Cu peste 750.000 de cazuri de coronavirus la nivel mondial si zeci de mii de decese, a devenit din ce in ce mai evident ca virusul nu doar discrimineaza in functie de varsta si conditii de sanatate subiacente, ci si de sex – cu barbatii mai susceptibili de a fi pozitivi si mai predispusi la mor din cauza bolii. Decalajul de decese sexuale a fost observat si in focarele SARS si MERS.
Desi faptele potrivit carora barbatii tind sa fumeze mai mult, consuma mai mult alcool si sunt mai putin susceptibile sa tina cont de sfaturile de sanatate publica pot reprezenta o parte din riscul crescut pentru barbati, exista, de asemenea, diferente biologice intre barbati si femei, care ar putea reprezenta diferente. Unele studii asupra virusurilor au fost realizate sugerand ca, in general, femeile au sisteme imunitare mai puternice decat barbatii si sunt capabile sa lupte mai bine impotriva infectiilor datorita femeilor care au doi cromozomi X – unde sunt continute multe dintre imunele asociate.
Cercetarile de la Universitatea din Iowa pe SARS, un virus similar cu coronavirusul care a aparut si in China a descoperit ca soarecii de sex feminin erau mai putin sensibili decat soarecii de sex masculin. Cu toate acestea, atunci cand ovarele au fost eliminate sau hormonul feminin estrogen a fost blocat, aceasta diferenta a disparut. Acest studiu a demonstrat ca diferentele hormonale intrinseci erau in joc – si a furnizat un argument extrem de convingator pentru studiile de date dezagregate de sex in politica de sanatate publica si dezvoltarea medicamentelor.
OMS a solicitat raportarea datelor dezagregate de sex cu privire la epidemii inca din 2007, dar in actuala criza, numai 11 tari furnizeaza detalii despre fatalitatea barbatilor si a femeilor, doar sase furnizand date specifice sexului atat pentru cazuri, cat si pentru decese (China, Franta, Germania, Iran, Italia si Coreea de Sud). Fara date mai bune, din mai multe tari, este dificil sa gasesti rapid tratamentele corecte si este mai greu pentru guvern sa puna in aplicare politici de sanatate publica care vizeaza grupuri de oameni care sunt mai vulnerabili decat restul populatiei. Atata timp cat aceste date nu sunt puse la dispozitia publicului, nu pot fi analizate de catre experti externi pentru indicii despre motivul pentru care mai multi barbati par sa moara de virus.
Caroline Criado Perez brilliant recent book, Invisible Women, details the significant issues in public healthcare caused by a lack of sex disaggregated data, and the problems women face in a healthcare system designed for men. The book shows one study from the University of Leeds that found women were 50% more likely to be misdiagnosed when having a heart attack because research, and symptoms taught to medical students, centres around the symptoms men experience, not women.
Atacurile de cord nu sunt singura problema in care lipsa de considerare pentru diferentele dintre sexe face diferenta in dezvoltarea medicamentului si a politicii de sanatate publica. Dupa cum evidentiaza Femeile Invisibile, medicamentele sunt testate pe soareci de sex masculin si apoi subiecti barbati – si tind sa se bazeze pe greutatea si inaltimea medie a barbatilor, fara a tine cont de faptul ca femeia obisnuita are hormoni semnificativ diferiti de barbati si astfel va reactiona la medicamente in un mod diferit.
This imbalance is visible almost across the board. A 2014 op-ed published in the journal the Scientific American stated that including both sexes in experiments was a waste of resources. It’s no surprise then that, according to research on phase one drug trials, women represent only 22% of participants. Yet the second most commonly observed reaction in women in later stages of trial are that the drugs simply do not work on them. If there are drugs that work on men but not on women, it is feasible that there are drugs that would work on women but not on men – but these go unexplored due to over 75% of the participants being male.
Where data exists, we can learn from it. Where it doesn’t, we can’t. I’d urge the Government to collate and release data disaggregated by sex so that researchers can study data gaps and start to learn from them.
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This would benefit men with regard to SARS, MERS and coronavirus, and would benefit women in most areas of public health policy development. Governments should also require a minimum number of women to be included in drug trials from phase one (unless the drug being designed is specifically for a male issue) and women could then benefit from drug research continuing that might be ineffective on men, but work for women.
In addition to requiring women to be included in trials, we should ensure that medical textbooks and medical courses teach the differences between genders. A 2008 Dutch study found that sex-specific information was absent from textbooks recommended by Dutch medical schools even for topics where sex differences have long been recognised. Based on conversations with former medical students in the UK, it appears that the same is true here. If we are not teaching the doctors, researchers and scientists of tomorrow about the importance of sex disaggregated data, learnings and research, how can we expect them to account for it in their work?
Finally, as per the World Health Organisation’s request, Governments should commit to releasing sex disaggregated data for coronavirus cases and fatalities – and all other public health related statistics – as soon as possible. Remedying the failure to account for the differences in gender responses to coronavirus could support the development of a vaccine and improve methods of treatment – saving lives now and in the future.
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Resham Kotecha is Head of Engagement at Women2Win and a former Conservative parliamentary candidate.
Columns are the author’s own opinion and do not necessarily reflect the views of CapX.
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