Since the first cases began to emerge in Wuhan at the start of 2020, it’s been clear that COVID-19 disproportionately affects men. While women and men are equally likely to contract the disease, men are dying at higher rates than women in the majority of countries that report data that is disaggregated or broken down, by sex.

It’s still not clear to scientists why this is happening. Some research suggests this could be because men have more of the ACE2 molecule which allows the virus to invade our cells, while others point to hormone levels, chromosomes or lifestyle factors. But one thing is certain: it will be difficult to find out for sure without disaggregated data.

When it comes to the economic fallout of the disease, however, it’s clear that women will bear the brunt. Women are more likely to lose their jobs in the coming recession and more likely to have to take on extra care work as a result of the crisis. In the short-term, lockdowns around the world are also leading to rising rates of domestic violence and making abortions more difficult to access.

What both of these problems have in common is that policymakers do not currently have enough data to be able to respond properly to the gendered effects of COVID-19. That’s why two organisations are pushing governments to collect and report more data on sex and gender.

Pushing governments to be accountable

Health data broken down by sex is one of the most basic pieces of information a government can collect says Sarah Hawkes, the cofounder of Global Health 50/50, an independent research organisation based at University College London. Sex has been recorded on birth and death certificates in most countries for many decades. But not all governments make use of that data when making policy, and that can be a problem for crafting responses during a crisis as significant as the coronavirus pandemic.

To push governments to do better, Global Health 50/50, an independent research organisation based at University College London, launched a sex-disaggregated data tracker in March, in partnership with news organisation CNN.

Every week, Global Health 50/50 staff and volunteers comb dozens of health department websites and social media accounts worldwide to extract data on confirmed cases, hospitalisations, intensive care unit (ICU) admissions and deaths. When governments do not make this information public, Global Health 50/50 emails them to ask for it. It’s a significant amount of work, said Anna Purdie, the programme manager at Global Health 50/50.

Purdie said data about sex and data is often left off government data dashboards, buried in surveillance reports or only mentioned in passing in Tweets or recordings of speeches on YouTube.

For Hawkes, this demonstrates the overall problem of governments not taking gender into account in policymaking. England and Wales, for example, only began reporting COVID-19 data broken down by sex at the end of April, she said.

“It's not as if they didn't know whether people dying were men or women, and it's not as if they haven't had that recorded on death certificates for hundreds of years,” she says. “It's the fact that they are not of the mindset to think that sex and gender matters. It’s not an absence of data – it’s an absence of paying attention to sex and gender as clear determinants of health outcomes.”

Hawkes says this may be because decision-makers in government are often men, who do not take gender considerations into account when responding to crisis because they see themselves as the default.

The data tracker sorts countries into three groups: those that report sex-disaggregated data (22%), those who partially report it (38%)  and those that don’t report it at all (40%). Some of the countries that have been hit worst by the pandemic, including Spain and Italy, have some of the most detailed data available on sex and gender, Purdie said.

But there are still gaps in our understanding of the countries that are publishing the full complement of data: most of the countries that publish full sex-disaggregated data show that men and women contract COVID-19 at similar rates but that men account for 50-60% of deaths. But there are some outliers – men account for 76% of deaths in Thailand, 74% in Pakistan and 73% in Bangladesh

Purdie said this could be that more men are being tested than women in those countries, and that it’s not possible to understand the numbers on confirmed cases unless we know who has access testing.

The Wider Fallout

At the disease level, COVID-19 may disproportionately affect men, but it’s likely that the social and economic effects of the pandemic will fall more heavily on women.

But Emily Courey Pryor, executive director of Data2X – an organisation based at the UN Foundation which campaigns for better reporting of gender data worldwide, said the full impact will be difficult to measure because governments have historically been so poor at collecting data on issues that disproportionately affect women.

“Only half of all countries in the world have data on unpaid and domestic work,” she said. “Of those who do have it, most only have one or two data points in the last 20 years. A lot of this data is close to ten years out of date.”

Data2X has launched a review of major international databases alongside Open Data Watch to assess these wider, gendered effects of the pandemic. This will cover data points that cover the primary effects of the pandemic and lockdown to the wider effects such as disruption of employment, access to education and social protections.

It’s not a pretty picture, according to their initial analysis, which finds:

“The data to track primary health effects by sex on cases and deaths is incomplete for the majority of the global population, non-existent for low-income countries, and unavailable for health care workers, except for a handful of countries.”

A data wake-up call

COVID-19 has exposed inequalities and gaps in our understanding of key issues across the board, not just in terms of gender but also relating to socio-economic status and ethnicity.

“If we want to have a real conversation about understanding gender and COVID-19, then we have to have a conversation about the data that we don't have and the willingness to change that for the future,” Pryor said.

And while some governments do lack sophisticated tracking and collection tools to disaggregate vast amounts of data efficiently, others have them but simply have not used them, both Hawkes and Pryor argued.

Hawkes says the Global Health 50/50 data tracker should not have been necessary because the coronavirus pandemic hit wealthy countries with strong data systems first – places where virtually all births and deaths are recorded and health surveillance are strong.

“We should have had this brilliant data right from the start, and we didn't,” Hawkes says. “That is just a reflection of the fact that the people in positions of power somehow don't think this matters, and that might be related to the fact that people in positions of power are predominantly men.” – Megan Clement

(Picture credit: Unsplash)

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