Thousands of India's transgenders are missing vaccines due to fear, follies and lack of IDs

Dr Aqsa Shaikh, India’s first and only transwoman serving as a nodal officer at a vaccination centre, told the author that vaccine hesitancy is the first and the tallest hurdle between an Indian trans person and their two doses. And hesitancy is only one of the many obstacles keeping trans persons from getting immunised.

The month of June, also known as international pride month, marks half a year since the start of India’s vaccination programme. As of 30th June 2021, 32 crore Indians have gotten vaccinated. Of the total number of people vaccinated, trans citizens constitute 55,886, meaning only 0.01% of the national population and 11.45% of the total transgender population.

Such low numbers can be attributed to the systemic barriers and the vaccination drive chalking trans persons into the system as an afterthought. Each step towards getting immunised is replete with challenges for the community that already exists on the margins.

The foremost barrier, namely vaccine hesitancy, comes from the transgender community's historically traumatic interaction with the Indian healthcare system. Many are denied medical treatment based on their gender. Those who do receive it find themselves up against insensitive registration procedures, hostile medical staff, inferior service, lack of facilities such as washrooms, among a plethora of other problems.

Furthermore, the lack of trans-representation in vaccine trials inspires apprehension around how the vaccine would interact with hormone supplements, gender affirmative surgery, STIs or HIV-AIDS treatments. Alisha, a transwoman from Rajasthan, illustrates this prevalent fear of side-effects by stating: “Didi we already are keeping ourselves indoors and what if something happens after vaccination? Even normal people are not getting beds in hospitals, who will bother about saving an orphan kinnar?”

Aside from vaccine hesitancy, the CoWIN system erects many obstacles through its insistence on registering online through a smartphone. This digital divide worsens when combined with the trans community's 54% illiteracy rate and inaccessibility to smartphones or the internet.

Even those who have technological access sign up only to discover that the vaccine registration form doesn’t offer a transgender category in the gender section. Instead, the application boxes anyone who doesn’t identify as cisgender into the "others" category. This othering goes against the 2014 NALSA judgment, which asserts that the State must undertake all necessary measures to mention a person’s self-affirmed gender correctly, especially when it's in the context of a mandated government policy. Dr Shaikh points out that the CoWIN site's choice to employ the word "others" is especially confusing since all official government IDs, from Aadhar Cards to IRCTC bookings, mention the correct term "Transgender Persons".

The CoWIN form also insists on providing a photo ID proof upfront. However, for an average trans person, possessing a valid government document is a rarity since only 2% of trans individuals live with their parents, most escape or are abandoned from their parental homes at an early age. A 2017 field survey reports that in UP and Delhi, 16.6% of trans persons have Aadhar cards, 15.4% have voter cards, 2.1% driving licence, and 1.6% PAN cards in their own name.

Those who don’t possess identification cards are reluctant to go through the process of obtaining one. Currently, the process doesn't recognise one's right to self-identify and demands a gender certificate. Under the Transgender Persons (Protection of Rights) Act (2019), a trans-Indian may obtain the certification by 'proving' their gender identity to a District Magistrate. The procedure requires a revised certificate from a Medical Superintendent post-operation or any other proof of undergoing gender affirmative surgery. The system disregards that a majority of the community don't wish to undergo surgery or cannot afford to and places a trans person’s entire legal existence in a District Magistrate’s hands. Expecting anyone to undergo expensive operations to gain government identification without which they cannot access essential welfare services, such as getting vaccinated, borders violation of fundamental rights.

The whole ordeal seems even more troubling when considering that the Ministry of Health and Family Welfare recognises the transgender community as a high-risk group. The community records the highest Human Immunodeficiency Viruses (HIV) infection rate among all high-risk groups in India. Some STI clinics record a significant 44-45% positivity rate in the trans community. To put this into context, there are 1,100 HIV-positive trans persons for every one HIV-positive cisgender individual. HIV makes an individual more vulnerable to other viruses allowing deadly infections to thrive in one’s body for more extended periods than average.

The situation demands a mix of short and long term policy measures. Long term goals such as socially and economically uplifting the community, improving literacy rates, repealing exclusionary laws such as the 2019 Transgender Persons Act, and allowing the right to self-affirm one's gender are the keys to overcoming systemic hurdles. However, more immediately, measures like vaccine awareness drives, vaccine registration programmes, home to home vaccinations, separate vaccination centres, and special officers responsible for the transgender person's immunisation would boost the vaccination rate in the trans community. Through this blend, India must work towards properly accommodating the trans community into the world’s largest vaccination drive.

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