Opinion: We lack an essential component to power COVID-19 response

Our COVID-19 coverage is free. Please consider a Devex Pro subscription to support our journalism.
A security guard checks the body temperature of a customer at a store entrance amid the COVID-19 pandemic in Dhaka, Bangladesh. Photo by: UN Women / Fahad Abdullah Kaizer / CC BY-NC-ND

Your gender and your sex — along with all the expectations, limitations, and experiences that both entail — affect your risk of contracting and dying from COVID-19. From the start of the health crisis, sex-disaggregated data has made this clear.

At the global level, men appear to account for slightly more confirmed cases, but data varies starkly across countries and reflects a variety of contexts, inequalities, and demographics. Wales, for example, reports that 62% of its cases are among women, while that share is just 9% in Qatar.

In contrast, men’s heightened mortality rates from COVID-19 appear to be a global phenomenon. In 67 of the 82 countries where data is available, more than half of all COVID-19 deaths are among men. In aggregate, men account for 40% more COVID-19 deaths than women.

This data is drawn from the revamped COVID-19 Sex-Disaggregated Data Tracker, the world’s largest database of sex-disaggregated data on COVID-19. Since mid-March, Global Health 50/50 has been collecting, collating, and publishing the tracker. In recent months, we’ve joined up with two of the world’s leading health research institutions, the African Population and Health Research Center and the International Center for Research on Women, to substantially deepen the project’s data collection and policy engagement capacity — and expand its impact.

Together, we find that reporting of sex-disaggregated data is often inconsistent, incomplete, or simply inaccessible. The high variability in the data is a major obstacle to both national analyses and intercountry comparisons.

Q&A: What early data says about gendered impacts of COVID-19

UN Women rolled out surveys in multiple countries in Asia and the Pacific just weeks after the pandemic was declared. Statistics specialist Sara Duerto Valero explains how the agency was able to act so quickly, and what the data reveals so far about the impacts of the crisis on men and women.

National COVID-19 data broken down by sex reflects the interaction between the coronavirus and social dynamics. Differences in COVID-19 health impacts are likely driven in part by biological factors, such as immune system responses that differ between men and women, but are also molded by the gendered landscape of professional and domestic roles, who has access to quality health services, and whose health status is already compromised.

In Afghanistan, Bangladesh, India, and Pakistan, men account for upward of 65% of COVID-19 infections and deaths. The high proportion of cases among men may be related to gender norms around the use of public space and participation in the paid labor market — both of which are often male-dominated. In public and at work, men may face a higher risk of exposure to COVID-19. Additionally, lower numbers of reported cases among women may also reflect gender inequalities that keep women from accessing testing and health care services.

In sub-Saharan Africa, men account for over 60% of confirmed cases in a majority of the countries where data is available. South Africa, which accounts for half of the continent’s cases, is the single outlier, as women make up nearly 60% of confirmed cases, and the gap appears to be growing. In varied ways, gender — including gendered differences in preexisting health conditions, occupational exposure, uptake of protective behaviors, and access to testing — is likely contributing to these disparities.

Disaggregated data has been used to transform national responses to other health crises. In the case of HIV, data from sub-Saharan Africa has shown that men and boys living with HIV are less likely than women and girls to know their HIV status and be accessing treatment. In response, some countries are working to tackle systemic and societal issues at play, including by scaling up community-based testing, engagement of men in maternal and child health services, and creative marketing to promote condom use.

In the case of COVID-19, however, we continue to lack an essential component to power similar solutions, because not all countries are reporting COVID-19 data separately for women and men.

Of the 170-plus countries we’ve tracked so far, just 30% are currently reporting sex-disaggregated data on cases and deaths, with 1 in 3 not reporting any COVID-19 health data by sex. Just 10 countries have reported testing data by sex. Without this, it’s impossible for researchers and planners to tell if gender disparities in confirmed cases are the result of real differences in risk and exposure — or artifacts of biased testing strategies.

Opinion: Without gender data, we leave critical COVID-19 clues on the table

It is not too late to prioritize sex-disaggregated data. Two U.N. directors in Asia and the Pacific discuss how gender statistics can inform the response to COVID-19.

Existing health system capacity and resources likely play a role in the lack of sex-disaggregated data in many countries. We see, for example, a relationship between a country’s economic status and its likelihood of reporting sex-disaggregated data. However, in limited-resource settings, some countries, such as Afghanistan and Uganda, regularly report data by sex.

Still, among high-income countries, fewer than half report COVID-19 case and death data by sex. Some countries that were reporting sex-disaggregated data have since stopped, indicating that the lack of data is not just a question of capacity, but also one of politics and priority.

We also see that sex-disaggregated differences in COVID-19 outcomes are not static. We are witnessing a changing and evolving pandemic, affecting regions, age groups, ethnicities, and genders differently. Sporadic reporting will do little to help us understand trends in who is at risk and what solutions are at hand.

At a minimum, countries should report sex- and age-disaggregated data on cases and deaths, as called for by the World Health Organization. But we can only really begin to understand the dynamics of the crisis — and how health and social systems are helping or hindering our efforts — with testing and hospitalization data, too. And data must be reported regularly and transparently.

In the last few months, we’ve seen that demanding this data from authorities — particularly in partnership with champions like Melinda Gates and Caroline Criado Perez — can drive change. In the face of the greatest global health emergency in 100 years — a pandemic fanning entrenched inequalities — robust data must be our first and last tool to ensure that our efforts will serve all people equally.

Devex, with support from our partner UN Women, is exploring how data is being used to inform policy and advocacy to advance gender equality. Gender data is crucial to make every woman and girl count. Visit the Focus on: Gender Data page for more. Disclaimer: The views in this article do not necessarily represent the views of UN Women.

The views in this opinion piece do not necessarily reflect Devex's editorial views.

About the author

  • Contributors

    Kent Buse, Sarah Hawkes, Athena Pantazis, Anna Purdie, and Sonja Tanaka of Global Health 50/50; Siki Kikongo, Michelle Mbuthia, Sylvia Muyingo, and Moreen Nkonge of the the African Population and Health Research Center; and Kakoli Borkotoky, Abhishek Gautaum, Ketaki Nagaraju, and Sneha Sharma of the International Center for Research on Women.