Men and Women in Immunology: Closing the gap on gender parity?

Heading home from an inspirational European Congress of Immunology, 2018 (ECI2018) meeting in Amsterdam, one cannot but wonder if we actually are getting anywhere with resolving the issue of gender equality in science in general and in the immunology field specifically. The sense that men and women are still being treated differently and that this is a disadvantage for women in advancing their carrier in immunology prevails. As organizers of the ECI2018, and with help of EFIS, we aimed to have an equal gender distribution at all levels. Despite intense efforts, we were only able to reach a 34% proportion of women among the invited keynote and symposia speakers, as compared to 56% of women among workshop and 59% among poster presenters. It is an established fact that there are differences between men and women, biologically and immunologically 1. We have everything to gain by appreciating the differences, while simultaneously recognizing that men and women need to be treated with equal respect and receive the same opportunities, support and resources to pursue their scientific careers. Steps have been undertaken to adapt the medical field and biomedical research accordingly. However, there is still a clear underrepresentation of women at more advanced levels in academy. We are all aware of this imbalance and the need to change it, but there is no consensus about the most effective approach. In order to discuss gender issues in immunology, EFIS has designated a ‘Women in Immunology’ session at earlier ECIs. These sessions ran in parallel with other interesting scientific talks, and were usually mostly attended by a few women, who already have a passion for the topic, while only a few men showed interest in the subject. The efficiency of addressing the gender inequity issue by having such sessions were already challenged at the last ECI congress in Vienna in 2015 by professor Agnes Wold. Prof. Wold published an article in Nature in 1997 together with her colleague Christine Wennerås. These two scientists identified the systematic disadvantage of being a women and found that women had to be about ten times better than men to have their grant application approved by the medical council 2. For the ECI2018 in Amsterdam we decided to tackle the inequity issue differently and organized a ‘Men and Women in Immunology’ session. As with all other challenges that we are facing as researchers, the gender inequity issue needs a scientific approach, including statistical evaluation of the data, proper evaluation of the strategies implemented to address the issue and, finally, it is important to define hypotheses that explain the current situation and how to improve it. All these aspects were discussed by Peter Openshaw, Catharine Williamson, and Jesper Fundberg during the session, and this article represents a summary of their presentations. Peter Openshaw is the President of the British Society for Immunology (BSI), one of Europe's largest immunological societies with 3,400 members. He presented results from an extensive survey of members and non-members of the BSI, also examining career destinations to those completing a UK PhD in immunology between 1975 and 2015 (www.immunology.org/careers-review). The survey showed that immunology has a higher percentage of women (55%) than other bioscience subjects (51%) but that with increasing academic seniority, the proportion of women decreases. By the time respondents reached professorial grade, 4% were women compared to 15% men. A higher percentage of women in immunology were found in administrative or junior positions compared to other biosciences. As a comparison, other countries, particularly in the Muslim world, do not regard Science, Technology, Engineering, and Mathematics (STEM) as a predominantly male domain. According to a UNESCO report (http://unesdoc.unesco.org/images/0023/002315/231519e.pdf), female STEM graduates are representing a majority of students in some countries, for example 67% in Iran and Myanmar, countries where women are already struggling for their rights in many other aspects. These cultural dependent selective barriers are interesting and indicate that there are deeply rooted attitudes that have evolved in different directions in different populations. In the UK, barriers to progression identified by both men and women were the lack of career support, in terms of money, opportunities, training and mentorship from supervisors. There were some areas in which women identified different barriers from their male colleagues like poor job security, work/life balance and need to work long hours. Worryingly, 13% of the respondents said that sexism, bullying or discrimination were the greatest barriers (16% of women compared to 7% of men). The BSI is developing a strategy of careers support based on these survey results. There are several other high-level initiatives aimed at supporting women in their careers in the UK, like the Global Institute for Women Leadership lead by Julia Gillard (the former Australian Prime Minister) and with the aim to build a network of researchers and practitioners to find evidences about what is effective in promoting gender equality. Another initiative that has drawn international attention