From routine data collection to policy design: sex and gender both matter in COVID-19

Abstract

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

Sex and Gender in COVID-19 Vaccine Research: Substantial Evidence Gaps Remain

“…In this mini review of studies reporting efficacy and/or safety outcomes of vaccines included under COVAX, we found that women and men were equally represented in RCTs, whilst women (and healthcare workers) comprised the majority of participants in observational studies. Despite global calls for the routine disaggregation of COVID-19 data by sex/gender (59)(60)(61)(62), only two RCTs reported efficacy data by sex/gender, and none stratified safety data by sex/gender. Among the 34 included observational studies, 13 (38%) presented all sex/gender-disaggregated data (n =1 (3%) for efficacy and n = 12 (35%) for safety).…”

Sex differences in incidence and mortality of bloodstream infections. Results from the population-based HUNT study in Norway

“…Interestingly, in covid-19 where men are more prone to a severe course, the use of antiandrogens in men have shown promising results on severity (47). Furthermore, in a review of health records in post-menopausal women with regular use of oestradiol, the fatality risk of covid-19 is reduced by more than 50% (48).…”

Thrombotic Adverse Events Reported for Moderna, Pfizer and Oxford-AstraZeneca COVID-19 Vaccines: Comparison of Occurrence and Clinical Outcomes in the EudraVigilance Database

“…That same article also covers older patients, finding that "older patients, and in particular, in female older patients, it has been reported a progressive functional decline in the immune systems" [11]. In some countries, differences in gender roles find women with "low autonomy, labour responsibilities, and unpaid care burdens were reasons for gendered barriers to vaccination that disadvantaged women" [12]. Others suggest hormone levels in both men and women impact vaccine tolerance [13].…”

“…There have been several articles which looked at sex and age differences of people who had experienced adverse events [10][11][12][13][14][15][16]. Some suggest women have stronger immune systems [10].…”

“…Men have been found to experience greater severity of disease and higher mortality [13,15]. However, this set of articles did not consider differences between vaccines nor the confounding impact of co-morbidities [10][11][12][13][14][15][16].…”