APS Comments on NIH-wide Strategic Plan for Research on the Health of Women

The following responses were prepared with the input of the APS Women in Physiology Committee and submitted in response to the NIH Request for Information on the NIH-Wide Strategic Plan for Research on the Health of Women (NOT-OD-22-186).

Research opportunities in the NIH Strategic Plan for Women’s Health Research FY 2019-2023 that should be modified to account for recent scientific advances

The American Physiological Society (APS) appreciates the efforts that NIH has made to address entrenched disparities in health research and to advance women’s health as a research priority. The 2019–2023 Strategic Plan outlined a series of laudable objectives to address knowledge and treatment gaps surrounding diseases and conditions that affect women. In addition to other challenges, COVID-19 has introduced significant changes to the landscape of women’s health. We hope that this update to the Strategic Plan will address these challenges.

Sex and gender remain underreported as variables in clinical data. As an example, even though COVID-19 affects males and females differently—the mortality rate is higher in men, while women are significantly more likely to develop symptoms of long COVID—only around 5% of clinical studies registered in the first year of the pandemic planned to include sex or gender as an analytical variable. Unless there is a sound reason not to, all clinical studies, as well as translational studies in animals, should include consideration of sex differences.

Emerging research needs and opportunities that reflect the changing landscape of the study of the health of women that should be added to the plan

The Strategic Plan will need to adapt to a changing landscape of women’s health, which has been significantly affected by COVID-19. Women will likely bear a disproportionate long-term health burden, as they are more likely to be affected by symptoms of long COVID, including fatigue, mood disorders, joint pain, and neurological problems. This disease needs to be understood in the context of sex and gender.

As a consequence of the pandemic, millions of women have shifted to remote work situations, and it is likely that in the long term many of these jobs will remain either remote or hybrid. This has had many consequences for women’s health, including exacerbation of mental health issues, changing access to healthcare facilities, and imbalanced expectations of childcare responsibilities. Research priorities will need to account for these significant changes that women face.

Additionally, support for research on the health and well-being of transgender individuals must be expanded. An increasing number of Americans are receiving gender-affirming hormone therapy. This is a life-saving treatment, but it is not the totality of care that is needed for this vulnerable population. Transgender healthcare is a rapidly changing field, and the updated Strategic Plan should include recommendations to focus research efforts to ensure that the mental and physical health needs of this population are met.

Cross-cutting scientific themes (for example, multidisciplinary research, and/or utilizing data science, natural language processing, and artificial intelligence) or research-related themes that should be common to all future strategic goals and objectives (such as considerations of sex, gender, and age on health and disease, and health disparities)

The 2019–2023 Strategic Plan aims to advance training and career development for a diverse and robust scientific workforce. However, many early-career scientists’ career plans were disrupted by COVID-19, especially for those with children or other caregiving responsibilities. It is important that the updated Strategic Plan not only carry forward the recommendations that would advance women in research careers but expand them to address those who faced disruptions.

It is vital that NIH provides sufficient funding and support for research relevant to the health of women across all centers and institutes. It is also essential to target robust support for the National Institute of Child Health and Human Development (NICHD), which funds research projects on issues specific to women, such as pregnancy, polycystic ovary syndrome, and endometriosis. The updated Strategic Plan should strive to ensure that all aspects of women’s health receive the necessary support.