is the Athena SWAN program, which was the next talk at the session and it is summarized below. Catherine Williamson has together with her colleagues investigated the impact of the Athena SWAN program, aiming at finding out if the program works for men or women, or both. She presented three major arguments in support of diversity and inclusion initiatives. The first is a moral case, as it is the right thing to do if you believe that everyone has the right to be treated with dignity and respect, regardless of characteristics. Secondly, it is against the law in the UK to not comply with the Equality Act 2010 that protects people from discrimination in the workplace and in wider society. Thirdly, there is a business case where a more diverse workforce will enable the inclusion of new perspectives that is likely to lead to more innovations and thus likely to attract resources to academic institutions. The funders in academy, like Horizon 2020, subscribe to the notion of the importance of diversity and inclusion, and promote a gender balance on all levels of personnel involved in projects and failure to fulfill this requirement can be taken into consideration for applications with the otherwise same score. The Athena SWAN charter (https://www.ecu.ac.uk/equality-charters/athena-swan/) was launched to promote women's advancement and leadership within academia. This is a national program that originally focused on gender equality in STEM subjects and which gives awards to those that have taken clear measures for gender equality in higher education. In 2011, the UK's Chief Medical Officer Professor Dame Sally Davies announced that the National Institute for Health Research would only shortlist grant applications from medical schools that had attained a ‘silver’ Athena SWAN award for research funding. This acted as a powerful motivator for engagement with Athena SWAN. The three levels that you can reach in this program are Bronze, Silver and Gold. A Bronze award is given to universities that have performed an assessment of the gender equity and written an action plan. A silver award is given if there has been successful implementation of an action plan and gold awards recognise institutions that have successfully improved gender equity. Data published by the UK's Equality Challenge Unit (ECU) in 2017 (https://www.ecu.ac.uk/publications/equality-in-higher-education-statistical-report-2017/) show that the proportion of women at different levels of seniority follows the well-known pattern of being more women at the first degree undergraduate level (55.5% women) and more men at professorial level (76.1% men). These proportions have not changed over time, from 2010 to 2015 and one can only wonder why. A systematic meta-analysis of 52 studies between 1985 and 2015 3 identified potential explanations for the attrition of female academics, including lack of adequate mentors, a paucity of role models and the fact that women experience gender discrimination and unconscious bias. To address these issues, typical initiatives taken by UK Universities applying for Athena SWAN awards included unconscious bias training, ensuring increased visibility of women in science and as role models, mentoring, facilitation of flexible working, addressing bottle-necks in career progression and involving both men and women in gender equity work. In April 2018, the overall impact of the Athena SWAN program was shown in ECU statistics; 731 awards had been given in total. Of these, 617 were department awards, 98 were university awards and 18 were research institution awards. Qualitative assessments of the attitude to the Athena SWAN program and its success in improving gender equity in academic medicine have been published 4-6. In Caffrey's study 5, five departments at King's College London were qualitatively assessed by observations of meetings and in-depth interviews with key personnel and heads of the department. Perceived positive outcomes of the program were that it had created a social space where gender equity could be addressed and unconscious bias training empowered people to challenge discrimination for example in interview panels. However, the study also highlighted some problematic practices, e.g. as a male professor expressed, the promotions procedure was “very dysfunctional” and thus the program identified a clear need to improve standards. The study also reported that women were overrepresented in the Athena SWAN self-assessment teams (SATs). A major concern was that such activity did not count towards career progression, unlike research grants or publications. Thus, paradoxically, gender initiatives were actually hindering female staff by consuming their time. The most striking example in the article is a quote from a female senior lecturer who was working two weeks before deadline to pull an Athena SWAN document together, to the detriment of her research project, and on a Saturday night when she was writing about work-life balance she thought, “something's not right here”. Now, Kings College London has changed promotion criteria so that diversity and inclusion work is also rewarded in career advancement. In the study by Ovseiko et al. 6, both women and men thought that the Athena SWAN program had brought about important structural and cultural changes in