IP barriers to COVID-19 health technology access compounds pre-existing gender inequalities

Women have suffered disproportionately from the impact of COVID-19 disease and lockdowns. The lack of, or inadequate availability of and access to COVID-19 technologies that could mitigate the negative impacts of COVID-19 – including reducing disease spread, severe disease, death, and hospitalisation – have worsened pre-existing gender inequalities within the country.

The World Health Organization’s constitution stipulates that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In addition to causing physical illness and death, the pandemic has done immense damage to women’s health when health is defined in this broader sense.

Globally and in South Africa, women – especially black working-class women – have suffered disproportionately from many of the negative effects of the pandemic:

  • Women have lost more jobs than men (data from the first year of the pandemic shows that two-thirds of all job losses were experienced by women);[1]
  • Women have been slower than men to see their employment opportunities and paid working hours return to pre-pandemic levels;[2]
  • Women have seen their unpaid working hours increase due to more work to be done in the household, especially during lockdowns when more people stay home and during episodes where sick household and/or community members need care;[3]
  • Women have suffered higher levels of hunger than other household members, often going hungry in order to shield children from hunger;[4]
  • Women have had less access than men to the COVID-19 Social Relief of Distress Grant;[5]
  • Women who are employed are over-represented in occupations that are public-facing (e.g. retail jobs). According to the Southern African Labour and Development Research Unit (SALDRU) at the University of Cape Town (UCT) “occupations dominated by women are reported to leave women 16% more at risk of contracting infectious diseases, such as COVID-19. Roughly 23% of the jobs occupied by women are directly exposed to infectious disease, compared with 7% of the jobs occupied by men. The data demonstrates that aside from making up most of the domestic workers and primary school teachers in the country, women also make up 78% of personal care workers, 92% of home-based care workers, 57% of doctors, 87% of nurses, 76% of medical assistants, and 47% of pharmacists”.[6] “The high interpersonal nature of women’s work coupled by the fact that they still carry out a larger share of child care puts them at a higher disadvantage relative to men in terms of income or job loss as a result of COVID-19. Finally, that men often do dangerous work (e.g., mining) is an often-invoked justification for the gender wage gap. However, the frontline response to COVID-19 has further shone a light on how the labour market undervalues the type of risky work often carried out by women given women are over-represented in health professional, retail shop clerk, and personal care work occupations.”[7]
  • Women tend to occupy lower positions in the occupational hierarchy (more women than men are nurses and CHWs) leaving them limited room to negotiate for safe working conditions – and this puts them at increased risk of contracting COVID-19 compared to male workers but also takes a toll on their mental and emotional health. Women make up 90% of nurses in South Africa. An online national survey of 7607 health workers conducted by HSRC and UKZN Nelson R. Mandela School of Medicine from 11 April – 20 May 2020 reports that nurses reported the lowest general health and well-being compared to medical practitioners and other health care professionals, and nurses reported significantly higher levels of distress than other health professionals.[8]  
  • Women’s access to reproductive and child-health services, as well as cervical cancer screening services was disrupted during the pandemic, especially during lockdowns (maternal mortality increased by 30% during the pandemic);[9]
  • Cervical cancer remains the biggest cancer killer of our women in SA. Further, the pandemic also disrupted the HPV vaccination roll-out to girls in public schools with the school closures at first and secondly the rotation system.
  • HIV test and treat services disrupted during the pandemic, disproportionately affects women who are over-represented amongst people living with HIV/AIDS. This is particularly concerning with respect to young women, as HIV prevalence is four times higher amongst women aged 15 to 24 years than men in this age group;[10] and
  • Women have continued to suffer from gender-based violence (GBV) with evidence suggesting that GBV increased during the pandemic.

The gendered effects of inequitable access to COVID-19 technologies

COVID-19 vaccines reduce the risk of severe illness and hospitalisation. Therefore, vaccines offer women in high-risk occupations (e.g., health workers) and public facing occupations (e.g., retail workers) a significant chance at protecting themselves – and their loved ones – against the worst health effects of the pandemic.

To the extent that vaccines allow for the reopening of schools, churches, retail spaces and transport, they also allow women greater freedom of movement, an improved chance of earning an income, and greater access to social networks and support services – including crucial health services – they need to enjoy a dignified quality of life. 

To the extent that vaccines allow for early childhood development centres and schools to reopen and reduce the intensity and duration of COVID-19 illness, they relieve women from the emotionally and physically intense work of looking after children and/or sick household members. In addition, by providing childcare, these institutions allow women the time and mobility they need to pursue income earning and skills development opportunities.

