Pregnancy and COVID: Why are vaccination rates so low?


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What’s happening

Of all the groups with low vaccination rates in the United States, one of the most concerning for public health officials is pregnant women. While nearly 75 percent of adults in the U.S have received at least one dose of a coronavirus vaccine, only about 24 percent have gotten one during the course of their pregnancy, according to the Centers for Disease Control and Prevention.

That low rate comes despite mounting evidence that pregnant women face a higher risk of severe COVID-19 infections compared to the general population. “It is very clear there are very severe adverse outcomes for mother and baby during COVID-19 infection,” Dr. Anthony Fauci said last month.

Doctors across the country are reporting an unprecedented number of pregnant women in intensive care units in recent months. COVID-19 infections also increase the likelihood of preterm birth, according to the CDC, and may be linked with other negative pregnancy outcomes.

All evidence suggests that the vaccines are safe for women who are pregnant and breastfeeding, despite widespread online conspiracies falsely connecting the vaccines to infertility and miscarriage. In fact, studies have found that babies can receive antibodies from the vaccine while in utero or through breast milk.

Why there’s debate

Given the benefits of vaccination and elevated risk from infection, why are so few pregnant women getting vaccinated? While the factors that contribute to vaccine resistance in the general population are certainly part of the answer, experts believe there are several reasons specific to pregnancy that are making the issue more pronounced.

One of the main reasons, many experts argue, is a lack of clarity from public health authorities on their safety during pregnancy. It’s standard practice for clinical trials of vaccines and pharmaceuticals to not include pregnant women because of the risk of unknown side effects. But in the case of the COVID vaccines, that omission meant that doctors didn’t have a robust volume of scientific data about the safety of the vaccines during pregnancy until recently. The CDC didn’t officially recommend the vaccines for pregnant women until last month, and the World Health Organization still only recommends them in certain circumstances.

That lack of clear information from health officials has allowed false claims about the risks of vaccine safety to take root, misinformation experts say. These conspiracies, they argue, are especially potent because of the understandable concern that pregnant women have about the health of children — a concern many argue is exacerbated by the way our health care system has left pregnant women vulnerable since long before the pandemic began.


Conspiracies filled the information vacuum created by health authorities

“With no clear endorsement from the medical community and anti-vax lies overtaking the mommyverse via Instagram, Reddit and Facebook, thousands of expectant parents decided to wait — either until they delivered, or until they reached the third trimester.” — Sonja Sharp, Los Angeles Times

The vaccines are just another example of how our health care system fails women

“Combating worries about the vaccines and fertility will require not just debunking the misinformation involved, but addressing the ways the medical system has failed American women — and allowed an amorphous wellness culture to swoop in and fill the gap.” — Anna North, Vox

Well-intentioned safety concerns during trials have left pregnant women vulnerable

“When new vaccines are being developed, manufacturers routinely test them in healthy adults first, later moving to more vulnerable demographic groups. Pregnant and lactating people and children are typically last on the list. It’s born of a desire to protect, but it often ends up creating a conundrum. If pregnant people weren’t included in clinical trials, how would they know if it was safe to be vaccinated?” — Helen Braswll, STAT

Until recently, there was no clear guidance from health authorities

“For many pregnant people, the decision of whether to get the COVID-19 vaccine has been fraught. Clinical trials do not include pregnant people for ethical reasons, so there wasn’t initially any data about us in relation to the vaccines. But we were still eligible for the shot.” — Kelly Lawler, USA Today

Vaccine developers made a major error by being overly cautious during clinical trials

“What many people miss is that there are risks to doing nothing. Not offering pregnant women the opportunity to be vaccinated and protect themselves, where there are known and severe risks of Covid amplified by pregnancy, is not a wise strategy.” — Denise Jamieson, obstetrician, to the New York Times

Concerns that go through everyone’s mind are heightened for pregnant women

“It was this faith in the tried-and-true nature of older, more familiar, vaccines that made me nervous about taking the COVID-19 one while pregnant. What if there were unforeseen effects down the line? What if, for example, I got the vaccine and our daughter developed birth defects as a result? My brain started speeding in irrational directions, despite the fact that the data show no heightened risk of birth defects from the vaccine.” — Charlotte Alter, Time

The heightened risks of infection have not been adequately explained

“Health systems must also deliver unvarnished evidence demonstrating the risk of serious complications and potential outcomes in a way that resonates with their patients. This conversation needs to include a reminder that the recent COVID-19 surge is affecting young and healthy pregnant people with no underlying illness or risk factors.” — Mark Simon, The Hill

Doctors must be honest about the real uncertainty that exists with the vaccines

“We need to meet our patients where they are, and be clear about why we can speak so confidently about the vaccines. No, doctors cannot definitively say that there will never be long-term consequences from a coronavirus vaccine, but we can underscore that there is no scientific reason to fear them either, given our decades of experience with myriad other immunizations.” — Leana S. Wen, Washington Post

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Photo illustration: Yahoo News; photos: Getty Images