that it had increased the support for women's careers, given greater appreciation of caring responsibilities and challenged discrimination and biases. Many felt that this would not have happened if the Athena SWAN awards had not been linked to governmental research funding. This study combined free text from a survey (answered by more females than males) and qualitative interviews (all females) to assess opinions of staff in Oxford. The concerns they identified were that the program had limited ability to address the longstanding and entrenched power and pay imbalances and that there was a persisting lack of work/life balance in the academic medicine institutions. In addition, there were questions about the sustainability of the positive changes, a concern that achieving an Athena SWAN award could become an end in itself and there was some resentment about perceived positive discrimination 6. In a report by the ECU that compared higher education institutions holding i) institutional and departmental awards, ii) only institutional awards, or iii) no awards, the overall results suggested a positive impact of the Athena SWAN program in changing the culture and attitude and to address inequity and unequal representation (http://www.ecu.ac.uk/publications/evaluating-athena-SWAN/). The positive consequences of institutional awards included the creation of a data-collection systems for more systematic overview of statistics. Furthermore, engagement of university senior managers in gender equity questions had increased, thus improved the processes for promotion. In addition, there were mentoring systems targeted at women, women's networking and leadership training events. Also the maternity (but not paternity) leave process had been improved. Further positive consequences were increased communication concerning equality and diversity matters, in particular the sharing of survey findings and proposed solutions. Women had to a larger extent been encouraged to apply for promotion and the voices of postdoctoral researchers were felt to be heard and acted upon. The final conclusion and recommendations from the ECU also identified the issue that the gender-equality work within academia was predominantly driven by women with the assistance of some men and mainly pursuing improvement of women rather than addressing the inequality for both women and men. They also encouraged applicants to consider other categories of discriminations like black and minority ethnic (BME), disability and sexual orientations. In summary, the Athena SWAN programme has had some positive impact upon gender equity within UK academia, but the problem is far from solved. Even though we would like to conclude that gender inequity is an issue for both men and women, this conclusion is challenged by Jesper Fundberg, who drives the hypothesis that even if the current structure and culture in academia is mainly a disadvantage for women, it is an issue that only men can resolve. Jesper Fundberg has a PhD in ethnology and is currently working at Malmö University in Sweden. His research area is masculinity in sports, higher education and business, focusing on gender and power, and especially masculinity and privileges. Fundberg started his talk by problematizing gender and power with the quotation “Feminism is the radical notion that women are people” as stated by Cheris Kramarae and another well-known feminist and philosopher Simone de Beauvoir and her classic book from the late 1940's, “The second sex”. Both Kramarae and de Beauvoir point to the self-evident but still so important notion, that men are seen as people, and women as something else, the second sex, or at least always as gendered. Turning it another way around “Feminism is the radical notion that men are gendered”. Both these quotations of feminism point to the relationship between masculinity and power and the need of analyzing power in order to both understand and be able to change today's society. What then is the actual definition of power? According to Steven Lukes, a British political and social theorist, power can be divided into three different dimensions. The first dimension is power as resource, when you own the power to force someone to do something or stop people from doing something because you are stronger. In this dimension, power is explicit and can be gained as a resource. Here, power is connected to a person or an agent and comes with an intention and a direction that is easy to grasp. The second dimension of power is the “agenda setting”, meaning the power to decide what is going to be on the agenda. This is a subtler dimension of power, a type of power that works in indirect ways and therefore harder to detect and criticize. Is, for example, the question of equality on the top or at the end of the agenda? Here an intention can still be possible to find and target. The third dimension of power is the most complicated, but also the most interesting. It can be called discursive power, or power of interpretation. Here, power is not easy to discern, it works through self-evident norms and the productions of what is taken for granted versus what is different, what is normal versus what is seen as exotic, special, something else. The norm becomes quite evident, and it is not just a question of language, it