Adapting the WHO BeSD COVID-19 Survey to Examine Behavioral and Social Drivers of Vaccine Uptake Among Transgender, Intersex, and Disability Communities in India.

BACKGROUND: During the COVID-19 pandemic, transgender and gender-diverse (TGD) people and people with disabilities in India faced disproportionate barriers to accessing vaccination services. Building on previous studies, this study explored the experiences of COVID-19 vaccine access in these two marginalized communities, using the WHO Behavioral and Social Drivers (BeSD) framework. METHODS: Keeping community-based participatory methods (CBPR) at heart, we conducted a survey adapted from the BeSD COVID-19 survey tool. The survey was adapted using insights from a prior study, a literature review, stakeholder consultations, and discussions with a community leadership group (CLG) and an advisory board (AdB). Participants were recruited through transgender, gender-diverse, and disability rights networks. Data were analyzed descriptively, using percent analysis, and psychometrically, using exploratory factor analysis on polychoric correlations. RESULTS: The adapted BeSD survey tool showed a high 0.85 (p < 0.05) internal consistency and criterion validity. Moreover, it showed a high willingness to be vaccinated (for ease of access to other services and community responsibility); however, systemic barriers hindered vaccination access. TGD people and people with disabilities faced multiple barriers in being vaccinated. The TGD community reported documentation mismatches and mistrust in health systems. People with disabilities reported mobility challenges, escort dependence, financial challenges, and variable accessibility at vaccination sites. Both groups faced digital exclusion, received inadequate information that did not address their specific needs, and experienced inconsistent implementation of inclusive policies. Community-led facilitation led to more uptake. CONCLUSIONS: Vaccine willingness alone is insufficient to ensure that vaccines reach everyone. Addressing trust deficits, infrastructural barriers, and digital exclusions requires diligent attention and commitment from the government to mitigate broader challenges faced by TGD people and people with disabilities.