Time for action: towards an intersectional gender approach to COVID-19 vaccine development and deployment that leaves no one behind

Gender shapes risk of infection, vulnerability to disease and experience of ill health, and socioeconomic disparities.1 Important interplays between biological sex and gender, as a social construct, and other variables such as age, race and ethnicity, and other health conditions, have demonstrated differential risks of COVID-19 exposure, acquisition and outcomes.2 3 Sex-based differences in vaccine-induced immune response and adverse events are well documented, and may influence vaccine acceptance, access and uptake, which are also highly gendered.4 Hence, it is imperative that sex and gender be meaningfully considered alongside other intersecting dimensions when developing and deploying COVID-19 vaccines.5 Inherent in this is the need for meaningful engagement of the expertise and leadership of women in all scientific research, policymaking and programmatic decision-making processes at global, national and local levels. Invest in the well-being and resilience of the health workforce by ensuring a respectful and enabling working environment, zero tolerance for sexual harassment and gender-based discrimination, measures to prevent burnout, provision of psychosocial support, sick leave, insurance and prompt payment of salaries, guarantee of equal pay, access to suitable personal protective equipment, essential hygiene and sanitation products, as well as essential sexual and reproductive health services. Civil society Advocate for transparent decision-making about prioritisation and deployment plans. Global aggregate data indicate an equal distribution of cases between women and men, but a higher case fatality rate in men.6 Partial data on hospitalisation and intensive care unit (ICU) admission from a handful of countries indicate greater severity of disease in men, explained by a combination of higher biological susceptibility and gender-related behavioural risk factors. Notably, transmission patterns and SARS-CoV-2 incidence and mortality vary between women and men across age groups in different countries as well as within countries.8–11 The age-specific female to male ratios and patterns of morbidity and mortality can further change over time, shaped by evolving exposure and transmission patterns in the society or extent of testing or diagnosis.8 While data continue to point to higher mortality among men, emerging data reveal that mid-adult women are more likely to suffer from post-COVID-19 condition.12 13 Gender differences can further vary within popul