Negligence of sex and gender considerations have been costly in the fight against Neglected Tropical Diseases

On the 5th World Neglected Tropical Diseases (NTDs) Day, we stand at a critical juncture in this global health fight. The progress made in recent years is a true cause for celebration. 54 countries have eliminated at least one NTD. But emerging and persistent challenges threaten to antagonise advancements. One of those is the reversal in gender equality, compounded by challenges such as climate change and struggling economies.?

Over 1.5 billion people worldwide are affected by NTDs, with women and girls disproportionately affected. Our study - Poverty-Related and Neglected Diseases through a Gender Lens - highlights how sex (as a biological variant) and gender (as a social construct) both through distinct, and intersecting means influence how #NTDs show differing prevalence and impact between men and women, boys and girls.*?

Sex and gender disaggregated data can not be taken as a given - far from it, but from the available data, we see prevalence rates vary between genders. Nine diseases, including Chagas disease, leishmaniasis, and schistosomiasis, show higher global prevalence among women than men.

A spotlight on Female Genital Schistosomiasis (FGS) - uniquely impacting women and deeply neglected

FGS affects an estimated 50 million women and girls in sub-Saharan Africa, particularly in rural communities. The infection occurs when parasitic larvae from contaminated freshwater sources penetrate the skin during daily activities often carried out by women, like washing clothes and fetching water. Its impact is severe. Women with #FGS experience serious gynecological complications including lesions, vaginal bleeding, pelvic pain, and potential infertility. The condition also increases the risk of HIV infection and human papillomavirus, a risk factor for cervical cancer, and in pregnancy can cause severe issues, such as anemia, miscarriage, and preterm labor.?

Due to the low awareness among clinicians of FGS, patients are often misdiagnosed. This can lead to women being wrongly accused of sexual promiscuity, which in some communities can have serious ramifications, including gender-based violence and social exclusion. The current approach to effectively diagnosing FGS requires a visual examination of the cervix and the vaginal wall. This procedure is far from ideal, with efforts to diagnose constrained in low resource settings, with ethical and cultural considerations potentially creating barriers to invasive diagnostic procedures - again highlighting the importance of considering both sex and gender, alongside other factors in medical research.?

Innovation can exacerbate inequalities, but has also the potential to end them?

The current R&D landscape is likely contributing to deepening these inequalities by systematically overlooking sex and gender considerations. From laboratory research to clinical trials, sex and gender analysis remains incomplete throughout the R&D cycle, which can result in the development of new technologies or policies that fail to address women's specific needs, especially of the most vulnerable, like pregnant women.??

However, change is finally taking root. Realisation is mounting of the critical role of sex and gender considerate research in driving excellent science and public health impact, and this starts with data. The WHO NTD Roadmap 2021-2030 has set bold targets, which puts gender at the heart of the solution. The roadmap aims for 90% of affected countries to track how NTDs impact women and men differently.

Yet, as said at the outset, the global health community faces new challenges, including the rise of anti-gender movements and the sweeping reforms in the U.S. under Trump, including the erasing of diversity, equality and inclusion considerations across departments and the U.S. withdrawal from the World Health Organization . These trends tend to amplify global vulnerabilities to health crises and undermine women’s health and rights, threatening decades of progress, with implications for the whole of society. ?

Now more than ever, global partnerships play a critical role in shaping a healthier world. To tackle NTDs, the EU must continue to join forces with the global health community to strengthen international cooperation and investments. For instance, the EU should step up its cooperation with the WHO and create a strong successor of the European and Developing Countries Trial Partnership ( Global Health EDCTP3 ) under the next European Research Framework Programme (#FP10), retaining its strong commitments to advancing research that considered the needs of populations often most at risk of NTDs, including children and pregnant and lactating women. Ensuring inclusive science results in excellent science, with everyone set to benefit when we improve the health of women, and as a result those of their families, and that of our shared environment, society, and economy.?

For these reasons, DSW proudly endorses the Kigali Declaration, and calls for:

• More systematic consideration of sex and gender, at every stage of R&D??
• Continued investment in resilient health systems that withstand political shifts against women’s health
• Sustained and increased gender-responsive investments in NTDs to Unite, Act & Eliminate these diseases for good!

Read more here

• World NTD Day 2025?
• Report: Poverty-Related and Neglected Diseases through a Gender Lens - Deutsche Stiftung Weltbev?lkerung
• Tackling NTDs will require closing the gender gap in research and innovation - Deutsche Stiftung Weltbev?lkerung
• Ending NTDs together towards 2030

*Limited data and literature is available for other gender populations.?