Commentary BMJ Glob Health: first published as 10.1136/bmjgh-2020-003549 on 1 October 2020. Downloaded from Symptoms of a broken system: the gender gaps in COVID-19 decision- making 1,2 3 2 Kim Robin van Daalen , Csongor Bajnoczki, Maisoon Chowdhury, Sara Dada,2,4 Parnian Khorsand,2 Anna Socha,3 Arush Lal,2 Laura Jung,2,5 6 7 8,9 Lujain Alqodmani, Irene Torres , Samiratou Ouedraogo, 10,11 2 12 3 Amina Jama Mahmud, Roopa Dhatt, Alexandra Phelan, Dheepa Rajan To cite: van Daalen KR, A growing chorus of voices are questioning Summary box Bajnoczki C, Chowdhury M, the glaring lack of women in COVID-19 et al. Symptoms of a broken system: the gender gaps decision- making bodies. Men dominating ► Despite numerous global and national commit- in COVID-19 decision- leadership positions in global health has long ments to gender- inclusive global health governance, making. BMJ Global Health been the default mode of governing. This is COVID-19 followed the usual modus operandi –ex- 2020;5:e003549. doi:10.1136/ a symptom of a broken system where gover- cluding women’s voices. A mere 3.5% of 115 iden- bmjgh-2020-003549 nance is not inclusive of any type of diversity, tified COVID-19 decision- making and expert task be it gender, geography, sexual orientation, forces have gender parity in their membership while Handling editor Seye Abimbola race, socio-economic status or disciplines 85.2% are majority men. within and beyond health – excluding those ► With 87 countries included in this analysis, informa- Received 27 July 2020 tion regarding task force composition and member- Revised 22 August 2020 who offer unique perspectives, expertise and ship criteria was not easily publicly accessible for Accepted 24 August 2020 lived realities. This not only reinforces ineq- the majority of United Nations Member States, im- uitable power structures but undermines an peding the ability to hold countries accountable to effective COVID-19 response – ultimately previously made commitments. costing lives. ► Lack of representation is one symptom of a broken By providing quantitative data, we critically system where governance is not inclusive of gender, assess the gender gap in task forces organised geography, sexual orientation, race, socio- economic to prevent, monitor and mitigate COVID-19, status or disciplines within and beyond health – ul- http://gh.bmj.com/ and emphasise the paramount exclusion of timately excluding those who offer unique perspec- gender- diverse voices. tives and expertise. ► Functional health systems require radical and sys- temic change that ensures gender- responsive and intersectional practices are the norm – rather than RETREATING TO THE NON-INCLUSIVE DEFAULT the exception. on September 25, 2021 by guest. Protected copyright. MODE OF GOVERNANCE ► Open, inclusive and transparent communication and The global community was unprepared as decision-making must be prioritised over closed- COVID-19 struck. As a result, countries swiftly door or traditional forms of governance. established expert and decision-making struc- ► Data collection and governance policies must in- tures through traditional processes: reaching clude sex and gender data, and strive for an inter- sectionality approach that includes going beyond out to government ministry directors, promi- binary representation in order to produce results that nent experts and heads of well- known institu- are inclusive of the full gender spectrum. tions. Most of these positions are typically held by men, as evidenced by our analysis of 115 expert and decision-making COVID-19 task task forces (table 2). For instance, the © Author(s) (or their employer(s)) 2020. Re- use forces from 87 countries: 85.2% of identified WHO’s first, second and third International permitted under CC BY. national task forces (n=115) contain mostly Health Regulations Emergency committees Published by BMJ. men, only 11.4% contain predominantly consisted of 23.8%, 23.8% and 37.5% women, For numbered affiliations see women and a mere 3.5% exhibit gender respectively. Expert groups, compared end of article. parity.* Similarly, 81.2% (n=65) of these task with decision- making committees, more Correspondence to forces were headed by men (table 1). frequently had higher proportions of women Ms Kim Robin van Daalen; Men were overrepresented in global task or gender parity, reflecting potential societal krv22@ cam. ac. uk forces to a similar extent to that of national biases and stereotypes in terms of gender van Daalen KR, et al. BMJ Global Health 2020;5:e003549. doi:10.1136/bmjgh-2020-003549 1 2 BMJ GlobalHealth Table 1 Identified national COVID-19 task forces Type of task Women head Women head of # Country (Reference) Name of the task force convened force Gender of force Public gov Note 1 Albania23 Technical Committee of Experts(for