccination strategies. This is likely to be particularly true for women in precarious work and those who live in poverty or in rural areas.

The delivery and administration of COVID-19 vaccines also depends on the paid labour of women as the majority of health-care workers. Administering the doses and vaccine delivery could increase exposure to other harms and increased workloads.

Attacks on health-care workers and immunisation teams are a real concern in global health settings and have occurred during polio campaigns and Ebola vaccination efforts. Such violence is distinct in that it can take place in conflict and non-conflict settings and is linked to both suspicion of the motives and legitimacy of the vaccinators and the vaccine itself. Given that most health-care workers are women, such attacks could be seen as a form of violence against women. As has been seen during COVID-19 thus far, violence against health-care workers exists and might be amplified over access to the finite resource of COVID-19 vaccines. Access to, and delivery of, COVID-19 vaccines is thus not only a security concern with regard to vaccine nationalism, cyber security, and as a protected commodity, but is also a concern for women, peace, and security agendas, given the feminised nature of the health-care workforce and vaccination teams responsible for vaccine delivery.

The feminised nature of violence surrounding vaccines extends to sexual violence and exploitation of women who access vaccines. During the Ebola vaccination programme that began in 2018 in Kivu, Democratic Republic of the Congo (DRC), some male health-care workers offered the Ebola-related services, including vaccination, in exchange for sexual favours from women and girls. This contributed to a wider picture of sexual exploitation and violence within the DRC that mired the response to the outbreak of Ebola virus disease in 2018–20, including reports of alleged sexual abuse by aid workers and wider mistrust towards the global health and vaccine community. Although the DRC may be an extreme example as a state with a history of sexual violence and protracted conflict, it showcases how gender-based violence is an important factor in responding to pandemics and in access to vaccines.

Debate over COVID-19 vaccines has rightfully focused on discovery and development, vaccine hesitancy, and equitable access. Vaccine delivery depends on the paid and unpaid labour of women around the world in ways that can threaten their economic and physical security. Vaccines are thus both an important component of the gendered nature of pandemics such as COVID-19 and of the relation between gender and global health security.