Lack of clear national policy guidance on COVID-19 vaccines influences behaviors in pregnant and lactating women in Kenya

Abstract

SARS-CoV-2 infection in pregnancy is associated with a greater risk of maternal and newborn morbidity and maternal death. In Kenya, pregnant and lactating women (PLW) were ineligible to receive COVID-19 vaccines until August 2021. How shifts in policy influence vaccine behaviors, such as health worker recommendations and vaccine uptake, is not well documented. We conducted qualitative interviews with PLW, health workers, and policymakers in Kenya to understand how different stakeholders’ perceptions of national policy regarding COVID-19 vaccination in pregnancy shaped vaccine behaviors and decision-making. Policymakers and health workers described pervasive uncertainty and lack of communication about the national policy, cited vaccine safety as their primary concern for administering COVID-19 vaccines to PLW, and expressed that PLW were inadequately prioritized in the COVID-19 vaccine program. PLW perceived the restrictive policy as indicative of a safety risk, resulting in vaccine hesitancy and potentially exacerbated inequities in vaccine access. These findings support the need for the development and dissemination of effective vaccine communication guidelines and the prioritization of PLW in COVID-19 vaccination policies and campaigns. To ensure PLW do not face the same inequities in future epidemics, data on infectious disease burdens and vaccine uptake should be collected systematically among pregnant women, and PLW should be included in future vaccine trials.

Determinants of COVID-19 Vaccination Decision-Making Behaviors among Pregnant Women in Sub-Saharan Africa: A Scoping Review

“…The characteristics of the included studies are described in Table 1 . All the included studies were observational studies [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ], with most ( n = 8) incorporating a cross-sectional study design [ 34 , 36 , 37 , 38 , 39 , 40 , 42 , 45 ]. There was one prospective cohort study, two qualitative research studies, and three mixed-methods studies.…”

“…While other studies also assessed COVID-19 vaccination willingness and uptake, five studies examined vaccine acceptance as the only outcome. Two studies assessed vaccine hesitancy as decision-making based on the Vaccine Hesitancy Determinants Matrix [ 41 , 47 ]. COVID-19 vaccine acceptance was measured as a survey question or as qualitative data from interviews/focus groups.…”

Vaccine inequity: a threat to Africa’s recovery from COVID-19

“…In this review, the lack of vaccine-related information was another barrier to vaccine acceptance and contributed to vaccine inequity in SSA. Following a qualitative study involving interviews with pregnant and lactating women (PLW), health workers, and policymakers in Kenya, a total of 59 participants were interviewed and the emerging themes from the results indicated uncertainty regarding PLW eligibility for COVID-19 vaccination as a matter of concern [ 75 ]. The lack of clear guidelines regarding COVID-19 vaccine use is further emphasized by the global disparities in policies, with a systematic screening of public health authorities’ websites from 224 countries indicating 176 countries had issued explicit guidance, with 38% recommending use, 28% permitting administration, 15% permitting use with qualifications, 2% not recommending but with exceptions, and 17% not recommending administration whatsoever [ 76 ].…”

COVID-19 vaccine eligibility of pregnant and lactating women in Bangladesh: Gap between policy and policy interpretation among policymakers and healthcare workers

“…As the COVID-19 pandemic was constantly evolving, the policy environment related to vaccine eligibility was also quite dynamic [25] . Many countries had similar challenges related to a gap between policy and policy interpretation (see Kenya, for example) [24] .…”

“…Government authorities must disseminate information through multiple channels for all audiences, including healthcare workers [3] . It is also important to note that without adequate vaccine safety data specific to pregnant women, which many policymakers utilize to make recommendations, confusion can occur during the policy formulation phase even before communication and dissemination begin [24] . Therefore, inclusion of pregnant and lactating populations in vaccine clinical trials to ensure appropriate data exists prior to vaccine rollout is critical [24] .…”