Covid-19) Expert 8W; 3M (11 Unknown Yes No, Edi Rama N/A “Komiteti i Ekspertëve” total) 72.7%W 2 Algeria24 National Committee for Monitoring and Follow- up of the Expert 0W; 11M (11 No, Yes No, Abdelaziz N/A Corona Virus (Covid-19) total) Abderahmane Djerad W Ben Bouzid%0 نوروك سوريف يشفت ةعباتمو دصرل ةيملعلا ةينطولا ةنجللا 3 Argentina25 26 Committee of medical and scientific experts Expert 4W; 6M (10 Unknown Yes No, Alberto N/A “Comité de expertos médicos y cientificos” total) Fernández 40%W 4 Armenia27 28 Interdepartmental Commission for Coordinating the Decision- 4W; 10M (14 No, Arsen Yes No, Nikol N/A Prevention of the Spread of the new Coronavirus making total) Torosyan Pashinyan “միջգերատեսչական հանձնաժողով” 28.6%W IT working group modelling spread of coronavirus in Expert 0W; 12M (12 Unknown Yes Photo Armenia total) reference(s) (No formal name) 0%W were used to determine gender composition. 5 Australia29–32 Australian National COVID-19 Coordination Commission Decision- 2W; 6M (8 No, Neville Yes No, Scott N/A making total) Power Morrison 25%W Australian Health Protection Principal Committee Decision- 3W; 6M (9 No, Brendan Yes N/A making total) Murphy 33.3%W 6 Austria33 Coronavirus Taskforce Decision- 6W; 4M (10 Unknown Yes No, Sebastian N/A “Hausinternen Stabs der Coronavirus- Taskforce” making total) Kurz 60%W Advisory Team to the Coronavirus Taskforce Expert 5W; 13M (18 Unknown Yes N/A “Beraterstabs der Coronavirus- Taskforce” total) 27.8%W 7 Bahamas34 35 National Coordination Committee on COVID-19 Decision- 6W; 11M (17 Yes (co- chair), Yes No, Hubert Minnis N/A making total) Pearl McMillan 35.3% and Matt Aubry 8 Bahrain36 National Taskforce for Combating Coronavirus Decision- 2W; 3M (5 Unknown Yes No, Khalifa bin N/A (COVID-19) making and total) Salman Al Khalifa expert 40% انوروك سوريفل يدصتلل ينطولا قيرفلا 9 Bangladesh37 National Committee for Prevention and Control of Decision- 4W; 28M (32 No, Zahid Yes Yes, Sheikh N/A Covid-19 making total) Maleque Hasina “জাতী붼 কমিটি কোভিড -১৯ এর প্রতিরোধ ও নি붼ন্ত্রণের জন্য” 12.5%W 10 Belgium38 39 Scientific Committee for Coronavirus Expert 3W; 2M (5 No, Steven van Yes Yes, Sophie N/A “Wetenschappelijk comité Coronavirus” total) Gucht Wilmes “Comité scientifique Coronavirus” 60%W Continued van Daalen KR, et al. BMJ Global Health 2020;5:e003549. doi:10.1136/bmjgh-2020-003549 BMJ Glob Health: first published as 10.1136/bmjgh-2020-003549 on 1 October 2020. Downloaded from from Downloaded 2020. October 1 on 10.1136/bmjgh-2020-003549 as published first Health: Glob BMJ http://gh.bmj.com/ on September 25, 2021 by guest. Protected by copyright. by Protected guest. by 2021 25, September on Table 1 Continued Type of task Women head Women head of # Country (Reference) Name of the task force convened force Gender of force Public gov Note 11 Benin40 Interdepartmental Committee Decision- 0W; 4M (4 No, unknown Yes No, Patrice Talon N/A “Comité interministériel” making total) 0%W 12 Bhutan41 Health Emergency Management Committee Decision- 2W; 11M (13 Yes, Lyonpo Yes No, Lotay N/A making total) Dechen Tshering 15.4% W Wangmo Technical Advisory Group Expert 2W; 11M (13 No, Sithar Yes N/A total) Dorjee 15.4%W 13 Bolivia42 Scientific Advisory Council Expert 2W; 6M (8 No, Carlos Yes Yes, Jeanine Añez N/A “Consejo Científico Asesor para la lucha contra COVID-19 total) Javier Cuellar en Bolivia” 25%W 14 Botswana43 COVID-19 Task Force Team Expert 0W; 4M (4 No, unknown Yes No, Mokgweetsi N/A total) Masisi 0%W 15 Brazil44–49 Interministerial Executive Group on Public Health Decision- 1W; 8M (9 Unknown Yes No, Jair N/A Emergency of National and International Importance making total) Bolsonaro “Grupo Executivo Interministerial de Emergência em Saúde 11.1%W Pública de Importância Nacional e Internacional” Crisis Committee for Supervision and Monitoring of Unclear 1W; 21M (22 Unknown Yes N/A Covid-19 Impacts total) “Comitê de Crise para Supervisão e Monitoramento dos 4.5%W Impactos da Covid-19” 16 Bulgaria50 Medical Council Expert 5W; 11M (16 Unknown Yes No, Boyko Committee “медицинския мозъчен тръст" total) Borisov was dispersed 31.3%W (functioned until 4 April) 17 Burkina Faso51 Name unknown Decision- 5W; 14M (19 Unknown No No, Christophe N/A making & total) Joseph Marie Expert 26.3%W Dabiré 18 Cape Verde52–54 Council of Ministers Decision- 3W; 12M (15 Unknown Yes No, Ulisses N/A “Conselho de Ministros” making total) Correia e Silva 20%W BMJ GlobalHealth 19 Canada55–59 Cabinet Committee on the federal response to the Decision- 4W; 4M (8 Yes, Chrystia Yes No, Justin N/A coronavirus disease (COVID-19) making total) Freeland Trudeau 50%W Special Advisory Committee on COVID-19 Expert 12W; 11M Yes, Theresa Yes N/A (23 total) Tam and Sadiq 52.2%W Shahab Continued 3 van Daalen KR, et al. BMJ Global Health 2020;5:e003549.