7 Communicable Diseases

Sex and gender influence disease incidence, duration, and severity through differences in vulnerability to infection, exposure to pathogens, and response to illness. For example, an individual’s immune system and pregnancy status both influence their vulnerability and response to illness. Gender influences on social norms or access to resources may also influence exposure to pathogens and illness progression through differences in the ability to access or
utilize treatments.

To effectively identify and address gaps in prevention and treatment measures that meet women’s needs, stakeholders must first understand the burden of infection, disease consequences, and socio-economic costs of key communicable diseases in women. Improving the availability and accuracy of data that captures the sex-specific burden and costs of key communicable diseases in women will enable R&D agenda-setting efforts to prioritize the highest need areas for women.

Infections not only present direct risks and symptoms but can also impact the development and prognosis of longer-term diseases, such as chronic gynecologic conditions and immune-mediated disorders, which disproportionately affect women. For example, understanding the link between human papillomavirus (HPV) and cervical cancer has revolutionized prevention efforts for this deadly cancer. Studies suggest that infectious agents may contribute to a range of conditions as varied as like irritable bowel syndrome, endometriosis, and Alzheimer’s disease. However, the links between infectious agents and chronic diseases require further investigation. Focusing investments on research to identify the role of microbes as potential underlying causes of chronic conditions can unveil innovative opportunities for prevention and treatment interventions for women.

Women are affected disproportionately or differently by several infectious diseases—such as HIV, STIs, and tuberculosis—that could be prevented through vaccination and other prevention interventions. Pregnancy can enhance the risks of severe presentation of infectious diseases, so prevention is essential to help control adverse outcomes. Pregnancy also presents a unique opportunity to pass disease protection to the growing fetus through maternal immunizations. Clinical trial enrollment has historically excluded pregnant women which has led to limited knowledge of vaccine safety during pregnancy upon initial licensure. However, greater interest in developing maternal immunizations presents an opportunity to accelerate the development of vaccines and prevention interventions that can preserve the health of both women and their infants.

Over one million STIs are acquired every day globally. Most STIs are asymptomatic, but if left untreated, they can lead to a range of adverse female reproductive tract outcomes, including infertility, chronic pelvic pain, ectopic pregnancies, stillbirths, and preterm births. Convenient and affordable rapid STI diagnostic tests are lacking in much of the world, particularly in LMICs, where the use of syndromic management (treating based on symptoms without lab tests) misses most STIs given their asymptomatic nature. However, the STI innovation pipeline is rich and numerous platforms exist to develop improved STI diagnostics. Increased attention is needed to bring these products through licensure, WHO prequalification, and implementation in LMICs.

As noted under Opportunity 7.1, sex and gender influence disease acquisition and progression. As a result, treatments may have a differential impact on men versus women, exacerbated by the fact that the male body historically represented the standard and women were largely underrepresented in clinical trials. Furthermore, drug safety in pregnancy is often obscure, with limited data on factors like the effects of gestational timing of exposure to medication. Increased investment in the development of new or improved therapeutics with sex and gender considerations can ensure that women’s needs are being met.