A gender equity commitment in research will end poor treatment outcomes for women, and also get us closer to a cure for COVID-19.

Women’s health research is chronically underfunded, and women’s health receives little attention across the spectrum of health research, from funding to academic opportunities. Although steps have been taken to incorporate sex and gender-based analysis (SGBA) into research in Canada, there is a continued lack of analyses of sex and gender across health research areas. This lack of attention paid to SGBA and to women’s health research has led to misdiagnoses, minimized symptoms and poorly targeted treatment in women.

Indeed, if we had provided more funding and resources to women’s health research, one could make the argument that we would be closer in our search for a treatment and cure for COVID-19. Why?

Mortality from COVID-19 follows from attacks on the immune and vascular system, and both systems have striking sex differences. Yet, there is little research on how female-specific factors affect immune and vascular systems. If we knew more about how these systems work in women, we would be in a better position to understand why female physiology offers some protection against COVID-19-related mortality as shown in higher mortality rates in males. We would also be further ahead in our quest for an effective COVID-19 treatment for both men and women.

A sex and gender-focused approach and targeted consideration of women’s health issues in health science research, policy and practice will ensure we do not deepen sex and gender disparities in COVID-19 research and outcomes and promote an inclusive and balanced path for the future health of all Canadians. And it will save lives, faster.

Sex differences matter in health research

Women’s health research may seem like a niche research area; however, many diseases disproportionately affect women compared to men. For instance: depression and anxiety-related diseases are more prevalent in women than in men; heart attack symptoms manifest differently between the sexes; and treatments for certain diseases are more effective in one sex versus the other.

It is essential to understand these sex differences and how female-specific factors, such as contraceptive use, pregnancy and menopause, may contribute to disease susceptibility, symptoms and treatment. These unique aspects of women’s health are compounded by a range of intersectional factors such as gendered societal norms, race and socioeconomic status, which can accumulate to negatively affect women’s health, and are often ignored in health literature.

Women’s health research is chronically underfunded. In a 2019 report commissioned by B.C. Women’s Health Foundation, we found that over the past ten years, one percent of salary awards went to women’s health researchers in Canada, and in B.C., women’s health grants made up only eight percent of Canadian Institutes for Health Research (CIHR) grants. Given that women make up over 50 percent of the population, these percentages are dishearteningly low.

Furthermore, the amount of funding per grant was $50,000 lower per year for women’s health grants compared to others. Perhaps unsurprisingly, more women than men researchers study women’s health and conduct research analysing sex and gender. Women, on average, have lower funding success rates at CIHR, and receive less money (over $100,000 less per CIHR grant).

Inequities exacerbated by COVID-19

COVID-19 has amplified these inequities in women’s health research affecting funding, authorship, data acquisition and analysis. Health research suffered a serious blow when CIHR cancelled their 2020 spring competition one month after grants were submitted. Thankfully, the decision was reversed; however, the subsequent delay and resulting interim funding gap will have a cascading negative impact on health researchers, disproportionately affecting those with less funding, including women’s health researchers. Unpredictability of funding opportunities and low funding levels greatly impede research progress according to a survey of Canadian health researchers.

Emerging data indicates that women researchers are being surpassed by their male counterparts in COVID-19 scientific outputs, likely linked to the increased volume of caregiving and domestic responsibilities falling on women during the pandemic. Females are conducting less research on COVID-19, as depicted by publications, registered reports and awarded grants.

Furthermore, fewer female researchers as first authors are submitting and publishing during the pandemic compared to the year prior and these trends appear to be getting worse as time goes on. From the CIHR funding decisions database, of the initial 99 grants awarded for the CIHR Novel Coronavirus (COVID-19) Rapid Research Funding Opportunity, only 23 percent of the grant awardees had a woman as the nominated principal investigator.

In the latest round of CIHR COVID-19 grants, which included grants on mental health, clinical management and social policy, the percentage of grants lead by a woman as principal investigator increased to 40 percent.

Yet the general picture is still worrying. Studies indicate that diversity breeds discovery. We need more minds with diverse interests and multidisciplinary research to solve the many health, economic and societal issues related to the pandemic. If women are missing from the equation, diversity is compromised, and we will continue to lag in our efforts to solve the pandemic crisis for all.

Worse yet, commitment to SGBA for COVID-19 research grants is not evident. Only four percent of awarded grants met SGBA criteria, and only two percent went specifically to studying women’s health. Two months after the funding announcements, a supplement to understand the effect of sex as a biological variable (SABV) was awarded and currently 11 percent of the COVID-19 grants consider SGBA.

This is still not enough. If we ignore sex and gender as a variable in COVID-19 research, we miss crucial information to propel the research forward.

Disaggregated data is a critical tool

Additionally, despite the Canadian government’s commitment to applying a GBA+ policy lens in its decisions, it is difficult to find Canadian data on COVID-19 infections, hospitalizations and deaths disaggregated by sex and age.

Canada is one of the countries now providing the Global Health 50/50 program with sex-disaggregated data. However, the troubling lack of commitment to SGBA in the CIHR COVID-19 funding decisions, makes it evident that little work in Canada is underway to investigate the known sex and gender differences of this disease.

To rectify these biases and inequities, first and foremost, funding for women’s health research needs to increase by creating dedicated funding sources specifically for women’s health research, both for COVID-19 and for women’s health research in general.

Second, Canada needs to create a national open repository where all federally funded research must be submitted with mandatory recording of sex, gender and age data. Doing so will enable secondary analyses of sex and gender and allow for new health initiatives that benefit women, men and gender diverse peoples.

Third, while federal funding agencies such as CIHR are to be applauded for making gender metrics public, granting bodies must consistently demonstrate a commitment to gender equity in funding awards, terms and amounts. One method is to employ  modular budgets, which have eliminated sex differences in funding amounts for the National Institute of Health in the United States and reduced sex differences in funded grant amounts to less than $5000 under the Natural Sciences and Engineering Research Council of Canada system.

These steps will improve health research both in response to this pandemic and more widely. It will also help us better respond to future pandemics. The solution is simple: fund more women’s health research.

This article is part of the Tackling inequality as part of Canada’s post-pandemic recovery special feature.

Photo: Shutterstock/By Gorodenkoff