Gender was an obvious theme through the literature, but rarely identified as such. It is included as a risk factor determining vulnerability for pandemic because of its intersection with all the other social determinants of health and the recognition for the need to consider gender as a cross- cutting theme in pandemic vulnerability. A full sex and gender-based analysis of vulnerability during pandemic is beyond the scope of this paper, however, we feel it is important to identify several issues which emerged from the literature review which could be explored further for more in-depth understanding of the role of gender in both resilience and vulnerability for pandemic influenza.

Enarson [47] highlights the importance of mainstreaming gender analysis in any discussion of vulnerability or disaster preparedness, response or recovery due to its role in determining women’s power in society, her access to resources, her risk of exposure and her access to appropriate care and treatment. Gender intersects with the other social determinants of health, and is particularly intertwined with income and income security, social and physical environments, employment and working conditions, early life income and child development, age and disability, and access to health services.

Income and income security is a prominent gender issue, particularly with regards to lone-parent households and child rearing. Many women work part time and have fewer financial reserves to cope with the socio-economic impact of pandemic. Caregiving, both at home and in the health sector is provided predominantly by women [132]. Higher social interactions, particularly when personal care is provided means women will have increased exposure to the contagion. They may be unable to comply with quarantine protocols and social distancing measures, and may need to miss work because of illness or to fulfill their caregiving responsibilities, which has financial implications due to lost income or job insecurity.

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