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Why are women more hesitant to get the Covid-19 vaccine?

Experts cite fertility concerns, ‘conspirituality’ and distrust of the Irish health system

In March, Irish members of the European Parliament were taken aback when they received thousands of emails from constituents over the course of two days.

The emails strongly objected to the proposals for digital vaccine certificates across the European Union, intended to ease the resumption of travel over the coming summer.

Many of the emails contained strong anti-vaccination sentiments. Some compared Covid-19 restrictions to Nazi Germany. Quickly, the MEPs' staff noticed something else; about 70 per cent of them came from women.

Total doses distributed to Ireland Total doses administered in Ireland
12,143,670 10,222,511

Evidence has been building up in Ireland and abroad that women are more likely than men to be either hesitant about taking a Covid-19 vaccine, or dead set against it.

According to research from NUI Galway released earlier this week, 31 per cent of women under 30 say they will not take the vaccine or are not sure. The figure for men under 30 was just 18 per cent.

In the over-30s group, 85 per cent of men indicated they would get a vaccine compared with 76 per cent of women.

The results tally with recent figures from the Central Statistics Office (CSO), showing women are more than four times more likely than men to say they will refuse the vaccine. However, Ireland is by no means an outlier.

Similar surveys around the world have found more vaccine hesitancy among women – a US study from December found 69 per cent of men would take a vaccine compared with 51 per cent of women.

What is not clear is why. Other research shows women are more likely to follow public health advice, such as the wearing of masks to stop the spread of Covid-19. Surely it follows that they should be more favourable to vaccinations?

Several reasons have been put forward . Perhaps women are concerned about the vaccine’s impact on pregnancy. Maybe they are being exposed to more online misinformation about vaccines.

Or maybe, after decades of medical controversies in the State involving female patients, such as CervicalCheck and hepatitis C, some women are justifiably distrustful of the medical establishment.

Fertility concerns

Fertility concerns are the most likely driving factor, said Dr Jane Walsh, a lecturer in psychology and director of the mobile technology and health research group at NUI Galway, who carried out the recent Irish research.

“That low number for young women really jumped out at me. So you’d have to wonder if it’s fertility.”

Dr Walsh said she had been surprised by the number of young women who had told her they were worried about the vaccine's impact on pregnancy. “While that’s not evidence, it’s definitely something worth exploring further.”

To date, no research has been carried out in Ireland on vaccine hesitancy in pregnant women but large-scale studies abroad suggest it is a major issue.

A 16-country study conducted in late 2020 found only 52 per cent of pregnant women indicated an intention to take the vaccine, compared with 73 per cent of non-pregnant women, with hesitancy tending to be higher in richer countries.

It is a trend the Department of Health noticed earlier this year after officials spotted online misinformation about the vaccine and pregnancy.

In response, the department drafted in chairwoman of the Institute of Obstetricians and Gynaecologists Dr Cliona Murphy to recommend everyone of reproductive age get vaccinated.

Confusion and mixed messaging, particularly around blood clots, has caused hesitancy for women

“There is no evidence that taking any of the Covid-19 vaccines affects a woman’s future ability to conceive, or to continue a pregnancy,” she told a National Public Health Emergency Team press briefing.

Concerns about blood clots relating to the AstraZeneca and Johnson & Johnson vaccines may also play a role. Most cases of vaccine-related blood clots have occurred in women under 60. However, clots in either gender remain extremely rare; for comparison, the evidence shows the contraceptive pill, Covid-19 and pregnancy itself are significantly more likely to cause issues.

“Confusion and mixed messaging, particularly around blood clots, has caused hesitancy for women,” said Orla O’Connor, director of the National Women’s Council of Ireland (NWCI).

Ms O’Connor said the NWCI had received a number of queries from women concerned about the vaccine.

“What’s needed is more targeted, clear public health messaging for women.” The benefits of this can be seen in the rollout of the HPV vaccines. “It had a low take-up in Ireland, but when there was a really concerted campaign to give out information to women, it increased.”

It is something health authorities were aware of, she said. On Wednesday, the NWCI was contacted by the HSE, asking it to use its social media channels to link to HSE messaging about the vaccine.

A deeper dive into the most recent CSO figures shows concerns over the vaccines’ side effects may not be the whole story. As well as being concerned about side effects, women were also found to be significantly more worried than men that vaccines will not prevent Covid, that they might not stop certain variants or that they might not stop transmission of the virus.

One possible explanation is the type of information women are being exposed to online.

Anti-vax conspiracies

Maireád, a healthcare worker in the midlands who asked that her real name not be used, began noticing last year that more and more of her friends, who were involved in yoga, mindfulness and childcare, had been sharing anti-vaccination views on Facebook.

“The amount of anti-vax, lockdown conspiracy stuff was shocking. I actually logged off of Facebook, she said. “These are intelligent people who I consider friends.”

Most of the friends sharing this information were women, she added.

Another person described his friend, a personal trainer, who had been sharing an increasing amount of anti-vaccination material recently. He pointed to a Instagram post shared by her, comparing Covid travel restrictions to the laws imposed by the Nazis on Jewish people.

