Transgender Pharmacist Advocates for Safe Access to Vaccines for Transgender Patients

[Image description: A picture taken from the right side of Jay Holloway in profile standing at a pharmacy counter talking with a patient on the phone. He has short brown hair, and is wearing a dark blue shirt, khaki pants, glasses, and a white KN95 mask. He is looking at a black and white computer displaying the USCF Transgender Guidelines webpage. His phone is in his left hand, and the black cord stretches across to the right side of the counter.]

Jay Holloway, PharmD, speaks with a patient by phone at Heart City Drug in Valentine, Nebraska.

Shortly after COVID-19 vaccines became available in North Central Nebraska, Jay Holloway, PharmD, received an email from a patient asking about safe places to get vaccinated. As a transgender man, the patient was not “out” to his primary care provider. He feared that if his provider wasn’t accepting of transgender people that, at the least, he might have a bad experience going to that provider for the vaccine—and at the worst, the provider might no longer want to provide health care services to him.

Holloway is all too familiar with these fears. A transgender person himself, he is certain that bad experiences with the health care system keep many transgender people from getting a COVID-19 vaccine.

One in three transgender people reports negative experiences with a health care provider related to their gender identity, according to a report on the 2015 U.S. Transgender Survey by the National Center for Transgender Equality. Almost one in four opted out of seeing a health care provider in the prior year due to fear of being mistreated.

"If a transgender person is not sure if a health care provider is a safe place to be out, it may limit their access to a COVID-19 vaccine, or any vaccine," Holloway said.

The pharmacy where Holloway practices in rural Valentine, Nebraska, does not offer COVID-19 vaccines. But that hasn’t kept him from advocating for safe vaccine access for transgender people.

Serving as an intermediary for the patient who sent the email, Holloway called the patient’s primary care provider to ask whether she was comfortable working with transgender patients. The provider said that she was and, in fact, people come to her for gender-affirming care. Holloway relayed this information to the now-relieved patient.

“It’s the least I can do. We could reduce a lot of the legwork that transgender people have to do if there were a directory of transgender-friendly and gender-affirming pharmacies,” Holloway said.

Holloway educates members of the pharmacy profession on how they can make their practices transgender-inclusive to ensure that transgender people not only stay up to date on recommended vaccines but also receive other care that pharmacies can provide. Most recently, he gave a guest lecture on the topic to first-year student pharmacists at Notre Dame of Maryland University.

“Other health care professions are running circles around pharmacy in terms of LGBT-inclusive and transgender-inclusive health care,” Holloway said.

The design of the national COVID-19 vaccine program itself, Holloway says, does not seem to take transgender people into consideration. For starters, vaccine databases, where immunizers enter patient information, use the terms sex and gender interchangeably. However, immunizers may not inform patients about the influence of sex on vaccine immune response and side effects.

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“A transgender patient who doesn’t know why this information is collected will wonder, ‘Do I put the sex I was assigned at birth or the gender that I identify as now?’ and that will lead to inaccurate data,” Holloway explained.

“These forms need to ask for ‘sex assigned at birth’ and explain to patients why,” Holloway said. If we had a data collection system that included transgender and gender-diverse individuals, then we would not only have more accurate data, but also, people would feel more comfortable answering these questions honestly.”

CDC vaccine cards can add to the bureaucratic chaos that nearly 90% of transgender people experience because, according to findings of the 2015 U.S. Transgender Survey, their IDs and other legal documents are not aligned under one name. Some documents bear their birth name and others their chosen name.

“This can lead to accusations of vaccine card forgery or problems trying to get a new vaccine card once the patient has changed their name legally,” said Holloway.

While individual pharmacists cannot change vaccine databases or CDC vaccine cards, Holloway calls all pharmacists to make their pharmacies safe and welcoming spaces for transgender people to receive COVID-19 vaccines and other care by making patient intake forms transgender inclusive, using gender-neutral signage in the store, wearing buttons that indicate the preferred pronoun of each pharmacy staff member, and displaying signage indicating the pharmacy is a safe space for transgender people.

Resources to Tailor Your Outreach and shareable Patient Resources to increase COVID-19 vaccine confidence are available at APhA’s Vaccine Confident microsite.