LGBTQ community study on COVID-19 vaccine fears

LGBT Health rainbow cross with doctors

The LGBTQ community is often “unseen” in public health efforts

Doctor holding a large syringe aimed at Earth
World COVID-19 vaccine image by Alexandra Koch

A new study shows what may be the nation’s first survey of COVID-19 vaccine reluctance among LGBTQ people. The survey offers a look into the attitudes of a community that has often gone unseen in public health efforts because information about sexual orientation and gender identity is rarely collected in federal, state or local health data.

The study notes the Department of Health and Human Services rarely collects this information in its public health surveys or other data gathering.

COVID-19 vaccine reluctance is real

“If LGBTQ people are not identified in data collection, we cannot be seen by public health agencies, hospital systems and other health care organizations,” said Mardi Moore, executive director of Out Boulder County, which provides advocacy, services, programs and support to Boulder County Colorado’s LGBTQ community. “If they don’t see us, we don’t exist, and getting resources allocated to us is nearly impossible. Sexual orientation and gender identity have to be part of the data that health organizations collect,” she added.

When it comes to COVID-19 vaccine reluctance, LGBTQ information is crucial to an effective community vaccination program. The success of a vaccine requires participation by people of every demographic. Like members of many marginalized groups, LGBTQ people may have greater distrust of health care systems or the government—both of which can contribute to reluctance to get the COVID-19 vaccine.

Studies around the U.S. have examined this reluctance among Black, Hispanic and other people of color, as well as by political affiliation. The new survey by Out Boulder County is the first to look at attitudes among LGBTQ people. It’s a reminder that LGBTQ identity has the potential to be nearly as important as race/ethnicity or political affiliation in determining whether a person is willing to get the COVID-19 vaccine.

Health care providers need to understand LGBTQ individuals better

The Centers for Disease Control and Prevention notes on its website that, without information about sexual orientation and gender identity, “patients and their specific health care needs cannot be identified, the health disparities they experience cannot be addressed and important health care services may not be delivered.” Efforts such as the Out Boulder County COVID-19 Vaccine Reluctance Survey may help public health experts and health care providers understand LGBTQ individuals better.

“I’m proud that, even though we’re a small organization, Out Boulder County is one of the first in the nation to spend the money and resources to do this research,” Moore said. “We’re proud to help put numbers to the issue of COVID-19 vaccine reluctance among LGBTQ people, and to call attention to the larger issue of lack of related data in public health.”

Survey Results

The Out Boulder County COVID-19 Vaccine Reluctance Survey found, if a vaccine were available today, 17% of respondents who identified as LGBTQ were hesitant or reluctant to take it compared to just 9% of non-LGBTQ respondents. The respondents most reluctant to receive a vaccine were cisgender LGBTQ individuals assigned a female sex at birth: 26% answered “no” or “unsure” when asked if they would take the vaccine. 18% of transgender respondents assigned a female sex at birth gave those answers. And, only 6% of non-LGBTQ people assigned a female sex at birth gave those answers.

Overall, 18% of people assigned a female sex at birth expressed COVID-19 vaccine reluctance, versus 9% of those assigned a male sex at birth. Wider surveys have consistently shown that women are more reluctant than men about getting a COVID-19 vaccine. There was little difference in reluctance between cisgender and transgender people assigned a male sex at birth.

Other results included a correlation among people who regularly get a flu vaccine and those who are likely to get a COVID-19 vaccine: 91% of those who get a flu shot every year are likely to get the COVID-19 vaccine. In contrast, only 34% of those who never get a flu shot are likely to get the COVID-19 vaccine. Overall, however, respondents seem more open to a COVID-19 vaccine than to an annual flu shot. While only 76% of respondents get the flu shot every year or most years, 84% said they intend to get a COVID-19 vaccine.

Among the barriers respondents listed most often were safety concerns, needing more information, concerns about effectiveness and distrust of the government.

The survey was conducted for Out Boulder County by research psychologist, Kaylin Gray, Ph.D. between Dec. 17–Jan. 7. Full survey results are available here:

HIV-Positive individuals have unique concerns

The Out Boulder County COVID-19 Vaccine Reluctance Survey also called attention to the unique challenges and concerns of the approximately 1.2 million HIV-positive people in the U.S. Several survey respondents noted the dearth of information about how the vaccine might affect those with HIV. They pointed to a lack of disclosure from vaccine makers about whether their trials included HIV-positive individuals, let alone how those individuals may have responded to the vaccine. They also noted fear of interaction between the vaccine and HIV medications.

LGBTQ individuals may be hit harder by COVID-19

LGBTQ people may gain an outsized benefit from vaccination, as existing data shows they are more likely to have preexisting conditions that can lead to severe illness when they contract COVID-19. An estimated 65% of LGBTQ adults have preexisting conditions such as heart disease, HIV or diabetes, which make them more vulnerable to severe illness. In addition, 49% of LGBTQ adults smoke, compared with 39% of non-LGBTQ adults, and 20% of LGBTQ adults have been diagnosed with asthma, versus 14% of non-LGBTQ adults.

In addition, LGBTQ people may be less likely to receive medical care, either due to fear of discrimination, prior bad experiences, cost or lack of access. For instance, 38% of LGBTQ households have been unable to get needed medical care, or delayed getting care, during the pandemic; 19% of non-LGBTQ households report the same issue, according to a survey done this summer by the Movement Advancement Project.

“In our survey, LGBTQ people were more reluctant than others to get a COVID-19 vaccine.”

“In our survey, LGBTQ people were more reluctant than others to get a COVID-19 vaccine,” Moore said. “We don’t know what a larger survey of the Boulder County population would show, or what state or national data would show, because sexual orientation and gender identity are not included in those surveys.”

While it’s not clear whether LGBTQ people are more likely to hesitate about getting a COVID-19 vaccine, it is clear that overall vaccine efforts will benefit from outreach, communication and distribution efforts targeting members of this community. This includes public health messaging campaigns to LGBTQ people, personal physicians talking about vaccination with their patients and delivering the vaccine in areas with significant LGBTQ communities.

Out Boulder County is working on a communications initiative, and is currently looking for partners. The organization is also working to set up a satellite clinic with COVID-19 vaccinations.

But, Moore notes, underlying all of this work is data. “Right now, because they don’t track sexual orientation or gender identity, public health agencies don’t even know who we are or where we live,” Moore said. “Without that information, it’s incredibly challenging to make sure that LGBTQ people are equitably included in COVID-19 vaccine distribution.”