The Covid-19 pandemic presented the scientific community with one of the fastest changing challenges of the 21st century. Scientists responded with agility, producing a vaccine that was effective, safe, and as close to universally available as possible. However, for one group in particular the vaccine encountered hesitancy and fear.

Despite assurances that maternal and perinatal heath were vulnerable to infection, the maternal community was disproportionately underrepresented at vaccination stations across the world. In late 2021, data revealed that 98% of women in the UK admitted with symptoms in pregnancy had not received the vaccine. This was despite recommendations from the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. Of the 235 pregnant women in intensive care, on 3 had received their first dose, and none the second. Why, despite recommendations, were women reluctant to get their jabs? 

Sebghati and Khalil reflected in October 2021 that there was “no safety data” on the covid vaccine’s effect in pregnancy. This was a result of their exclusion from early research into a covid vaccine. This happened despite the acknowledgement that pregnant women were at greater risk of “severe disease” after infection. A consequence of this exclusion was that healthcare professionals and government advisors had no concrete evidence that the benefits outweighed the risks. At a time when the world tuned in to daily news broadcasts to see graphs and figures, the need for data was greater than ever.

Dr Flor Munoz stated in January 2021 that in order to “inform and implement safe and effective maternal and infant vaccination strategies” information needed to be collected through clinical studies. Maternal immunisation, she said, is “likely the best available option to protect both pregnant and lactating mothers as well as their infants”.* 

Facts and figures, however, are not the only influential factor in a person’s decision to accept a vaccine. Wider vaccine rejection of the influenza and tetanus jabs, among others, resulted in a lower likelihood of vaccine uptake.  The covid vaccine was no exception to a wider problem. Mistrust and safety concerns associated with maternal immunisation are not assuaged by public health advice. This mistrust was enforced by exclusion from vaccine research due to “heightened safety concerns in this population”, a self-fulfilling prophesy. 

*Dr Flor Munoz-Rivas led the World Vaccine Congress maternal immunity workshop in Washington 2022. To book your place at the congress in 2023 visit the website.