A vaccine will offer protection from coronavirus – but we can’t inoculate against sexism

There is one prediction about coronavirus that can be made with confidence: when a vaccine is developed there won’t be a male and female version. Evidence suggests we need two, as we’ve known for some time that there is a sex-specific response to vaccines. Women have more severe adverse reactions and develop higher antibody responses. Without a male and female version of the vaccine, women will be given suboptimal treatment, potentially paying with their lives.

Underpinning my prediction about a sex-specific vaccine is the history of science. To date, our understanding of health has developed through a male lens, based on studies of men, carried out by men. In 2020, this is nothing short of a scandal, albeit one that rarely gets an airing.

It wouldn’t be so bad if we used intelligence gathered from previous global virus threats. With the last global pandemic, Sars, the World Health Organisation pointed to the gender data gap, specifically the lack of systematic tracking of outcomes for pregnant women, despite knowing that Sars symptoms were particularly severe for this group. Some gender data is available for coronavirus infections – whether this data is just collected or intended to be used to inform interventions like a vaccine, is still unclear.

More broadly, there is more research and knowledge about erectile dysfunction despite affecting only one in five men compared with the nine in 10 women experiencing premenstrual syndrome.

Despite all the talk of equality and sexism, we are still in a position where we know far more about the health of men than women, even though women make up 50 per cent of the population. It was only in 1993 that women were required to be included in research trials. Prior to that, women were viewed as either too complex or risky, particularly those of a childbearing age. But it took until 2016 for academic journals like The Lancet to sign up to guidelines that encouraged researchers to report sex differences in published trials. It’s depressing to think that even when research trials included women, the results of the trial weren’t disaggregated by sex and journal editors didn’t insist on this basic detail being reported.

From cancer to coronavirus, there isn’t an area of health research or science more broadly that isn’t gender blind. Science, it seems, is institutionally sexist. Acknowledging this is the first step towards change, but it’s not just about ensuring women are included in trials – we need more women in senior research roles. This is about more than a nod to equality; it will enhance our collective knowledge. As it stands, men monopolise senior research, journal editor and research grant positions. Unlike commerce, which has set targets to redress the gender imbalance among chief executives, science has no such target. It doesn’t matter how intelligent or aware a senior man in such a position is, they can never fully understand a woman’s health or experience of a health intervention.

Increasing the number of women in senior positions would provide a perspective and insight that is often missing about women’s health and the male-orientated treatments provided to them. Most medicines are tested on men, consequently, dosing is calibrated on the average male physique despite clear differences between the sexes. This also leaves a clinical blind spot as to any female-specific adverse reactions which only come to light after a drug is approved, leaving women at greater risk than men exposed to the same medication.

So, although women dominate the early-career levels of research, it is their male peers who are four times more likely to become professors. Senior academics decide not only what is researched but are responsible for designing the method of investigation. So junior female researchers have limited influence over research topics and the ability to highlight any gender bias in the research design or reporting. Most junior researchers are employed using short contracts, dependent on their senior, usually male, colleagues to ensure their career continues and develops. These elements foster subservience, rather than challenging the status quo, which takes away from the need to tackle this systemic sexism.

We need the brightest and the best minds in science. Excluding half the population is not just morally wrong, it wastes talent and is as detrimental to men as it is to women. While a vaccine will offer protection from coronavirus, we unfortunately can’t be inoculated against sexism, a social virus that’s proven to be so resistant that it has stunted the advancement of science.

Ian Hamilton lectures in mental health at the Department of Health Sciences, University of York