A groundbreaking study conducted by the Initiative for Health Equity Advocacy and Research (iHEAR) at the Sangath Bhopal Hub reveals the pivotal role of trust and access to information in shaping attitudes towards COVID-19 vaccination among India’s transgender and disability communities.

Spanning from September 2021 to February 2023, the study engaged 24 community representatives identifying as transgender individuals or persons with disabilities, alongside 21 key informants including vaccine program managers, providers, and community advocates. What sets this study apart is its co-led and co-designed nature by members of the trans and disability communities, ensuring a nuanced understanding of the challenges faced.

Key findings from the study shed light on the complex dynamics influencing vaccine decision-making within these marginalized communities. A central concern highlighted was the fear of potential side effects in relation to specific health needs. Individuals expressed apprehensions regarding how vaccines interact with their unique healthcare requirements, leading to prolonged decision-making periods and delays in vaccination.

For transgender individuals, considerations such as the impact of vaccines on gender-affirming care, such as hormone therapy, weighed heavily on their minds. Similarly, persons with disabilities voiced worries about the potential side-effects of the vaccines in relation to their existing medical conditions or medications, highlighting the need for tailored information dissemination and support.

Moreover, the study underscored the profound influence of systemic trust on vaccine decision-making. Participants' attitudes towards COVID-19 vaccines were significantly shaped by their trust in institutions such as government health systems, pharmaceutical companies, and scientific bodies. However, historical and ongoing marginalization within these systems fueled skepticism and distrust among some community members, leading to hesitancy or outright rejection of vaccination.

In light of these insights, the study proposes several recommendations to enhance vaccine uptake and address systemic inequities. These include the inclusion of trans and disability communities in vaccine trials, co-designing communication campaigns in collaboration with community members, partnering with community leaders for targeted outreach, sensitizing vaccine program teams to affirmative care needs, and adopting intersectional approaches to service delivery.

Dr. Satendra Singh, a co-investigator of the study, emphasized the imperative of an intersectional approach and addressing communication inequities to restore trust and increase vaccine uptake. Dr. Harikeerthan Raghuram stressed the importance of regaining trust step by step, highlighting the deep-rooted historical experiences influencing current vaccine decisions.

Dr. Anant Bhan, the co-principal investigator, emphasized the need to invest in the socio-economic and health needs of marginalized communities and rebuild trust. Dr. Sunita Bandewar praised the community-based participatory research approach for offering collaborative insights, while Sharin Dsouza highlighted how vaccine inequities begin at the decision-making stage due to lack of clear information.

This study serves as a wake-up call for policymakers and healthcare providers to adopt more inclusive and empathetic approaches towards marginalized communities in India, ensuring equitable access to life-saving vaccines amidst the ongoing pandemic.