“Funny thing is, she sells essential oils and can’t see the irony in being anti-vax. [She] also had no issue taking lots of supplements when she was training regularly in the gym before.”

New-age thinking has built itself around transgression. And transgression today is embodied by conspiracy theories and being anti-vaccination

Online spaces which tend to be more popular with women, such as yoga, wellness and homeopathy communities, have become a hotbed of Covid misinformation, said Cécile Guerin, a researcher with the Institute for Strategic Dialogue, which works to counter online disinformation.

There is even a word for it: “conspirituality”, which Guerin, who is also a qualified yoga teacher, described as the “intersection of spirituality and conspiracy theories”.

Anti-vaccination sentiment has always been present in such communities, she said.

“New-age thinking has built itself around transgression and going against the norm. And transgression today is embodied by conspiracy theories and being anti-vaccination and anti-lockdowns.”

But such groups had seen a surge in misinformation and conspiracy theories since Covid, and particularly since the summer when adherents of the QAnon conspiracy theory started to infiltrate them, said Ms Guerin.

“It took a darker turn. People’s fears about vaccine side effects were being hijacked by conspiracy theorists claiming global elites were using vaccinations to restrict our freedoms.”

“Conspiracy theorists in the yoga and wellness world have also become quite good at co-opting the language of feminism,” she said. “For instance one of the slogans that’s always used with reference to vaccines is ‘my body, my choice’.”

The motivations for influential people to spread conspiracy theories in these spaces varies.

Gaining followers

“There are people who have truly fallen down the rabbit hole and believe what they are saying. Others are more opportunistic about it in the sense that they realised when they started sharing some of these conspiracy theories that they were gaining followers and attention.”

Some used their platforms to sell personal sessions, advice books and food products, Ms Guerin said.

There is ample evidence of the prevalence of anti-vaccination sentiment in new-age groups in Ireland, although adherents who spoke to The Irish Times stressed it remains a minority position.

Earlier this week businesswoman Carina Harkin, who describes herself as a naturopath, an acupuncturist and a homeopath, stood in Eyre Square in Galway telling a small crowd that Covid deaths in India are being faked and that the country's soaring death rate is a result of lockdowns. "Who cares about India, I want to be free," she said.

Ms Harkin’s Galway-based business advertises consultation costing up to €250 and homeopathic kits for children costing €150 – the kit contains 18 ingredients which she claims will protect against polio, smallpox and dengue fever, among other ailments. A disclaimer at the bottom states the substances are not an alternative to vaccinations.

Most major medical scandals in recent decades have involved women as the primary victims

It is not just new-age influencers jumping on the bandwagon. High-profile personalities involved in fashion, parenting advice and the media have rebranded themselves as anti-vaccination campaigners.

Dr Walsh of NUI Galway mentions Aisling O'Loughlin, a former presenter of the then TV3 fashion show, Xposé, who has recently taken to sharing daily anti-vaccination messages to her 25,000 Instagram followers.

“Even if people are educated, that stuff does affect them,” Dr Walsh said. “She’s in their face like the McDonald’s sign when you’re driving down the road. This is what is reaching young people. They don’t watch the news.”

Dr Walsh raises a fourth reason Irish women may be more likely to be hesitant when offered a vaccine. “When you think about the recent history with women in this country, it’s very bad.”

Most major medical scandals in recent decades – CervicalCheck, symphysiotomy, contaminated blood products – have involved women as the primary victims. “You couldn’t blame them really for not having trust,” Dr Walsh said.

This would tally with studies in the US, which found much higher vaccine hesitancy among black people, partly resulting from a history of medical experiments carried out over decades on the black community.

It is a theory Ms O’Connor of the NWCI has considered, but she is not convinced. “The evidence isn’t there to support it. Actually, polling we did prior to the referendum [on the Eighth Amendment] found women in Ireland trusted our health service.”

Addressing vaccine hesitancy and misinformation has become a major issue for academics, NGOs and health authorities, with most agreeing that different approaches are needed to deal with the different levels of hesitancy shown by different people.

Vaccine confidence

“The majority of individuals do not have an inherent bias for or against a vaccine. The vaccine confidence continuum ranges from a small minority who refuse all vaccines with conviction, through to those who have valid concerns and need more information before deciding to take a vaccine” said a Department of Health spokeswoman.

“It’s a spectrum,” according to Ms Guerin. “You have people who are hesitant and you have people who believe vaccines are a conspiracy by the elite.”

Helping the latter was a difficult task, she said, requiring strong support networks, education initiatives and the regulation of the tech industry.

Reassuring the much greater number of women who simply had concerns about side effects was a good deal easier, she said. They simply need high-quality, accessible information about the minuscule risks posed by vaccines.

“The research shows one in five women are simply unsure about the vaccine rather than against it,” Dr Walsh said. “They’re almost begging to be reached with good information.

Ms Guerin said it was important to understand women’s concerns and not dismiss them.

“Because that’s where the conspiracy theorists come in. They fill that space where people are not being listened to. And that space cannot be left to them.”