Funded by the Sabin Vaccine Institute, iHEAR VaccinEquity 2.0 (VE 2) is a research project building on the work done in VaccinEquity 1.0 (VE 1), unpacking the structural barriers experienced by the transgender and disability communities in accessing COVID-19 vaccines in India.

Behavioural and Social Drivers of Vaccination (BeSD) is a framework and a set of surveys and interview guides given by the WHO to facilitate immunisation programs to understand the drivers of vaccine uptake in a community.

VE 1 recognised a host of structural gaps for the transgender and disability community related to vaccine communication, information, access and delivery. VE 2 seeks to expand the BeSD framework and survey to understand the drivers and barriers of adult vaccination for transgender, intersex and disability communities. The goal is to develop a survey that captures the specific needs of these marginalised communities, so that immunisation programs can become more equitable.

Flowchart Of The BeSD Framework Illustrating That Domains Like ‘Thinking And Feeling’ And ‘Social Processes’ Impact ‘Motivation’ To Vaccinate And ‘Practical Issues’ Like Availability And Affordability Can Affect Vaccine Uptake (WHO, 2022)

Flowchart Showing Various Structural Barriers To COVID-19 Vaccine Access For The Trans* And Disability Community Like Inaccessibility Of Registration Portals, Challenges With Mandatory Identity Cards, Infrastructural Inaccessibility Etc

The one and half year project is sectioned into three phases:

1. Survey development: In this phase, we will use various strategies to come up with potential questions for the survey, like revisiting VE 1 interviews, additional interviews and a review of the existing research on adult vaccine access among the three communities in the global south. This phase will be guided by the BeSD framework and Socio-Ecological Model, that looks at the interactive influence of different layers of social and structural factors. After arriving at a list of questions we will conduct an expert review and culturally adapt the survey.
2. Testing the survey with the community: In this phase, the survey developed in the previous phase will be conducted with a sample of people from the transgender, intersex and disability communities from different regions in India. These surveys will be conducted by researchers and social workers, trained in consent-taking, ethics and inclusive and accessible ways facilitating survey administration.
3.  Analysing the properties of the tool: This phase will analyse the data from the surveys filled in the previous phase and test the reliability and validity of the final tool.

In line with VE 1, VE 2 also takes a community-based participatory approach (aiming to address inequities in the research process through collaborations between communities, researchers and other stakeholders), with community members as part of the research team and through the guidance of a Community Leadership Group of 9 community representatives giving feedback at key stages of the research process.