Global Health and Pandemic Responsiveness Through a Sex and Gender Lens Part 2

Show Notes for Episode Twenty-Five of seX & whY, Part 2: Global Health and Pandemic Responsiveness Through a Sex and Gender Lens

Host: Jeannette Wolfe
Guests: McKinzie Gales and Emelie Yonally Phillips

• McKinzie Gales – Global Health Fellow at the CDC and co-lead for Phase I of the multi-agency SAGER IOA project aimed at facilitating better collection, analysis, and use of sex-disaggregated data and gendered data for outbreak response.  
• Emelie Yonally Phillips – Global Health consultant (Epicentre/MSF) and core member of the Integrated Outbreak Analytics initiative

Phase 1 of the sex and gender equity in research (SAGER) for Integrated Outbreak Analytics (IOA) study involved A systematic literature review to better understand what is already known about the influence of sex and gender in outbreaks and to investigate if sex-disaggregated data and gendered data is being collected, analyzed, and used. Five different databases were searched and articles meeting the inclusion criteria were included. All included articles were published in English between 2012-2022, included the key terms “sex,” “gender,” or “pregnancy,” and discussed infectious disease outbreaks (e.g., cholera, dengue, Ebola, zika, hepatitis E, Malaria, influenza, yellow fever) in a low- and middle-income countries. Notably, they intentionally excluded articles focused on covid and tuberculous as sex and gender research is being extensively conducted on these diseases. 

Of the 15,000+ articles in their original search, only 71 articles examined potential sex and/or gender related factors associated with outbreaks in low- and middle-income countries. 

Although currently there is very limited data on the impact that sex and/or gender play in outbreaks and pandemics, what is known, underscores the complexity of these relationships. Studying specific outbreaks in specific contexts is important because who is most likely to get infected and how rapidly an infection is spread is influenced by several intersecting factors. These include the infectious agent, sex specific immunological factors and local socio-cultural practices and norms.

McKinzie highlighted that when there is a lack of gender and sex sensitive responses in outbreaks, evidence suggests that women, girls, and those with female anatomy are disproportionately negatively affected. For example, women are at greater risk for gender- based violence during a lock down and those with female anatomy are more directly impacted by the diversion of health care resources from clinics that offer reproductive health and pregnancy related services.

We went through an example as to how the SAGER IOA model might work in a theoretical outbreak. In establishing a functioning multi-disciplinary team, Emelie emphasized the importance of working within local systems to build long term relationships, community trust and capacity.  She underscored how critical it was to understand the values and priorities of the individuals most impacted by the outbreak and to ensure they had a voice in decision-making. She also discussed the importance of effective and transparent community health messaging- particularly if new data suggests a change from current practice. A recent example of this was the confusion experienced by many pregnant women surrounding the safety of Ebola vaccination. 

Emelie also spotlighted the opportunity to better understand how gender nonconforming and sexual minorities experience outbreaks as there is currently an absence of data on these groups. Finally, she emphasized that the failure of considering sex and gender specific needs in an outbreak can have tremendous downstream effects. Specifically, generational poverty, educational and professional inequities, gross domestic product, global trade, and security can all be impacted.

One of the other interesting areas we touched upon was how personal protective equipment (PPE) and other medical related equipment was initially designed for the anatomy and physiology of a male body and may not always work for a female one. Below are a few articles on this point.

Respiratory Personal Protective Equipment for Healthcare Workers. This study reported findings on adequate mask fitting in one hospital system’s fit test data for FF3 masks.  Their data set suggested that 18% of women had an inadequate FF3 mask fit compared to 10% of men. 

Unions say coronavirus crisis has brought ‘into sharp focus’ the problem of women being expected to wear PPE designed for men.

Here is a very interesting article that further explores whether medical equipment should be adjusted to better fit the anatomical variations of different users. The article - Does surgeon sex and anthropometry matter for tool usability in traditional laparoscopic surgery? makes a strong argument that most of the advances in laparoscopic surgical equipment have previously focused on accommodating different patient related factors and that their remains an opportunity to modify products to better align with anatomical characteristics of different users.  In turn, this may help enhance performance, outcome, and injury prevention of the users - AKA in this case the surgeons. 

Thanks for listening and be well.