Without Women, COVID-19 Vaccination Efforts in the U.S. Would Fail

With two parents in their 60s who both have preexisting conditions, Lana,* a resident of Pennsylvania, hoped she'd be able to secure COVID-19 vaccine appointments for them both, sooner rather than later. But met by confusing sign-up systems, she found herself trying to navigate the process alone, and from a different state.

“I would copy and paste any sites that were posting, ‘Oh, CVS is dropping open availability, Rite Aid has this—you need to do this trick, that trick,” Lana tells Verywell. She would drop these links in her family’s WhatsApp group chat, constantly looking for availability. If appointments dropped, she'd even call her parents at 1 a.m., saying, “Wake up. Wake up and get on a computer. You can’t do this on your phone.”

Lana, who had been on top of sending vaccine leads over to her family who resides one state over in New Jersey, says she felt a double sense of urgency to get her parents vaccinated. She was worried about their vulnerability to the virus, yes, but she was also anxious about what her 21-year-old brother would bring home. “My youngest brother still lives with them and he is not corona-safe,” she says. “So the whole project has this ticking time bomb feel."

While vaccine rollout has lifted hopes, the process of obtaining appointments has also brought added stress, especially for women. As caregivers—an overwhelmingly female demographic—many are expected to arrange vaccines for their older relatives but are having trouble navigating the often decentralized and confusing protocols. 

Rosemary Morgan, PhD, a researcher and a professor of gender analysis in health research at Johns Hopkins Bloomberg School of Public Health, tells Verywell that traditional roles many women take on in the household have been exploited during the pandemic, and vaccines are quickly becoming the boiling point.

Women Are More Likely To Be Caregivers

Since the beginning of the pandemic, women have been leaving the workforce at staggering rates. Of all the U.S. jobs that were lost in the first 10 months of the pandemic, women lost the most—5.4 million—nearly 1 million more than men. Women in minority groups fared the worst of all; in December 2020, all job losses were from Black, Hispanic, and Asian women.

Already disproportionately impacted by factors like a more limited cash flow, increased caretaking of children in the home, and caregiving of older relatives, many women are being pushed to their limits by a confusing vaccine rollout.

"Contextualizing this within the impact on women already: Women losing their jobs, social impacts, economics, having to homeschool," Morgan says. “And now this on top of it? Where are the men?"

But in many ways, vaccine rollout falling on the shoulders of women isn’t a surprising phenomenon—caretaking roles are typically taken on by women. 

A 2011 report from the American Psychological Association (APA) found that almost one-third of the adult population in the U.S. were family caregivers for an ill or disabled relative. The majority of these caregivers are women.

A more recent study from the Institute on Aging (IOA) found that likely more than 75% of all caregivers are female, spending 50% more time on related duties than males. The IOA study described the average caregiver as a: "married woman, age 46, working outside the home for $35,000 annually."

Most of the women who were spending an average of 21.9 hours a week on caregiving (compared to 17.4 hours a week for men) were also employed full or part-time. Almost half came from lower-income households. One study estimates that women lose an average of $324,044 in compensation—not to mention benefits, the possibility for promotion, and an opportunity to build savings—when taking on caretaker roles.

Racial and Ethnic Disparities

Morgan says that beyond the general statistics, it's important to hone in on which groups of women are most affected.

Although 62% of caregivers identify as White, on average, Hispanic and Black caregivers spend more time caregiving and do more "burdensome" tasks (such as toileting and bathing) than White and Asian-American caregivers.

Here's the breakdown of time spent caregiving, according to the Family Caregiver Alliance's statistics:

• 33% of White caregivers spend 20 hours a week caregiving
• 30% of Asian-American caregivers spend 16 hours a week caregiving
• 57% of Black and 45% of Hispanic caregivers spend 30 hours a week caregiving

Shouldering the Burden

For many women, frantically searching the internet and vaccine Facebook groups for decentralized information, has only added to their burden.

"It's not even the simple fact of a daughter trying to figure out, 'OK, when's my father's appointment and how am I going to get him there on time?'" Julia Smith, PhD, a health sciences researcher at Simon Fraser University in British Colombia, tells Verywell. "She has to go and search multiple sites and call people. The amount of time that takes can be astronomical, and that's time that maybe she can't spend working, sleeping, exercising, or taking care of her children. That time burden is real."

For Alexis,* an Alabama resident, searching for appointments has taken up as much time as work. "My parents were able to get appointments, but staying on top of the research and options for them—in Alabama, where the rollout had been pitiful—has been a nightmare and fourth job for me," she tells Verywell.

