From the boardroom to the consulting room, we need women in pharma

• Pharma companies putting greater priority on women makes sense financially and in terms of healthcare impact.

• Women in low-income countries bear a disproportionate disease burden.

• More women in pharma boardrooms should affect drug development and delivery strategies on the ground.

Pharmaceutical companies have a chance to make the world a healthier place by curing gender bias. Empowering women in decisions about drug research and access to medicines can pave the way to truly equitable healthcare.

The business case for promoting gender equity is now widely accepted. Indeed, diversity has been a focus for companies and investors alike for nearly a decade, with the UK's 30% Club launched in 2010, and France having gender quotas for boards since 2011. Investment firms are also watching intently, with Morgan Stanley recently launching a scorecard to assess gender balance within workforces. In healthcare, the World Health Organization now uses a gender responsiveness scale for assessing health programmes.

So how can pharmaceutical companies do a better job of rebalancing their working practices and eradicating gender biases in the way they bring healthcare to the world? To begin with, CEOs and investors need to understand what it means to make gender equity a pillar of strategy – and appreciate how this will benefit them both financially and increase their healthcare impact.

Let’s start with women in leadership. Only a few of the biggest pharmaceutical companies – such as GSK, Mylan, Biocon, and Biological E – currently have a female CEO, and women make up under 30% of executive directors at the top firms. This is despite the fact that similar numbers of men and women enter the workforce with advanced degrees in life sciences and medicine. While a few companies, like Johnson & Johnson and Pfizer, have women in pharma in about 40% of executive committee roles, many more have only negligible female representation. Women at Bayer, for example, make up under 10% of the senior executive team. For better decision-making, gender equity is needed across the company, including country-level teams.

The financial argument for gender equity with more women in pharma is strong. Companies in the UK’s FTSE 350 index with no women on their executive committee achieved an average 8.9% net profit margin, while those with at least 25% women executives averaged 13.9%, according to a 2018 report.

There are specific reasons why gender matters in pharmaceuticals – starting with R&D. If drug companies are to fulfill their contract with society, they must tackle the most deadly diseases of the world, equitably. But in low-income countries, women and girls bear a bigger burden of disease than men. Some diseases only or disproportionately affect women, such as gynecological conditions, breast cancer, or sexually transmitted infections (STIs). So paying attention to diversity means ensuring that R&D serves both genders equally.

In some areas, the industry is making important contributions. New contraceptives designed for low-income countries have been prioritized by the likes of Bayer, Merck & Co, and Pfizer, while heat-stable carbetocin for post-partum haemorrhage (the leading cause of maternal deaths) has been developed by Ferring Pharma and Merck for Mothers. Two drugs against resistant forms of gonorrhea are also being developed by GSK and biotech firm Entasis. Yet there are still many gaps. A new treatment for endometriosis is desperately needed, as are better drugs for STIs. The message is clear: More companies must get involved, include more women in pharma and stay committed if we are to eradicate gender as a social determinant of health.

Appropriate female enrolment in clinical trials is also critical. This may be obvious in a disease like breast cancer, but other conditions such as osteoarthritis also disproportionately affect women, and studies need to reflect this by including adequate female numbers.

The US Food and Drug Administration has highlighted the need for better gender balance in trials since 1992, following official reports noting a lack of female representation in federally funded studies of diseases including HIV/AIDS and hypertension. More recently, there has been a push to boost inclusion of cis and transgender individuals. Yet problems persist. In October 2019, a product for pre-exposure prophylaxis (PrEP) of HIV/AIDS was not granted FDA approval for expanded use in cisgender women due to lack of data, while it was approved for men and transgender women, where data was available.

Gender is also important when it comes to the way companies deliver products since women and girls all too often fail to access effective and timely treatment in low-income countries. Even as we celebrate progress in the global response to HIV/AIDS, girls and young women in sub-Saharan Africa, who account for 71% of new HIV infections, are getting left behind. Companies can help with targeted programmes like the DREAMS partnership for adolescent girls with HIV, backed by the likes of Gilead, Johnson & Johnson and ViiV.

Similarly, the Mothers2Mothers initiative, supported by Johnson & Johnson and others, employs women living with HIV/AIDS as community health workers, calling them “Mentor Mothers”, tackling gender inequities in employment in health. And the HALOW scheme, backed by GSK, Marks & Spencer and CARE International, tackles healthcare inequities among workers in the garment industry – mostly impoverished women from rural areas who live in slums and lack access to health services due to their income and gender.

In the third decade of the 21st century, as we strive to meet the UN Sustainable Development Goals, it is unacceptable that problems of access to medicines should be multiplied by gender inequity – and the ability to reach the vulnerable, leaving no one behind, is a key predictor of how companies perform on access to healthcare.