Barriers and facilitators to vaccination for COVID-19, pertussis, and influenza during pregnancy: Protocol for an umbrella review

Abstract

Pregnant women are particularly vulnerable to infection. Furthermore, infection from pertussis, influenza and COVID-19 increases the likelihood of adverse consequences to the mother and developing baby such as stillbirth, ICU admission, and pre-term caesarean birth. Increased rates of transmission and risk of adverse consequences from infection justifies the provision of national maternal vaccination programmes. Additionally, maternal vaccination helps protect the infant until they are able to receive their own vaccinations; a time when they are most at risk of mortality from influenza and pertussis. Vaccination during pregnancy has been repeatedly demonstrated as safe and effective in reducing harm, although rates of uptake remain low compared to the general population. The current protocol describes the methodology for an umbrella review aiming to explore the barriers and facilitators of vaccination during pregnancy for pertussis, influenza, and COVID-19. Systematic reviews that investigate the barriers and facilitators of at least one of either pertussis, influenza, or COVID-19 will be included in this review. Multiple databases will be searched, and included reviews assessed for quality (using the Joanna Briggs Institute (JBI) quality assessment for systematic reviews) and degree of overlap of included primary studies. Included reviews will be analysed according to the WHO SAGE model of determinants of vaccine hesitancy and separated by whether these explore influenza and pertussis, or COVID-19. The outcomes of this review will help inform the development of interventions to increase uptake of vaccination during pregnancy, and on whether interventions need to be tailored depending on the infectious disease. The key findings will identify the specific barriers and facilitators of vaccination hesitancy by considering contextual influences (e.g. sociodemographic variables), individual/social group influences (e.g. trust in the institutions), and vaccine-specific issues (e.g. safety and recommendations).

Barriers and facilitators of vaccine hesitancy for COVID-19, influenza, and pertussis during pregnancy and in mothers of infants under two years: An umbrella review

“…The protocol for this umbrella review was registered via PROSPERO [ 28 ], (registration number: CRD42022327624). The PRISMA guidelines for reporting were used throughout [ 29 ].…”

SARS‐CoV‐2—Placental effects and association with stillbirth

“…Vaccine safety is a concern for many women, perhaps fuelled by a lack of clear messaging at the start of the pandemic, with pregnant women not included in clinical trials, 12 followed by a relative delay in the national recommendations for vaccination 10,13 . This has been further fuelled by opinions on social media, within social networks 69 and poor vaccine literacy among healthcare professionals 70 . However, what is clear is that COVID‐19 vaccination in pregnancy is safe 71 …”

Facilitators and Barriers to Vaccination Uptake in Pregnancy: A Qualitative Systematic Review

“…Studies on factors in uencing vaccination decision-making during pregnancy suggest that healthcare professional (HCP) recommendations and beliefs about vaccine safety and e cacy are key drivers of vaccination uptake [53][54][55]. However, the impact of HCP recommendations could be diminished by factors such as belief in vaccine-induced harm, particularly for novel vaccines like COVID-19 [54,56,57].…”