These considerations are particularly important in a country such as South Africa where a large proportion of the population suffers from comorbidities. An ableist approach that assumes that everyone will be able to “fight off COVID-19” by relying on their “natural immune system response”, instead of having access to affordable therapeutics, diagnostics and vaccination, obscures the health vulnerabilities such as diabetes, hypertension, malnutrition, obesity, cancer, and HIV/AIDS-TB that many people already manage daily. Women have higher rates of these conditions than men.[11]

Protecting patents and other forms of intellectual property on COVID-19 health technologies at the expense of expanded manufacturing and access clearly compounds pre-existing gender inequalities. This is at odds with the state’s legal obligations under domestic and international law. Chapter 2 of the Constitution obliges the state to “respect, protect, promote and fulfil” the rights in the Constitution, which include the right to access health care services and the right to equality. With respect to equality, Section 9(2) specifies that “Equality includes the full and equal enjoyment of all rights and freedoms. To promote the achievement of equality, legislative and other measures designed to protect or advance persons, or categories of persons, disadvantaged by unfair discrimination may be taken.”[12] Under the ICESCR, to which South Africa is a signatory, the state has an obligation to realise the right to enjoy the benefits of scientific progress and its application. This right seems particularly significant in the context of many South Africans having volunteered to participate in clinical trials for COVID-19 vaccines.[13]

Reforming domestic patent laws would be a concrete step to enabling women access to life-saving COVID-19 technologies, but would also have a lasting legacy beyond the pandemic as it would help facilitate access to patented medicines needed by women in particular, e.g., for cervical and breast cancer, and which they currently struggle to access.[14]

Table 2. COVID-19’s impact on women

DateSummary
July 15, 2020Research on the gendered effects of the hard lockdown demonstrates that women workers counted for two-thirds of the approximately 3 million job losses during this period.[15]  
August 6, 2020Women make up 90% of nurses in South Africa. An online national survey of 7607 health workers conducted by HSRC and UKZN Nelson R. Mandela School of Medicine from 11 April – 20 May 2020 reports that nurses reported the lowest general health and well-being compared to medical practitioners and other health care professionals, and nurses reported significantly higher levels of distress than other health professionals.[16]  
November 17, 2020  The Southern African Labour and Development Research Unit (SALDRU) at the University of Cape Town (UCT) releases a report indicating “occupations dominated by women are reported to leave women 16% more at risk of contracting infectious diseases, such as COVID-19. Roughly 23% of the jobs occupied by women are directly exposed to infectious disease, compared with 7% of the jobs occupied by men. The data demonstrates that aside from making up most of the domestic workers and primary school teachers in the country, women also make up 78% of personal care workers, 92% of home-based care workers, 57% of doctors, 87% of nurses, 76% of medical assistants and 47% of pharmacists”.[17] “The high interpersonal nature of women’s work coupled by the fact that they still carry out a larger share of child care puts them at a higher disadvantage relative to men in terms of income or job loss as a result of COVID-19. Finally, that men often do dangerous work (e.g. mining) is an often-invoked justification for the gender wage gap. However, the frontline response to COVID-19 has further shone a light on how the labour market undervalues the type of risky work often carried out by women given women are over-represented in health professional, retail shop clerk and personal care work occupations.[18]  
December 1, 2020Peer-reviewed article published indicates that maternal mortality increased by 30% from April to September 2020 compared to the same period in 2019. These deaths were attributed to a lack of transport, lack of beds and human resources, delays in referral, lack of expertise, and delay in appropriate action – all factors likely to be indirectly related to the first wave of COVID-19 and the lockdown that preceded it.[19]  
February 2021  Peer reviewed research published indicates women-headed households experienced higher levels of hunger and income loss compared to male-headed ones.[20]  
July 8, 2021Researched published which finds that women suffered disproportionate job losses, decline in average hours worked (for employed women), a slower and more “incomplete” job market recovery post-lockdowns, and an increased burden of unpaid work as compared to men. The study showed that “women accounted for the majority of the unemployed (or those not working) throughout the period, as well as the majority of the net job losses recorded between any two time periods, they were under-represented in the COVID-specific government income support provided for unemployed and furloughed workers”. Fewer women than men received the special COVID-19 Relief of Distress Grant (CRDG) because women already receiving any other grant (e.g. child support grant) were automatically disqualified from the CRDG.[21]  
July 19, 2021STATSSA reports that the pandemic has coincided with a decline of life expectancy. For males, life expectancy declined from 62,4 in 2020 to 59,3 in 2021 (3,1 year drop) and for females life expectancy declined from 68,4 in 2020 to 64,6 in 2021 (3,8 year drop).[22]  
October 27, 2021The Public Health and Social Development Sectoral Bargaining Council rules against a demand tabled by NEHAWU that community health workers (CHWs) be permanently employed and integrated into the public health service instead of receiving stipends and being employed on a rolling basis on short-term contracts. This is despite CHWs repeatedly being described by various government officials as foot soldiers of PHC services and taking on additional work due to the COVID-19 pandemic. Most CHWs are working class black women.[23]  
November 19, 2021Research report released on the experiences of sex workers in KwaZulu-Natal and the Western Cape during the COVID-19 lockdown. The study identifies 80.4% of participants as “female” and 13.7% as “transgender women”. The findings show that 83.7% of the participants in the study felt they were specifically targeted by law enforcement during lockdown, 60.8% had been arrested at some point during lockdown, and 66% of respondents had received a fine during lockdown.[24]   