is also a question of resources. First, we need to see to that the normal ones get what they need, then we could discuss if there are any “left-overs” to the others. This third dimension of power is a self-regulating processes. The French philosopher Michele Foucault describes it to be about governmentality, how you govern yourself, a power that is part of yourself, permeated in your own body and mind. Therefore this power becomes very difficult to resist. By using Lukes’ third dimension of power we can identify men are the norm, thus men are people and are not considered to have a gender. The different roles men and women play to get confirmed can be exemplified by the way men are taken for granted, they have status, can speak out, be visible and are used to getting attention. Women can be good, but not brilliant, they are expected to be quiet, sweet and nice, and to be the supporting colleague that fix all the missing parts. We are used to accepting men to control and lead. They are often highly valued and regarded as competent, therefore allowed a great proportion of “slack line” where they can be confused and careless without this affecting the general impression of competence. Women on the other hand start from a lower value, should be patient and wait for their turn, time and opportunity and they are seldom allowed any slack behavior without this severely affecting the impression of their competence. They are expected to be positive and loyal, willing to adapt by changing themselves. If men are expected to be supported and taken care of, women have been given the role to do this. From this angle it is interesting to again look at the evaluations of the Athena SWAN report. It is rare in reports and other documents concerning equality to actually identify a problem with the program, which was done here. However, they also address women as a problem – which is very common. From the quantitative angle women were identified as underrepresented at higher levels, but we have a problematic situation when women are seen as responsible for making the changes. Again, if this is about power or misuse of power by men, men are taken for granted and women seen as the problem (the Other) that must change, become something else. But what about men? What if one would turn it around and say that there are too many men at higher levels and that this is a qualitative problem (about power) and give men the responsibility for making the changes needed? As seen in many programs, a common solution provided in order to challenge equity problems is often to educate the women, but never to touch or question men. This was avoided in the Athena SWAN program by suggesting to educate both men and women. But one could question what it is we still do not know and need to be educated about that cannot be provided by annual reports, evaluations and mappings? Maybe we should shift focus and ask ourselves a different set of questions? When scrutinizing the strategies on gender equality one could question if men are untouchable and if we all, both men and women, are ignorant when we ask women to change despite that we have an issue of problematic masculinity right in front of us. Why do we ask for education as the single solution when we are surrounded by sexual harassment and male violence? What is it we don't know or fail to see and acknowledge? Why do we ask for more facts, statistics and tools when what we really have to challenge is male domination and subordination of women? Should we rather ask for strategies to decrease the number of men in different rooms and discipline boys and men to learn that sexual harassment is never acceptable, that locker room talk and earning more money because of one's power is problematic and unethical? To reach true and sustainable results, power has to be redistributed from men to women, which would include a need of changing men, of changing men's behavior and making men's behavior an object actually possible to change. However, there is a lot of resistance when boys and men are questioned, and their behavior is addressed as problematic, indicating that boys and men have privileges as status quo. There are many people, and not only men, who do not agree when voices are raised for change of masculinity. Critique of men's problematic behavior touches the very bullet eye of men's power: to be taken for granted, not being seen as gendered and not be a part of a collective 7. “Not all men!” is always argued when we talk about problematic behavior among men, but when using the concept “complicity masculinity” from Raewyn Connell we can answer: yes, all men, in the way that all men are complicit to the problematic masculinity. All men have the responsibility to change boys and men´s behavior, the power of men and to stop the subordination of girls and women. This article summarizes the information presented during the ‘Men and Women in Immunology’ session at ECI2018. By presenting it here in writing, we hope that thoughts will be awakened and spread to a wider audience. We also hope that the issues/ideas raised here will help to address the gender imbalance with new perspectives that will generate improved interventions giving significant impact within a reasonable timeframe.

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