Global disparities in public health guidance for the use of COVID-19 vaccines in pregnancy

Abstract

IntroductionGaps in information about the safety and efficacy of COVID-19 vaccines in pregnancy have led to substantial global variation in public health guidance regarding the use of COVID-19 vaccines in pregnancy over the course of the pandemic.MethodsWe conducted systematic screenings of public health authorities’ websites across 224 countries and territories every 3 weeks to track the development of policies on COVID-19 vaccine use in pregnancy. Policies were categorised using a 1–5 permissiveness scale, with 1 indicating policies that recommended use, and 5 indicating policies that recommended against use.ResultsAs of 30 September 2021, 176 countries/territories had issued explicit guidance on COVID-19 vaccine use in pregnancy, with 38% recommending use, 28% permitting use, 15% permitting use with qualifications, 2% not recommending but with exceptions, and 17% not recommending use whatsoever. This represented a significant shift from May 2021, when only 6% of countries/territories with such policies recommended the use of COVID-19 vaccines in pregnancy (p<0.001). However, no policy positions could be found for 21% of all countries and territories, the vast majority being low and middle income. Policy positions also varied widely by vaccine product, with Pfizer/BioNTech and Moderna vaccines being most commonly recommended or permitted.ConclusionOur study highlights the evolution of policies regarding COVID-19 vaccine use in pregnancy over a 5-month period in 2021, the role of pregnancy-specific data in shaping these policies and how inequities in access for pregnant people persist, both within countries and globally.

Prioritizing Pregnant Women for Coronavirus Disease 2019 Vaccination in African Countries

“…Data on COVID-19 vaccine coverage in pregnancy are scarcely available, even in African countries with permissive policy recommendations [ 35 ]. Although policies regarding COVID-19 vaccine use in pregnancy have evolved over time, imbalances in recommendations between jurisdictions exacerbate prevailing inequities in access and use of COVID-19 vaccines [ 36 ].…”

COVID-19 vaccine express strategy in Malawi: An effort to reach the un-reach

“…A systematic review from the USA showed vaccine acceptance rates ranging from 12-91.4%, which is lowest in Black/African Americans (most of Malawi population were also black), pregnant and breastfeeding women [6] . Low vaccine acceptance among women, especially pregnant and breastfeeding, may be due to a lack of firm and consistent guidance in national policy regarding COVID-19 vaccination [8] . A Nigerian study found that unreliability of clinical trials, safety, and high cost are the main reasons for vaccine hesitancy [9] .…”

COVID‐19 vaccine and pregnancy outcomes: A systematic review and meta‐analysis

“… 10 , 11 , 12 , 13 , 14 , 15 , 16 Recently, the American College of Obstetricians and Gynecologists, the Society for Maternal‐Fetal Medicine, and the Centers for Disease Control and Prevention declared that all pregnant women should be vaccinated to reduce maternal and fetal‐neonatal morbidity and mortality. 17 , 18 However, although it is growingly recognized that COVID‐19 vaccination programs, including booster doses, are safe and open to pregnant women, 19 , 20 Zavala et al 21 observed that, by September 2021, 17% of national policies still continued to recommend against the use of any COVID‐19 vaccine during pregnancy, of which 25% were low‐ and middle‐income countries, taking into consideration the lack of clinical trials, and developmental and reproductive toxicology data involving pregnant women. Moreover, there are still reports of a poor acceptance rate in this category of patients, mainly because of the maternal fear of consequences for fetal‐neonatal health.…”