COVID-19 has demonstrated that men and women experience public health crises differently. Some gendered inequities have received extensive media attention, like how shuttering schools has driven disproportionately more women from the workforce, with the effects felt most acutely by women of color.

Now, with vaccines offering hope, a new gender difference has appeared: U.S. women seem less willing than men to get the vaccine. Sixty-seven percent of men would take a vaccine, compared to 54 percent of women, according to Pew Research.

Women’s greater reluctance is surprising given other research showing that women are more likely than men to fear COVID-19’s spread and to follow public health recommendations. But women (and women of color in particular) long have expressed skepticism about the healthcare industry—often with good reason.

Women may be less susceptible to conspiracy thinking about the coronavirus itself, but gender, race, and class intersect to explain why women may resist vaccines.

Women may be less susceptible to conspiracy thinking about the coronavirus itself, but gender, race, and class intersect to explain why women may resist vaccines. Policymakers looking to persuade the public about the coronavirus vaccine’s safety need to account for the ways that misogyny, racism, and the spread of misinformation online give rise to vaccine hesitancy among different groups of women.

The Pandemic’s War on Women

Much has been made of women’s better public health behavior during the pandemic, from mask-wearing to physical distancing. But even if this health-oriented behavior means women take greater precautions than men—and even if they have biological differences that lower their risk of severe infection—the pandemic has harmed women in significant ways.

Women are 70 percent of frontline healthcare workers. but are less likely to fit in hospital-grade respiratory masks designed for men. They are underrepresented in leadership and research opportunities related to the pandemic. Gender inequalities in the home, especially with respect to parenting, are being exacerbated by school and daycare closures. Women’s departure from the workforce threatens to overturn decades of progress. And pandemic-related lockdowns have dramatically increased women and girls’ exposure to domestic violence and sexual abuse, with the stress of the pandemic increasing the prevalence of violence.

So it’s not surprising that women have suffered worse mental health outcomes during the pandemic, reporting less sleep and worse moods. And all these effects, from job loss to higher anxiety, are most pronounced among women of color.

Misogyny and Medicine

The good news is that a majority of Americans seem willing to get a COVID-19 vaccine. The bad news is the sizeable gender gap, ranging from 6 percentage points in Gallup’s recent poll to 18 points in a poll by National Geographic.

This gap is not necessarily new. Previous research found a small but important gender difference in vaccine hesitancy. Women may perceive greater risk from vaccines compared to men. Importantly, vaccine skeptics aren’t necessarily anti-science – they believe in climate change, for instance – but are distrustful of medicine and the pharmaceutical industry.

Their skepticism isn’t entirely misplaced. Women are less likely to have their pain and illness taken seriously by doctors, and are often excluded from drug and medical device trials. For example, the FDA approved implantable cardiac devices for everyone despite women’s underrepresentation in the device’s trials. Millions of female patients received a surgical procedure that had at best no apparent benefits and at worst, severe side effects.

The exclusion of pregnant and breastfeeding women from medical trials creates further data gaps and leaves women with fewer therapeutic options, including now.  Pregnant and breastfeeding women were excluded from the coronavirus vaccine, even though most women healthcare workers are of reproductive age and pregnant women have greater risk for severe COVID-19.

Medical Racism

Racism then intersects with sexism such that Black and brown women suffer even more acute care gaps, making their skepticism about the healthcare industry entirely rational. Modern gynecology unfolded as doctors experimented on enslaved Black women without anesthesia. California forcibly sterilized about 20,000 incarcerated and institutionalized women between 1920 and 1960—most of whom were non-white.

People of color endure daily exposure to discrimination and racism­, resulting in chronic stress and more “biological wear and tear”—but women of color’s health concerns are routinely overlooked. Black women have the worst maternal mortality in the United States. In 2017, tennis megastar Serena Williams nearly died after giving birth, receiving treatment for a life-threatening blood clot only after begging doctors to take her chest pain seriously. Black infants are four times more likely than white infants to die from low birth weight.

Not surprisingly, then, the same Pew poll found Black Americans the most hesitant about the COVID-19 vaccine: 61 percent of whites are willing to receive the shot, compared to 42 percent of Blacks.

Organic Parenting and Online Misinformation

On the other side of the privilege continuum are middle- and upper-class women, whose vaccine skepticism goes back to the now-debunked claims that vaccines cause autism.

These women see “natural” parenting methods as best. Their vaccine hesitancy is about protecting their children against “foreign agents”—like the chemicals purportedly contained in vaccines. In wealthy enclaves across the U.S. and Canada, vaccine opt-outs have eroded herd immunity to once-rare diseases like measles and whooping cough. In California’s Santa Monica and Beverly Hills, vaccination rates approximate those of South Sudan.

Vaccine-skeptic moms share information through networks, including online groups susceptible to digital misinformation from conspiracy theory movements like QAnon. Myths about COVID-19—and now the coronavirus vaccine—have worked their way into online wellness communities, groups that overlap with vaccine-skeptic communities and whose messages are shared and amplified among women. One falsehood circulated among online mom groups claimed that avoiding vaccines during COVID-19 would lower infant mortality.

Messaging Vaccine Safety to Women

Women’s greater compliance with public health directives and greater reluctance to get the COVID-19 vaccine share a common source: ideas about risk and protection are gendered, with women socialized to be more risk-averse and protection-minded.

Many of the common responses to vaccine hesitancy fail to address the underlying gendered and raced causes of reluctance.

But many of the common responses to vaccine hesitancy, including educational pamphlets and campaigns, fail to address the underlying gendered and raced causes of reluctance.

Rather than targeting individuals, policy matters. For wealthier groups accustomed to receiving exemptions, U.S. states can raise COVID-19 vaccination rates by making opt-outs harder, such as by restricting valid exemptions and demanding additional paperwork.

For Black and brown women living with the intertwined legacy of medical racism and misogyny, on-site vaccination programs can produce higher take-up rates, with Black doctors already building trust through face-to-face conversations in their communities. Having respected leaders—like former First Lady Michelle Obama and Vice President-elect Kamala Harris—get and promote the vaccine can further establish buy-in.

Gaining widespread buy-in to vaccination requires better understanding the dimensions of vaccine hesitancy and designing policies that address community-specific needs. The pandemic harms women in disproportionate ways, but a return to normal life may well be in women’s hands.