Vaccine equity is a growing concern of COVID-19 vaccination roll-outs and uptake globally. Gender has a role in vaccine uptake 1 but goes largely unrecognised in vaccine policies and programmes, undermining attempts to ensure equity. There is a wider gender blind spot that pervades national health responses to COVID-19 beyond vaccination, ranging from the way countries collect and report data to the commitments they make in pandemic health policies.Socially constructed gender norms can mean that women's access to COVID-19 prevention, testing, and treatment, including vaccination, is hindered by unaffordable fees or inability to travel to services. 2 In immunisation programmes before COVID-19, factors such as low autonomy, labour responsibilities, and unpaid care burdens were reasons for gendered barriers to vaccination that disadvantaged women. 3 COVID-19 vaccine uptake may be impacted by poorer access to health services and information about vaccines or perceptions of lower risk, among other factors. 4 Sex is thought to account for greater efficacy of some vaccines in women compared with men due to the different regulation of immune responses related to factors that include hormonal and chromosomal differences. 5 According to the Global Health 50/50 (GH5050) COVID-19 Sex-Disaggregated Data Tracker, among countries reporting COVID-19 vaccine uptake data, women comprise 53% of individuals receiving at least one dose. 6 However, only 34 of the roughly 180 countries that have begun vaccination programmes reported sexdisaggregated data on vaccine coverage between mid-April and mid-May, 2021. 6 Poor recognition by governments of the importance of considering sex and gender is also evident in national policies designed to guide vaccine roll-out. The GH5050 Sex, Gender and COVID-19 Health Policy Portal shows only five (9%) of 58 vaccine policies available as of March, 2021, mentioned gender. England, India, and Lebanon were the only countries found to include gender in their COVID-19 vaccine policies and to publicly report on vaccine uptake by sex. 6,7 However, the inclusion of gender is just a starting point. In-depth analysis of the UK Government's COVID-19 Scientific Advisory Group for Emergencies (SAGE) meetings

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Labour migrants who travel overseas for employment can face deep health inequities driven in a large part by upstream social and structural determinants of health. We sought to study the ‘labour migrant health ecosystem’ between one sending country (Pakistan) and one host country (Qatar), with a focus on how the ecosystem realizes the rights of labour migrants when addressing the social and structural determinants (e.g. housing, employment law, etc) of health. Study objectives were to: (1) undertake an in-depth review of policies addressing the structural and social determinants of the health of labour migrants in both Pakistan and Qatar, analysing the extent to which these policies align with global guidance, are equity-focused and have clear accountability mechanisms in place; and (2) explore national stakeholder perspectives on priority setting for labour migrant health. We used a mixed methods approach, combining policy content analysis and interviews with stakeholders in both countries. We found a wide range of guidance from the multilateral system on addressing structural determinants of the health of labour migrants. However, policy responses in Pakistan and Qatar contained a limited number of these recommended interventions and had low implementation potential and minimal reference to gender, equity and rights. Key national stakeholders had few political incentives to act and lacked inter-country coordination mechanisms required for an effective and cohesive response to labour migrant health issues. Effectively addressing such determinants to achieve health equity for labour migrants will depend on a shift in governments’ attitudes towards migrants—from a reserve army of transient, replaceable economic resources to rights-holding members of society deserving of equality, dignity and respect.