[1] https://cramsurvey.org/wp-content/uploads/2020/07/Casale-Gender-the-early-effects-of-the-COVID-19-crisis-in-the-paid-unpaid-economies-in-South-Africa.pdf (cited 6 February 2022)

[2] https://cramsurvey.org/wp-content/uploads/2021/07/3.-Casale-D.-_-Shepherd-D.-2021-The-gendered-effects-of-the-COVID-19-crisis-and-ongoing-lockdown-in-South-Africa-Evidence-from-NIDS-CRAM-Waves-1-%E2%80%93-5..pdf (cited 6 February 2022)

[3] https://cramsurvey.org/wp-content/uploads/2021/07/3.-Casale-D.-_-Shepherd-D.-2021-The-gendered-effects-of-the-COVID-19-crisis-and-ongoing-lockdown-in-South-Africa-Evidence-from-NIDS-CRAM-Waves-1-%E2%80%93-5..pdf (cited 6 February 2022)

[4] https://www.dailymaverick.co.za/article/2020-07-15-many-mothers-going-hungry-for-the-sake-of-their-children-new-data-shows/ (cited 6 February 2022)

[5] https://mg.co.za/coronavirus-essentials/2020-09-06-the-pandemics-effect-is-gendered/

[6] https://www.news.uct.ac.za/article/-2020-11-17-COVID-19-could-derail-gender-equality-progress-in-sas-labour-market (cited 6 February 2022)

[7] http://opensaldru.uct.ac.za/handle/11090/992

[8]http://www.hsrc.ac.za/uploads/pageContent/12151/FULL%20DECK%20OF%20SLIDES%20for%20WEBINAR%206%20AUGUST%202020%20FINAL.pdf (cited 6 February 2022)

[9]https://journals.co.za/doi/10.10520/ejc-medog-v30-n4-a10; https://www.spotlightnsp.co.za/2021/03/05/30-increase-in-maternal-deaths-during-COVID-19-lockdown-reported/ (cited 6 February 2022)

[10] https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/south-africa#Groups%20most%20affected%20by%20HIV%20in%20South%20Africa

[11] Stokes, Andrew, et al. “Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: evidence from the SANHANES-1, 2011-2012.” PloS one 12.10 (2017): e0184264. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624573/ (cited 6 February 2022)

[12] https://www.gov.za/documents/constitution/chapter-2-bill-rights#9 (cited 6 February 2022)

[13] https://www.wits.ac.za/COVID19vaccine/novavax-COVID-19-vaccine-trial/; https://www.wits.ac.za/COVID19/COVID19-news/latest/oxford-COVID-19-vaccine-trial-results.html; https://www.news24.com/health24/medical/infectious-diseases/coronavirus/phase-3-of-COVID-19-vaccine-trial-kicks-off-in-south-africa-20201109   (cited 6 February 2022)

[14] https://canceralliance.co.za/wp-content/uploads/2021/08/Cost-of-Cancer-Advocacy-Report-V1.pdf; https://www.msf.org.za/news-and-resources/press-release/patient-groups-march-access-medicines-south-africa (cited 6 February 2022)

[15] https://cramsurvey.org/wp-content/uploads/2020/08/Casale_policy-brief.pdf (cited 7 February 2022)

[16]http://www.hsrc.ac.za/uploads/pageContent/12151/FULL%20DECK%20OF%20SLIDES%20for%20WEBINAR%206%20AUGUST%202020%20FINAL.pdf; http://www.samj.org.za/index.php/samj/article/view/13104/9520 (cited 7 February 2022)

[17] https://www.news.uct.ac.za/article/-2020-11-17-COVID-19-could-derail-gender-equality-progress-in-sas-labour-market

[18] http://opensaldru.uct.ac.za/handle/11090/992 (cited 7 February 2022)

[19] https://journals.co.za/doi/10.10520/ejc-medog-v30-n4-a10; https://www.spotlightnsp.co.za/2021/03/05/30-increase-in-maternal-deaths-during-COVID-19-lockdown-reported/ (cited 7 February 2022)

[20] https://www.sciencedirect.com/science/article/pii/S0276562420301050

[21] https://cramsurvey.org/wp-content/uploads/2021/07/3.-Casale-D.-_-Shepherd-D.-2021-The-gendered-effects-of-the-COVID-19-crisis-and-ongoing-lockdown-in-South-Africa-Evidence-from-NIDS-CRAM-Waves-1-%E2%80%93-5..pdf (cited 7 February 2022)

[22] http://www.statssa.gov.za/?p=14519 (cited 7 February 2022)

[23] https://www.dailymaverick.co.za/article/2021-11-10-arbitrator-rules-against-nehawu-over-bid-to-make-contract-workers-permanent-state-employees/ (cited 7 February 2022)

[24] https://genderjustice.org.za/publication/side-lined-experiences-of-sex-workers-throughout-the-lockdown/ (cited 7 February 2022)