Vaccines have become the tower of refuge for the world in the current coronavirus disease 2019 (COVID-19) crisis. With several vaccines based mostly on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike antigen having been rolled out in many countries, the focus now is on extending the reach of vaccines as far as possible.
A new study, recently released as a preprint on the medRxiv* server, describes COVID-19 vaccine willingness among pregnant women in the UK.
Including pregnant women in the eligible population
The UK’s Joint Committee on Vaccination and Immunisation (JCVI) recommended that pregnant women be allowed to be vaccinated simultaneously with the rest of the population, in accordance with their age and clinical risk stratification. The study reported in the preprint examined how women felt about being vaccinated against this virus when pregnant and non-pregnant, using multiple methods.
This information is important since pregnant women were excluded from the clinical trials of all vaccines being used at present, mainly because there was not much understanding of the risk posed by COVID-19 in pregnancy. Today, there is known to be a significant though small risk of progressing to severe COVID-19 if infected during pregnancy, especially after 28 weeks of gestation.
Other studies have shown that risk factors for severe COVID-19 in the UK include being part of an ethnic minority. However, these women are less likely to agree to get the vaccine for their children. Black women have previously been found to have a lower acceptance of pertussis and influenza vaccines during pregnancy.
The eventual impact of these feelings on children born to these mothers may include not being willing to have them immunized either. This was also, therefore, included in the current study.
Finally, the researchers wanted to gain precise information about how women thought about COVID-19 vaccines, so as to help shape an appropriate corrective information campaign to remedy the effects of fake news about the dangers of the vaccines being proliferated today.
The survey approached 1,300 women, mostly 30-34 years of age, with over a thousand being white British women and full-time workers. Over a thousand were from England, mostly from London and South-west England.
About 70% were pregnant by the end of the study, the rest having already delivered their babies.
What were the findings?
While over 80% of women who participated in the survey expressed willingness or at least a favorable attitude towards getting vaccinated with a future COVID-19 vaccine, there was a perceptible shift during pregnancy. Just over 60% said they would definitely or probably be willing if they were pregnant.
The difference was clear, with over two times more women saying they would never get vaccinated in pregnancy, but almost three times more women saying they would definitely get the vaccine when not pregnant.
About 70% said they would definitely or likely get the vaccine when available, for their babies, again because only half the women who were willing to take the vaccine themselves agreed that they would get their babies vaccinated. And of those who agreed they would probably take the vaccine while pregnant, 96% said they would also get it for their babies – but only less than 30% of those who would not take it themselves.
Women in late pregnancy or post-partum were also more willing to accept a future vaccine against COVID-19 compared to those still pregnant or in early pregnancy.
Ethnic and income barriers
The researchers found that women from minority ethnic groups were twice as likely to express unwillingness to take a future vaccine, whether pregnant or not, as well as refusal to have their babies vaccinated, relative to white women.
Other associations with vaccine unwillingness included lower-income household female members, being below the age of 25, and from certain regions of the UK.
When adjusted for confounding factors, the study shows that low income and ethnicity are the main predictors of vaccine unwillingness, and explain the contribution of both geographical and age-based variation.
A history of having taken the pertussis vaccine in pregnancy predicted a four-fold higher chance that the women would be willing to get the vaccine both during and out of pregnancy, and for their babies.
The major reasons given for vaccine unwillingness included doubts about the safety of the COVID-19 vaccines, though many women also were generally skeptical of vaccines. Women who trusted healthcare systems and vaccines were more likely to accept the COVID-19 vaccine.
What are the implications?
It is clear that most women are favorable towards the COVID-19 vaccine, especially for themselves, as against getting their babies vaccinated, and also getting it when not pregnant.
The survey preceded large-scale vaccine rollout, and “it would be of great interest to repeat this survey now that there is more data on these aspects following the publication of data from large COVID-19 vaccine trials in adults.”
It is noteworthy that vaccine trial data from pregnant women and children is yet to be published, however.
Our findings add weight to the calls to involve pregnant women in vaccine trials earlier, in order for vaccine safety data to be available so that pregnant women to make informed vaccine decisions.”
A 16-country study found a markedly lower level of vaccine acceptance, indicating that trust in a country’s healthcare system precedes and drives vaccination uptake in pregnancy. Moreover, facilitating change in women’s attitudes towards the COVID-19 vaccine could improve vaccine compliance in children as well.
The study suggests the urgent need for strategies to communicate the safety of currently available COVID-19 vaccines to pregnant women, in particular, to win their assent for vaccination. Similarly, targeted campaigns to persuade ethnic women and those from low-income families are also needed.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.