Ontario revises vaccination guidelines
Pregnant people can now get the vaccine after ‘ informed counselling’
Pregnant, breastfeeding and immunocompromised people will now be able to get the COVID19 vaccine in Ontario, if they choose to, according to new guidance from the Ministry of Health.
It’s a change from a previous policy, which excluded these groups because they were not included in clinical safety trials for both the Pfizer and Moderna vaccine. As the Star reported last week, the old provincial guidance had resulted in some inconsistencies across hospitals.
Dr. Tali Bogler, chair of family medicine obstetrics at St. Michael’s Hospital, has been advocating for pregnant and breastfeeding health- care workers to be able to make their own decisions.
“It’s a step in the right direction,” she said. “We know that the risks are high in pregnant people with COVID, so this is also going to be safer,” especially as the majority of health- care workers in Canada are women, many of them of child- bearing age.
“To be completely excluded and denied was really a question about people’s autonomy, and I think that was really upsetting to so many people,” she added.
The new guidance says that pregnant women “may choose to receive the vaccine after informed counselling and consent.” This should include a discussion of the risks and benefits of the vaccine, the risks of COVID in pregnancy and acquiring it, and the lack of evidence of the vaccine in this population. Those with autoimmune conditions or who are immunocompromised should have a similar discussion with their doctor.
People who are breastfeeding should also understand the lack of evidence. As the COVID vaccines that use messenger RNA are not live vaccines, they’re not “hypothesized to be a risk to the breastfeeding infant,” the memo notes.
A spokesperson for the Minister of Health said in an email their health experts originally advised that pregnant and breastfeeding women not get the vaccine as they were not included in the safety trials, and revised this recommendation “after careful review.”
“As always, we will continue to monitor the emerging scientific evidence from clinical trials and from Health Canada approvals,” the spokesperson added.
These individuals will not need sign off from their doctors/ midwives or nurse practitioners to get the vaccine, but they will need to attest that they’ve discussed the risks with a care provider.
Bogler co- founded the Instagram account Pandemic Pregnancy Guide to provide free evidencebased advice for moms and babies navigating a new COVID reality, and said she’d heard from hundreds of women on the issue, many of whom wanted the choice to get the vaccine, especially those who were essential workers.
According to Bogler the new guidance has “already been pushed out to hospitals,” although the government has not made it public yet.
Dr. Paula Cleiman, a Toronto emergency physician who is currently nursing her daughter, was “very relieved” to hear the guidance has changed.
“It’s very important that they reversed this decision,” she added. “Women should be allowed to choose.”
The National Advisory Committee on Immunizations, a body that provides expert advice on vaccines, recommends that in general, the vaccine not be offered to pregnant people, as they were also not included in either the Moderna or Pfizer trials. But it may be offered if there is a benefit that outweighs the risk, and a discussion with their doctor about the unknowns.
The Society of Obstetricians and Gynaecologists of Canada has also developed guidance on pregnancy and COVID- 19.
It says the underrepresentation of pregnant women in the development of COVID- 19 vaccines “should not automatically exclude pregnant women from being vaccinated when vaccines become available.”
Women of child- bearing age were given a pregnancy test before participating in the PfizerBioNtech clinical trial, Dr. Supriya Sharma, Health Canada’s chief medical adviser, told the Star in December.
But, according to the evidence summary by Health Canada for the Pfizer vaccine posted online, 23 women in that trial became pregnant. They are being followed by the company, which will report back.
Thirteen women became pregnant in the Moderna trial. They are also being followed.
“Based on the studies so far, there isn’t any evidence of a specific risk for pregnant women, but the issue again is kind of the lack of data,” Sharma said. Pregnant people are at a higher risk for “severe COVID disease” than their peers of the same age, she added.