This week The Guardian reported
that one in six of the most critically ill NHS patients are unvaccinated pregnant women with Covid and I am furious. This was all so avoidable.
From the very beginning of the pandemic, experts called
for vaccine manufacturers not to forget pregnant women in the rush for a vaccine. I myself back in March 2020
wrote about the dangers of excluding pregnant women from data collection given the evidence we already have over the impact of Sars on pregnant women, as well as emerging evidence of the risks of Covid in pregnancy.
The recommendations for how to ensure pregnant women were excluded from life-saving treatment included making at least one (one!!) of the vaccine candidates suitable for use in pregnancy and getting started early with the reproductive toxicity (DART) studies so that pregnant women could be included in the vaccine trials along with everyone else.
Development of coronavirus vaccines that pregnant women aren’t able to use would be not only a tragedy but a grave injustice. Yet if old paradigms persist, that is exactly what will transpire. (Source
It is so heartbreaking to read these words because that is exactly what happened – and it has ended in tragedy.
Old paradigms persisted. Even the most basic recommendations were ignored. Not a single vaccine was developed for use in pregnancy and the DART studies were delayed so long that they hadn’t even finished before several vaccines were already approved.
The situation was slightly different for pregnant healthcare workers (not an insignificant number given the disproportionate number of healthcare workers who are female), who in many countries could have the vaccine, so long as they were happy to assume all the risk of a trial onto themselves with no support.
One US healthcare worker wrote about
deciding to get the vaccine despite the lack of data and being shocked by the lack of follow-up:
When I got my Covid-19 vaccine, I was instructed to scan a QR code on a poster. Doing that brought me to V-safe
, a vaccine safety tracking system from the CDC. One of the questions I answered with each dose was, “Were you pregnant at the time of your Covid-19 vaccination?” to which I answered “Yes,” fully expecting to be asked a series of other questions about my pregnancy. I wasn’t.
Instead, I only answered routine questions
about arm soreness, fatigue, and fever. I waited for an email or phone call inviting me to enroll in a study of pregnant people receiving the vaccine. Instead, silence. Why is nobody asking us for more information?
This echoes the experience of a UK-based healthcare worker who contacted me with the same story: she got vaccinated while pregnant and was crying out for someone to take her data and use it. She too was met with silence.
In the UK, the advice against pregnant women routinely receiving the vaccine gradually, over several months, turned into advice for pregnant women to urgently receive the vaccine, as the severe impact of Covid on pregnant women became clear. But as I wrote last month for The Sunday Times
, the change in messaging has come too late. Pregnant women are already scared and confused, let down by a lack of data and the lack of urgency to get it. And now they’re fighting for their lives in hospitals across the country. Not all of them will win that fight.
Oh and just to head off the inevitable person who at this point pipes up, wringing their hands about how it’s dreadful that poor pregnant women don’t have the data, but what choice do we have, we have to protect them, I’m going to conclude by quoting myself
This blanket exclusion is often defended on the basis of protecting the pregnant woman and her foetus, a rationale that makes sense only in a world in which pregnant women never get ill. The result is that pregnant women routinely take untested vaccines and drugs outside of the relative safety of a well-constructed and closely monitored clinical trial. The only winners here are insurers and drug companies, who have successfully transferred the risk of a trial from themselves onto individual women, who then have to make high-stakes health decisions for themselves and their babies based on little to no information.