An open letter from Women in Global Health to the leaders of the G7 

With the covid-19 pandemic only widening inequalities, it’s time for the G7 to lead with humility, vaccinate the world, and invest in the women who deliver health and social care, say Roopa Dhatt and Ann Keeling

Dear G7 leaders

The G7 meets during an exceptional time in our global history when covid-19 has infected around 175 million people and caused nearly four million deaths. The pandemic is far from over and it will not be the last. It has tipped the world into a deep global recession, felt hardest by countries and social groups with the least protection, at the centre of which are women and girls. 

A “shadow pandemic” has struck women who have been the first to lose their jobs and experienced increases in both unpaid work and intimate partner violence. In low income countries, disruptions to maternal and reproductive health services have increased maternal deaths, unwanted pregnancies, and unsafe abortions. Growing poverty has forced girls out of school and into child marriages. 

Viruses do not respect national borders. Unlike Ebola, this pandemic came into cities, hospitals, and homes in G7 countries. In an interconnected world we cannot safeguard the health of our own citizens when ignoring the rest of the world. While the virus continues to spread outside the G7, it may come back to haunt countries that have vaccinated their citizens. The G7 has to make this a break in history, change direction, and resolve to invest in a future based on equality and equity—the only solid foundation for global health and economic security.

Women in Global Health has five messages for G7 leaders:

First, vaccinate the world and do it fast. Start with health workers and older people who are most vulnerable. It is the best possible investment the G7 can make. Beyond the moral imperative to achieve the right to health and avoid deaths, vaccine equity is in the self-interest of wealthier nations since the International Monetary Fund estimates that US$9 trillion will be lost if world trade does not resume.

Second, lead with humility. The early stages of the pandemic demonstrated that countries in the global north do not have a monopoly on knowledge or political wisdom. Ethiopia, for example, with 109 million people and a per capita income of US$800, has recorded around 4000 deaths from covid-19. Countries like Ethiopia that had experienced SARS or Ebola were quick to put public health measures in place to contain the virus. Within three months of the start of the pandemic, Ethiopia had screened 40 million people. The G7 can learn important lessons from health experts in the global south by enabling them to be equally represented in global health decision making and research.

Third, ensure women are equally represented in leadership. With only one woman out of seven leaders at the G7 and the prospect of no women leaders at the G20 in November, it is timely to note that diverse decision making groups make better decisions. Currently, women make up 70% of health and care workers but hold only 25% of senior decision making roles and this weakens health systems and pandemic response. Our research in 2020 showed that 85% of national covid-19 taskforces had majority male membership. The extraordinary work by women in the pandemic has not translated into an equal seat at the decision making table. We have all lost out on their talent and expertise. Since gender inequities in health drive poorer health outcomes for everyone, health leaders of all genders should be gender transformative leaders. Addressing gender inequality in health is not solely the responsibility of women leaders, it is the responsibility of all G7 leaders meeting this week.

Fourth, invest in health and care workers. There is a projected global shortage of 40 million health workers with 18 million health workers needed in low and middle income countries alone to achieve universal health coverage. To date, many G7 countries have relied on migration to fill health and care worker shortages and have not made long term plans for human resources for health or invested in training. The pandemic has taken a heavy toll on health and care workers. Around 115 000 health workers are estimated to have died from covid-19 (likely an underestimate) and millions will have long term health impacts. Health workers all over the world are exhausted; experiencing high levels of mental trauma; and many health workers, but women in particular, are considering leaving the profession. If the world is to meet global health goals and achieve global health security, we must retain trained health workers.

Fifth, invest in safe, decent, and equal work for women in health to retain and attract health workers. Women make up 70% of the global health workforce and 90% of nurses. They are, however, clustered into lower paid and lower status roles, paid on average 28% less than male counterparts, frequently subject to violence and sexual harassment, and marginalised in leadership. In India alone around one million frontline women health workers in the pandemic have been unpaid or grossly underpaid. It is estimated that women contribute US$3 trillion to health annually but half of that is in the form of unpaid work. The poorest women in the world subsidize health systems with their unpaid work and it leaves the whole world vulnerable. Women health workers have been applauded in the pandemic but not rewarded with safe, decent, and equal work.

It should not have taken a pandemic to focus the world’s attention on health and the deep inequalities within and between countries. With 2021 the Year of Health and Care Workers and of the Generation Equality Forums marking the 1995 Beijing Women’s Conference, there’s never been a more fitting moment to rethink what we value. In February 2021 France, WHO, and Women in Global Health launched the Gender Equal Health and Care Workforce Initiative to drive change on leadership, pay, safety, and decent work for women health workers. We ask all G7 leaders to join us and commit to a new social contract for women in the health and care sector.

Roopa Dhatt, executive director, Women in Global Health. Twitter @RoopaDhatt

Competing interests: none declared.

Ann Keeling, senior fellow, Women in Global Health. Twitter @annvkeeling

Competing interests: none declared.