Exploring the relationship between sex and gender, country income level, and COVID-19

Recorded but not revealed: exploring the relationship between sex and gender, country income level, and COVID-19. Sarah Hawkes et al. The Lancet, April 06, 2021. https://doi.org/10.1016/S2214-109X(21)00170-4

In 2020 we witnessed a seeming exponential spread of information about COVID-19. From understanding the pathogen to understanding its effect on populations, we have a wealth of evidence for decision making in pandemic control. Nonetheless, there remain some fundamental areas of investigation and response for which evidence remains oddly and inconsistently absent. The role of sex and gender in understanding the testing-to-outcome pathway of the pandemic is one such area.

Identifying the contribution of sex and gender to SARS-CoV-2 infection yields important evidence on both biological mechanisms that underlie differences in illness outcomes,1 and social and structural dynamics that influence individuals' risk and vulnerability depending on their position in the gender hierarchy in any country or community.2 Such information can help identify sites for tailored individual-level and population-level health interventions that are more responsive to sex and gender and potentially more effective. The minimum starting point for analysing the contribution of sex and gender to the COVID-19 pandemic, and identifying opportunities for reducing health inequities, requires data that is sex-disaggregated, which can be analysed to understand and explain gendered inequalities.3

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As we move towards the global distribution of COVID-19 vaccines, we believe that this moment must serve as a wake-up call for the importance of recording sex-disaggregated data accompanied by gender analysis. Monitoring the coverage of the vaccine by sex will be a vital component of ensuring equity and promoting equality. It could lead to more effective vaccine programmes. For example, a population-based survey in the USA found higher rates of COVID-19 vaccine scepticism in females compared with males.

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 Will vaccine scepticism lead to lower uptake rates in women? We will not know unless we acknowledge that the purpose of sex-disaggregated data is not only to record it, but also to reveal it publicly, analyse it (including from a gender perspective) and, crucially, act on it.