Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India.
Initiative for Health Equity, Advocacy and Research, Bhopal Hub, Sangath, Bhopal, India.
Vaccine. 2024 Nov 14;42 Suppl 5:126174. doi: 10.1016/j.vaccine.2024.126174. Epub 2024 Aug 8.
Undervaccination and vaccination-related anxieties among marginalised communities like the transgender and gender-diverse (TGD) and disability communities are underexplored in the Indian context. Our study seeks to understand the role of structural and historical inequities in shaping COVID-19 vaccine access for the two communities in India.
Using a participatory qualitative research approach, TGD and disabled individuals were involved in and consulted throughout the research process. We interviewed 45 individuals for our study, hailing from the two communities and other key stakeholders and health system representatives involved in vaccination roll-out in India. We conducted an inductive thematic analysis guided by the socio-ecological model and intersectionality approach.
Despite intent to get vaccinated among most participants, several structural barriers shaped COVID-19 vaccine access for people from the TGD and disability community. This included information and communication gaps with respect to the specific health needs of the two communities, barriers related to vaccine registration, data collection, transport, infrastructure and actual or anticipated mistreatment at vaccine centres. Each emergent structural gap in vaccination had parallels in past health systems experiences, pointing to the longstanding and pervasive inequities within health and allied systems which impact how communities perceive and respond to new health system interventions.
This study uncovers the structural inequities within health systems that have permeated the planning, design and outreach of COVID-19 vaccination programs in India. Moving beyond notions of vaccine hesitancy among the TGD and disability community, we underscore the importance of socio-historical contexts of marginalisation and advocate for systems to recognise these contexts and respond equitably to the vaccination and health needs of the two communities. While some challenges among the two communities were distinct, the study explores how a shared experience of exclusion from public systems can provide avenues for cross-movement advocacy and solidarity, and help inform health system reforms.
在印度，边缘化群体（如跨性别和性别多样化群体以及残疾群体）的疫苗接种不足和与疫苗接种相关的焦虑问题在很大程度上尚未得到探索。我们的研究旨在了解结构性和历史性不平等现象在塑造印度这两个群体获得 COVID-19 疫苗方面所起的作用。
我们采用参与式定性研究方法，让跨性别和残疾群体的个体自始至终参与并咨询整个研究过程。我们采访了来自这两个群体以及参与印度疫苗接种工作的其他主要利益攸关方和卫生系统代表的 45 个人。我们根据社会生态模型和交叉性方法进行了归纳主题分析。
尽管大多数参与者都有意接种疫苗，但一些结构性障碍影响了跨性别和残疾群体获得 COVID-19 疫苗的机会。这包括与两个群体特定健康需求相关的信息和沟通差距、与疫苗注册、数据收集、交通、基础设施以及在疫苗接种中心实际或预期的虐待有关的障碍。每个疫苗接种方面出现的新结构性差距都与过去卫生系统的经验平行，这表明在卫生和相关系统中存在长期存在且普遍的不平等现象，影响了社区对新卫生系统干预措施的看法和反应。
本研究揭示了印度 COVID-19 疫苗接种规划的规划、设计和推广中存在的卫生系统结构性不平等现象。我们超越了跨性别和残疾群体的疫苗犹豫概念，强调边缘化的社会历史背景的重要性，并倡导系统承认这些背景，并平等应对这两个群体的疫苗接种和健康需求。虽然这两个群体面临的一些挑战是独特的，但该研究探讨了如何通过共同被排除在公共系统之外的经历为跨运动倡导和团结提供途径，并有助于为卫生系统改革提供信息。
