SARS-CoV-2 Vaccine Willingness among Pregnant and Breastfeeding Women during the First Pandemic Wave: A Cross-Sectional Study in Switzerland

Abstract

As pregnant women are at high risk of severe SARS-CoV-2 infection and COVID-19 vaccines are available in Switzerland, this study aimed to assess the willingness of Swiss pregnant and breastfeeding women to become vaccinated. Through a cross-sectional online study conducted after the first pandemic wave, vaccination practices and willingness to become vaccinated against SARS-CoV-2 if a vaccine was available were evaluated through binary, multi-choice, and open-ended questions. Factors associated with vaccine willingness were evaluated through univariable and multivariable analysis. A total of 1551 women responded to questions related to the primary outcome. Only 29.7% (153/515) of pregnant and 38.6% (400/1036) of breastfeeding women were willing to get vaccinated against SARS-CoV-2 if a vaccine had been available during the first wave. Positive predictors associated with SARS-CoV-2 vaccine acceptance were an age older than 40 years, a higher educational level, history of influenza vaccination within the previous year, having an obstetrician as the primary healthcare practitioner, and being in their third trimester of pregnancy. After the first pandemic wave, Switzerland had a low SARS-CoV-2 vaccination acceptance rate, emphasizing the need to identify and reduce barriers for immunization in pregnant and breastfeeding women, particularly among the youngest and those with a lower educational level.

The Approach of Pregnant Women to Vaccination Based on a COVID-19 Systematic Review

“…In the current study, the COVID-19 vaccine acceptance rate was over 80% for pregnant women in Mexico and India and less than 45% in the US, Australia, and Russia. In contrast, the lowest vaccine acceptance rates among pregnant women were found in the trial performed in Switzerland (29.7%) among pregnant and breastfeeding women by Suckelberger et al [ 36 ], and in the study conducted by Geoghegan et al [ 35 ] (38%) among pregnant women in Ireland. In seven out of nine studies, it was found that the vaccination acceptance rate among pregnant women exceeded 50%.…”

“…The level accepting vaccines against COVID-19 varied over time, from the level of approx. 29% for the study conducted in June and July in Switzerland [ 36 ] to the level of 77.4% for the study in China [ 33 ] or Qatar [ 37 ] totaling 75% in November or January, and in February, 74.5% for the Italian study [ 34 ].…”

“…Increased perceived risk of infection, benefits of vaccines, government restrictions, penalties for not using masks, as well as intense communication of the threat from traditional and social media can have a significant impact on willingness to vaccinate [ 53 ]. In most of the analyzed studies, older age, higher education, and higher income were also associated with higher official acceptance of the vaccine [ 1 , 30 , 32 , 33 , 34 , 36 ]. Many factors affecting the acceptance of the COVID-19 vaccine, such as geographic or socioeconomic factors, are difficult to modify.…”

“…Factors that recur in most of the studies included in the review are those related to the level of awareness of COVID-19 risks in pregnancy and the safety of vaccination during its duration. Factors such as trust in received information on vaccination [ 30 ], confidence in the safety and efficacy of the COVID-19 vaccine [ 1 ], belief in the importance of vaccines [ 1 ], trust in routine childhood vaccines [ 1 ], concern regarding the COVID-19 pandemic [ 1 ], trust in public health agencies, no fear of vaccine side effects [ 31 ], reliable information [ 35 ], explicit communication about the safety of COVID-19 vaccines for pregnant women [ 34 ], having an obstetrician supervising pregnancy [ 36 ], influenza vaccination within the previous year [ 35 ], as well as confidence in the safety of the COVID-19 vaccine [ 34 ], all seem to have a common denominator. These are factors that concern providing information and awareness to pregnant or breastfeeding women about the current state of knowledge on COVID-19, vaccination against COVID-19, or vaccination in general.…”

Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review

“…The acceptance rates of the general population are around 77%, based on two surveys done in March/April 2020, while one study, which included a small sample of patients with inflammatory bowel disease, reported considerably lower intentions to be vaccinated (around 55%) [81] . A survey done in pregnant and breastfeeding women from Switzerland reports very low intention of this population to get vaccinated, with higher rates observed among the breastfeeding population (29.7% vs 38.6%) [112] Data obtained from German healthcare workers indicates a fairly higher acceptance rate in May/August 2,020 [113] compared to the data obtained during the initiation of vaccination (December 2020/January 2021) [114] . However, it should be noted that the first study had a significantly smaller sample size.…”