For months, local, state and federal officials have been consumed with how to persuade Americans who are wary of the COVID-19 vaccine to get the shot anyway. The conversation has focused in large part on specific demographic groups and how to overcome certain cultural factors to get the vaccines into people’s arms. Experts worried about low turnout among women, who reported significantly more vaccination hesitancy than men prior to the vaccine rollout. And public health officials warned that non-Hispanic Black Americans would be more hesitant than other racial groups because of the historical abuses and exclusion they’ve experienced at the hands of medical professionals and researchers.
But the data on actual gender differences in vaccination rates veered in an unexpected direction, leaving an entire group of vaccine-hesitant Americans largely untargeted: men.
As of Monday morning, the Centers for Disease Control and Prevention reported that nearly 9.5 million more women than men have been vaccinated in the U.S.,1 and in the 42 states2 that collect gender data, a greater share of women are getting the vaccine as well. The magnitude of the gender gap varies from state to state but has hovered just below 10 percentage points on average over the past month.
According to experts and the latest research, the reasons why we are seeing this persistent gap are complicated. On the surface, it’s a matter of which groups were targeted early on, but when we look deeper, other behavioral and ideological divides between women and men appear to be at play. These four hypotheses may explain the imbalance.
Hypothesis 1: Early Access
The simplest explanation for the vaccine gender gap is that women got a head start. Among older Americans, who had early access to the vaccine, women outnumber men: The U.S. Census Bureau estimates that women make up about 55 percent of all adults age 65 and over. And in specific occupational groups with early access in most states, women also outnumber men — among child-care workers and health-care practitioners, for example, women constitute about 95 percent and 74 percent, respectively.
Seems logical enough, except that those early restrictions on who could get the vaccine are gone now. The numbers remain imbalanced, however, so other factors must be contributing to the disparity as well.
Hypothesis 2: Traditional Masculinity
COVID-19 isn’t the only health matter that men are less likely to be proactive about. Compared with women, they tend to see a doctor less often and use harmful substances like alcohol and illicit drugs more often; men also tend to eat less fiber and fruit, and they are even less likely to use sunscreen when compared to women. According to Dr. Jonathan Metzl, director of the Center for Medicine, Health, and Society at Vanderbilt University, men’s shorter lifespans are the result of the cumulative effects of poor health decisions, not physiology. “There’s no real biological reason that men die earlier,” said Metzl. “The things that make you a successful, cool, tough man in America are also inversely related to health and longevity.”
Researchers are nearly unanimous in their assertion that traditional masculinity — the idea that men should be self-reliant, physically tough and emotionally stoic — is a risk factor for men’s health. James Mahalik, an expert on masculinity and health outcomes at Boston College, studies how traditional masculinity gets in the way of health-promoting behaviors. His lab’s research on mask-wearing indicates that men who conform to traditional masculine norms have lower levels of empathy toward people who are vulnerable to COVID-19, and they are less likely to trust the scientific community. Mahalik suspects the same is true for their views about the vaccine.
Hypothesis 3: Preventive Health Behaviors
My conversation with Mahalik led me to ask other scholars about potential differences in how men and women evaluate medical evidence. Jennifer Reich, a sociologist at the University of Colorado Denver who has studied vaccination behavior for more than a decade, told me that women were more used to making decisions about their own health and the health of their families than men were. “Women are accustomed to seeking out health care in the form of reproductive health from a young age on a biannual or annual basis, so much so that women are more primed to be thinking about preventing illness in a way that men tend not to participate in until they’re about 50,” she said.
According to Reich, women are typically held responsible for the health of others in ways that men are not: “Women know that if members of their family become sick, they’re the ones who will be responsible for caregiving.” Although vaccine distributors don’t track the gender of people who schedule vaccine appointments for family members, sociologists are concerned that women are taking on the brunt of this work — an extension of what has been called women’s “second shift.” Women’s greater responsibility for maintaining not just their own health but the health of others makes Reich suspect that women are more likely to be in contact with health services and seek out health-related information. Social expectations that women care for others and vigilantly monitor their reproductive health demand it of them.
Hypothesis 4: Political Ideology and Susceptibility to Conspiratorial Thinking
Scheduling a doctor’s appointment or putting on sunscreen is relatively uncontroversial; getting the COVID-19 vaccine is not. According to national polling from the Kaiser Family Foundation, 29 percent of Republicans reported that they would “definitely not” get the vaccine compared with just 5 percent of Democrats. This divergence could partially explain the vaccine gender gap when we consider gender differences in political leaning. Women are more likely than men to say they lean toward the Democratic party, while men are more likely than women to say they identify as Republicans or independents.
“I think it’s government control,” Calvin Lambert, a 65-year-old carpenter living in western Virginia, said when I reached him on the phone. “First you’ll be taking the vaccine that the government tells you to get, and next you’ll only be allowed so much money per month.”
I spoke with six other men around the country who identified as conservatives, and they echoed Lambert’s concerns and had more to add. All of them worried about the role of the vaccine in facilitating the rise of socialism, and two of them falsely believed that COVID-19 vaccines contain government-controlled tracking devices. José Rodríguez, a community-outreach worker who partners with hospitals and churches to run vaccine clinics in western Virginia, said that misinformation was a major barrier in persuading men to get vaccinated. His concerns fall in line with research on gender differences in susceptibility to COVID-19 misinformation: Early in the pandemic, men — particularly those who identified as conservatives — were more likely than women to subscribe to COVID-19 conspiracy theories. The researchers have yet to collect data for 2021, so we don’t know whether this is still the case.
Closing the Gap
Appealing to traditional masculinity, such as framing the vaccine as a way to strengthen the body against the virus, could be one way of closing the gap. That approach may reinforce ideologies that are known to be harmful to men’s health on the whole, but it might be worth the trade-off. “You have to recognize where people are coming from,” said Metzl.
And states appear to be making an effort to do just that. Several have announced new vaccination initiatives, offering things like hunting and fishing licenses, free beer and even custom rifles to those who get the jab. Although not directed explicitly at men, many of these incentives have strong cultural associations with traditional masculinity.
But beyond appealing to masculinity, one of the best ways to increase inoculation rates among those who are hesitant could be making vaccine information readily available in the places where trust already exists, such as churches or barber shops. Reich put it this way: “Often there are other community leaders, brokers of trust or allies that are influential to people beyond doctors. In many ways the solutions really have to educate and empower people in the community to understand information in ways that are accessible.”