I’m fat so I get a lot of advice from the internet. I can’t always walk into a shop and get what I need so I have to rely on the kindness of online strangers. I’ve collected tips for the best plus-size tights that won’t fall down and the best potions from the chemist to prevent chub rub, which is what those in the know call chafing in hot weather.
Fat people share healthcare recommendations online almost as much as they share recommendations about well-fitting clothing. Recommendations for GPs who care about your health more than they care about your weight are passed down like heirlooms. Earlier this year online communities started bubbling with speculation about whether a higher BMI would mean earlier access to the Covid-19 vaccine in Australia, as it had in the US and the UK.
The BMI has an awful lot of staying power for a formula that was developed by a mathematician in the 19th century. Initially, I bristled at the idea that having a high BMI was all it took to qualify for vaccination. What did an outdated calculation tell anyone about my health? This indignation lasted about five minutes. I’ve presented to a GP with a urinary tract infection and was told to eat less fruit if I want to lose weight. If I contracted Covid-19 I’d be vulnerable to systemic fatphobia in the medical system. I planned to book my vaccination as soon as it was available.
The online fat activism community lit up when phase 1b was announced. Severe obesity was included as an underlying medical condition and the only criteria was having a BMI of 40 or higher. Commenters shared links to the eligibility checker and swapped stories of attempts to book appointments. I was scrolling these comments when I learned fat people need to be immunised with a larger needle.
A registered nurse I spoke to explained to me that the Covid vaccine, just like the flu vaccine, is designed to be given into the muscle. “The needle usually used for this is 25mm long, but it is recommended to use a 38mm needle in fat people as the needle needs to pass through a more subcutaneous fat layer to reach the muscle,” she said. “All Covid immunisers in Australia are required to complete training provided by the Australian government, and this training advises that 38mm needles are required ‘for individuals with obesity’.”
When I asked if this was a new requirement, the nurse told me “a study in 1997 found that the amount of fat over the deltoid muscle where we have our vaccines injected varies, especially for women. If a vaccine made to be injected into the muscle is injected into the fat layer, this has less blood flow than the muscle and the immune reaction likely won’t be as strong.”
Brodie Lancaster, a writer from Melbourne, also credits her understanding of the Covid vaccine and the larger needle to social media. “I’ve been immunised for the flu and other viruses before – and have always been fat – and never knew this was required to ensure we’re immunised properly,” Brodie says. “Considering we spent all of last year being told that obesity made us more at risk of the most severe implications of Covid-19, it would’ve been appreciated to know that we’re also eligible for the protection the vaccine provides.”
I booked my vaccination as soon as I could. Eventually I made a booking at the Sydney Olympic Park vaccination hub. When I got there, it reminded me of a theme park. Waiting in a long line, snaking through check-in, a brief thrill, a sticker.
I sat down and the nurse prepared my arm. “My friend is a nurse and she says I need a bigger needle because I’m fat,” I said, my voice ringing through the hall. Another nurse was beckoned over and after a minute the bigger needle arrived. It seemed easier, and less confrontational, to describe the online community as my friend.
Afterwards, I was filled with Pfizer and relief but I also had a sinking feeling. If I hadn’t advocated for my own health I would have been vaccinated with the regular needle. Darcy*, a 34-year-old teacher, had a similar experience at the Sunshine hospital vaccine hub.
“I informed the nurse straight away that I would require the 38mm needle,” Darcy said. “The nurse seemed surprised I asked for it but went and got it straight away after inspecting my arm and was back in less than a minute.”
Online, people’s experiences are mixed. Some fat people were vaccinated with the larger needle as a matter of course, which many immunisers will do without flagging with their patients. Some people had to ask for it. Some were denied because the correct needle wasn’t available or their immuniser wasn’t aware of the requirement.
So often, fatphobia is couched in concern. Harmful stigmas against bigger bodies are justified as caring for our health. With the vaccine rollout, the Australian health system had an opportunity to come good on those concerns. If being fat is enough for people like me to be vaccinated, why isn’t it enough for us to be vaccinated properly?
Fat people have been left to share information from person to person about the eligibility and administration of vaccines when this could have easily been avoided.
I’ve wondered before, in my more poetic moments, if fat activism has saved my life. I’ve found joy at the beach swimming with people who look like me. It’s re-routed the wires in my brain that told me I hated myself. I never imagined the fat community would have such a tangible impact on my physical health. I’m vaccinated, and vaccinated correctly, because of the care that fat people have for each other.
Using the word fat to describe my body has always felt like freedom but I didn’t know I’d need to use that word to advocate for the correct medical treatment during a pandemic.
At the height of the pandemic, I worried about whether ICU beds in Australia would overflow, and my body would be deemed unhealthy enough to be left without care if I contracted Covid. Now that a vaccine is here, fat people are not receiving the protection available to us as a high-risk population. Not everyone living in a bigger body has the access to the fat activism community that I do. Some fat people spend their life willing their body to be smaller. Some fat people don’t speak English. Do they know they need to be vaccinated with a longer needle? Are they even aware they need to be vaccinated at all?
The only way that we’re getting out of this eventually is with herd immunity. If fat people aren’t immunised correctly, we’re all in jeopardy.
More training and communication is needed on vaccine eligibility and needle size as a matter of urgency, both for the medical profession and for the general public. As much as I value the information shared with me online, private Facebook groups shouldn’t be the source of knowledge for a vaccination rollout.
Ally Garrett has been writing and speaking about body politics for the past decade, with work published in ABC Life, Daily Life and Jezebel
* Darcy’s name has been changed at their request