COVID-19 put Canada’s pandemic preparedness to the test, not only in grappling with the primary impacts of illness and deaths, but also in responding to the secondary effects on millions of Canadians, which were sustained and gendered.

A good example is the gendered effect of the stay-at-home advisories put in place by federal and provincial governments. In the emergency messaging, the governments failed to acknowledge that home is not a safe space for everyone. It was only after advocacy by non-profit organizations that the messaging shifted, and funding was made available to survivors of gender-based violence. Yet  reports of violence continued to increase across the country.

Had preparedness plans considered the gendered effects of pandemics, drawing on substantial evidence from past pandemics, this rise in violence might have been prevented and support provided to meet increased service demands.

In reality, Canada was ill prepared to address the secondary gendered effects of COVID-19, due to its lack of an intersectional, gender-responsive pandemic preparedness and response plan.

What do we mean by secondary effects? These are the effects of not the virus itself but of the policies enacted in response to it. Examples of secondary effects are the loss of employment and social protections, increased unpaid care work, deteriorated mental health, declining school enrolment, and increased cases of gender-based violence. In other words, stay-at-home advisories and the closure of services meant that those at risk of violence had limited recourse in situations of confined contact with a perpetrator.

The secondary effects of the pandemic are not experienced equally. For instance, while women make up 47 per cent of all workers in Canada, they accounted for 63 per cent of COVID-19 related job losses during the initial lockdown and 58 per cent one year into the pandemic.

Canada’s preparedness for and response to influenza-like pandemics such as COVID-19 are largely informed by two documents, which were updated in 2018. These are “Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector” and “Federal/Provincial/Territorial Public Health Response Plan for Biological Events.” Despite lessons built  on strong evidence from previous outbreaks, these two documents do not meaningfully address gender inequality.

The preparedness planning guidance only refers to gender in the context of pregnant women’s vulnerability following outcomes from the H1N1 pandemic. While it highlights the disproportionate burden on health care workers and the ethical need to minimize these burdens, it fails to acknowledge the gendered nature of the health care workforce, of which 80 per cent are women.

Health equity is listed as a guiding principle in the response plan, acknowledging pre-existing health inequities and vulnerabilities associated with race, ethnicity, gender, age and socio-economic status, among other intersecting circumstances. However, the document fails to acknowledge or address the effects of recommended public health responses in maintaining or creating these inequities.

Instead, guidance on meeting the needs of individuals experiencing vulnerabilities during pandemics is deferred to a report by the International Centre for Infectious Diseases (ICID) which “may not necessarily represent the official policy of the Public Health Agency of Canada.” Like the policy documents we mentioned above, the ICID report addresses vulnerabilities primarily from a health equity lens, with no mention of how socio-economic vulnerabilities can be exacerbated by strategies such as physical distancing and closure of services.

The preparedness planning document does note the psychosocial impact of distress arising from “economic downturn, caregiver burnout, occupational stresses, stigma/social exclusion.”  However, rather than providing Canada-specific guidance on how to address these effects, it refers to guidelines on mental health and psycho-social support by the UN-led Inter-Agency Standing Committee, which primarily apply to humanitarian crises in low-income countries.

In failing to prepare for the secondary effects of the pandemic, the government has downloaded the responsibility for it onto civil society and frontline organizations. The response to the primary impacts of the pandemic is mainly through public health measures, leaving civil society groups and individuals to clean up the mess caused by economic loss, increased violence and overall insecurity. Not only does this approach ignore the relationship between public health and social and economic policies, it fails to respond to the most pressing needs of women, children and those made vulnerable.

Our recommendations

1. Gender-responsive pandemic planning must draw on lessons learned from COVID-19 and from previous pandemics, prioritizing responses that address gender-based violence, mental health, economic security and unpaid care work. The Gender and COVID-19 Project has collated these lessons and developed a tool to assist policy-makers in creating a gender-responsive pandemic plan.

2. Gender-segregated and intersectional data on both the primary and secondary effects of pandemics should be collected to ensure accurate responses to arising and evolving needs, and to inform future preparedness and planning.

3. Pandemic response structures should include as key stakeholders non-profit and other community organizations that serve individuals and diverse demographics experiencing vulnerabilities. Undue burden, however, should not be placed on these partners as they are often in the front lines of pandemic responses. Representation in such structures should include those most affected.

4. The federal government’s Gender-based Analysis Plus (GBA+) commitment should be extended to policies around pandemic preparedness and responses. The GBA+ framework is useful in identifying the gendered and intersecting secondary effects of public health responses. Its application, however, should not only recognize gendered risks in pandemic responses but also include steps to address these risks.

Canada is not unique in its reactionary approach to the secondary effects of pandemics. Preparedness for the primary and secondary consequences of pandemics is critical, as both pose significant risks to individuals and societies. With its commitment to the Gender-based Analysis Plus (GBA+) framework, Canada is well placed to lead and innovate pandemic preparedness to include consideration of the secondary effects.

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Alice Mũrage
Alice Mũrage is a research fellow in the Faculty of Health Sciences at Simon Fraser University and is collaborating on the multi-country Gender and COVID-19 Project.
Julia Smith
Julia Smith is a research associate in the Faculty of Health Sciences at Simon Fraser University and a faculty member of the Centre for Gender and Sexual Health Equity. With a background in health policy and governance and the social and commercial determinants of health, she currently co-leads the Gender and COVID-19 Project.

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