July 16, 2021

Men die at a higher rate from COVID than women. So why are they less likely to take the vaccine?

Kelley Perkins rolled up her sleeve with no hesitation when the COVID-19 vaccine was first made available to health care workers last December.

The 32-year-old worked as a traveling nurse in the Houston area at the time and was posted at St. Joseph’s Medical Center near downtown. In the intensive care unit, she saw the virus devastate family after family when their loved ones died.

But her experience as a nurse isn’t the only reason she was ready to take the vaccine.

“I believe in evidenced-based medicine, and I believe public health is a social issue,” Perkins said. “For us to get back on our feet, we have to eradicate (COVID), and the only way to do it is with the vaccine.”

Perkins’ boyfriend, Al Ruiz, is not so sure. He hasn’t taken the vaccine yet.

Ruiz, 34, and Perkins have been dating for nearly two years. He doesn’t work in the health care industry, but he remained an essential worker at a Houston car dealership throughout the early part of the pandemic.

Ruiz said his 10-year-old twins are up to date on their vaccines for school. For himself, the COVID vaccine is just not a priority.

“It’s more just hearing other people’s reaction to it. Kelley got sick; she ran a fever. A lot of people I talk to, that second shot tends to be the doozy,” Ruiz said. “Generally, I don’t even take the flu vaccine.”

In Texas, nearly 1 million more women and girls are vaccinated against COVID than men and boys, according to the Department of State Health Services. Women between the ages of 16 and 49 account for more than a quarter of the 12 million Texans who are fully vaccinated, the agency reported Thursday.

And it’s not just in Texas. According to the Centers for Disease Control and Prevention, 53 percent of Americans who have received at least one dose identify as female.

Elizabeth Gregory, director of the Institute for Research on Women, Gender and Sexuality at the University of Houston, presumes the difference in vaccination rates is pretty simple.

“It’s the dynamics of women just being more interested in taking care of themselves, which leads to men being in worse health overall,” Gregory said. “Why (men) were dying before the vaccine connects to why they’re not taking the vaccine — they’re less likely to take care of themselves.”

More men than woman die from COVID as well, according to the institute’s report published in October, before the vaccines were available. Last fall, the Houston Health Department recorded a total of 1,154 deaths, of which 423 were women and 731 were men — a difference of 70 percent. In Harris County, slightly more than 100 more men than women had died out of 756 deaths.

“There’s a gap in fatalities, but the infection rate was about the same,” Gregory said. “It wasn’t that women weren’t getting it; it’s that they weren’t dying.”

The institute published multiple reports on the pandemic in Houston and Harris County by gender, age and race or ethnicity. The October version found that 61 percent of local COVID deaths were male and 39 percent were female. Houston’s numbers are consistent with the “global pattern of more male deaths, likely due to a combination of biological and behavioral factors.”

There were also racial disparities among death rates. For instance, while Hispanic men make up 42 percent of the county’s male population, they accounted for 51 percent of all male deaths. White men, who make up 33 percent of the male population, accounted for only 22 percent of deaths among men.

Gregory’s department found that the racial disparities for men could be attributed to social and economic inequalities. White men are less likely to work in frontline jobs and typically have better access to health care.

Josh Garza, 43, had pre-existing Type II diabetes, so he was eligible to receive the vaccine earlier than his peers. But he said no.

“I felt like I was doing everything I needed to do: I was wearing the mask, social distancing and washing my hands,” the Sugar Land man said. “We were doing what we were supposed to do, so I didn’t need the vaccine. Plus, it was so new.”

By the end of January, Garza had developed symptoms and was admitted to a Sugar Land hospital. His health plummeted so quickly that doctors told him to get any end-of-life affairs in order, which included a difficult phone call to his 12-year-old son.

In February, he was placed on a lung transplant list and transferred to Houston Methodist. He received a double-lung transplant in April.

Cultural and societal standards for Hispanic men played a role in his decision not to take the vaccine when it was first offered to him, Garza said. After this experience, he said he will take better care of his health.

“Being Hispanic, we’ve always had to be tough — you just kind of play it off and let it go,” he said. “This has made me realize that you have to pay attention to your body and address it when you can. You can’t let it linger because then it will get worse.”

“We do see men having a lower life expectancy overall because their self-care is worse,” Gregory said. “What’s notable is that it’s such a large difference in fatalities, particularly among young people. Many men have frontline jobs in industries that don’t prioritize their health whereas women in frontline jobs are typically in health care or education, which both supported them wearing masks.”

This is true for Perkins, a nurse, and Ruiz, who works at a car dealership.

Seven months after her vaccination, Perkins continues to wear her mask every day at her new rheumatology clinic job. Still unvaccinated, Ruiz stopped wearing a mask after a few weeks because his employer did not require them.

Before vaccines were available, Ruiz would sometimes mask up if Perkins did. But more often than not, he went maskless.

“A lot of it has to do with my schedule; I don’t have a lot of free time,” he said.

Perkins has laid out the data for her boyfriend and explained what happens to patients who are admitted to the hospital. She’s offered to make the appointment for him, but he hasn’t agreed to go.

Though she believes his vaccine hesitation is politically based, Ruiz said Perkins just doesn’t understand why he’s not rushing to take something so new.

“She feels it’s political because it’s been politicized,” he said. “I think ultimately I will end up getting it, but I’ve been working this whole time in public, meeting complete strangers all day long. And I haven’t gotten sick.”

From being on the health care frontlines, Perkins has become used to hearing why people do or do not want to be vaccinated. And usually, the ones who do had COVID themselves or lost family members to the virus, she said.

There’s no reason a person should pick and choose what scientific research to believe, Perkins added.

Gregory, the director at UH’s gender-focused institute, said men are more vulnerable to dying from COVID because of how men are raised, the types of job they work and their economic status.

“There’s some sense among men that they should be tough and shouldn’t get care,” Gregory said. “If more men die of COVID, I think more men would want to get the vaccine.”

julie.garcia@chron.com

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