Ellen,* who lives in upstate New York, where the nearest vaccination site is two and a half hours away, tells Verywell "getting my 80-year-old dad the vaccine was an honest-to-God nightmare. My parents are not tech-savvy at all, so it was all on me."

Because many older parents aren’t tech-savvy, it’s caused tension between how older relatives may think the system should work, and reality.

“The biggest challenges have been balancing his lack of understanding of the system, urgency, and his specific physical needs in where he could/couldn't go," Theodora Blanchfield, who is based in California, tells Verywell about looking after her father in New Jersey. "In New Jersey, the system is that you register in a state registry that says they will call you when, in actuality, you need to keep checking each vaccine site's individual sites, which just feels like a mess."

Theodora resorted to seeking help through a post in a Facebook group, where someone she knew from high school responded and helped her dad get vaccinated.

Amanda Krupa, MSc, based in Illinois, who was trying to get both her father and father-in-law vaccine appointments, says both are confused by "mixed messaging" about vaccine availability. "They don’t understand why they can’t walk into the neighborhood Walgreens, since that is what they seem to think is happening in other states based on news coverage," she tells Verywell.

Eventually, both Krupa and Blanchfield were able to access Facebook groups that helped them find appointments. While social networks helped them individually, Smith says it’s an example of when "systems don't function clearly and accessibly, the burden falls onto women."

"You shouldn't be dependent on going to Facebook groups and connecting with an old high school friend to get a vaccine,” Smith says. “Wherever we are in the world, this is the government's responsibility. And when the government shirks that responsibility, again it falls onto women to pick up that slack and ensure public health."

Morgan sees these women's experiences struggling with the COVID-19 vaccine system as "another example of the way in which COVID-19 is exacerbating existing inequalities, or fault lines.” In the news and in academic studies, Morgan says, “the titles are always saying, ‘More women are doing this.' Shouldn’t we be asking: why aren’t men pulling their weight?”

This gender gap comes from deeply-ingrained social and biological norms, Morgan adds, but not stepping up and helping in times of crisis is “a disservice” to everyone. “If we had fewer gender inequities, more men would benefit from it in their roles and in their well-being," she says.

Addressing Disparities

Smith is hopeful the gender disparities underscored during the pandemic can be prevented in the future. "I really hope that this pandemic has highlighted how essential the care work of women is, and how we cannot have a public health response and vaccine rollout unless we have women who are willing to get people to vaccinations, organize them, and make sure the people they care about are vaccinated," she says.

Looking at census data, it's clear the U.S. is reliant on a health workforce made up of mostly women who often work precarious jobs for lower pay compared to men.

"It's not just women sticking needles in our arms that are essential to the vaccination programs," Smith says. "It's the people who are cleaning the floors in clinics. It's the people who are changing the garbage. Those are all people who are part of the health workforce, and therefore essential to delivering vaccines, and who are also working in very difficult situations, for poor pay, and precarious work."

Along with recognition, Smith hopes to see that the work be better paid, supported, and resourced.

Kate Power, MA, a researcher and a consultant based in Germany, tells Verywell that more support and better pay will likely involve having more women at the policy-making table, and additional paid leave for parents and caregivers. Changing social norms at the same time could help support these types of policies.

Power hopes that after the pandemic we can "put care at the center of our societies, acknowledging it as the basis of our prosperity and wellbeing, rather than treating it as an unpleasant chore that we don't value and don't want to see." 

Practical Solutions

Ellen and Krupa, both wondered if small solutions like centralized forms, communication through local doctors, or updated computer systems, could have made the vaccine rollout simpler and less stressful.

"Why not make signing up for the vaccine easier, like putting all your information into a form, and they alert you when it’s your turn, or when a local place has the vaccine?" Ellen says. "I had about seven different tabs up on my browsers that I was checking every hour looking for an appointment. I got nothing done."

When Ellen called her doctor for advice, she says she was shocked to learn that doctors' offices were being denied vaccines from the governor. "Doctors know their patients best, and older people trust their doctors, making it easier to get people to take the vaccine and making sure the vaccines go to the most vulnerable people," she adds.

Krupa, who has spent over 15 years working in public health communications at the national level, hopes that more national organizations wield the power of social media, or work to place community advocates who can get the word out to everyone on a local level.

"We live in an era where people listen better to the advice of their neighbors, so why not empower community advocates with the resources they need to help others on social media seeking out help and credible information?" she says. "Investing in social media research and raising up the voices of thought leaders rather than senior leaders can make a tremendous difference for not just the COVID-19 vaccine, but for so many other public health issues impacting people locally."

*In order to respect their privacy, Lana, Alexis, and Ellen's last names have been omitted.

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