Deutsche Welle (English edition)
COVID: Is it safe to get vaccinated in pregnancy?
Pregnant women are a risk group for severe COVID-19. But vaccinations among the pregnant are running slow in Germany, compared with other countries.
Pregnant women are a risk group for severe COVID-19. But vaccinations among the pregnant are running slow in Germany, compared with other countries.
If only the medical advice were clearer, Anja W., a 35-yearold woman in the 25th week of pregnancy, would want to get vaccinated against COVID-19.
She's a doctor, and she knows her way around all the issues.
"If the German Society for Gynecology and Obstetrics and the Standing Committee on Vaccination would clearly recommend vaccination for pregnant women, and if a COVID-19 vaccination was deemed a lower risk than an infection with the virus itself, I would get vaccinated. I've been watching the advice in other countries. In the US, they've been vaccinating pregnant people for months," said Anja W.
In addition to the US, other countries, such as the United Kingdom, Israel and Belgium have recommended that pregnant people get vaccinated. In fact, they are to be treated as priority cases.
But the Standing Committee on Vaccination (STIKO) has yet to recommend it in Germany, either during pregnancy or for those people breastfeeding newborn babies.
Delay due to lack of data
In April 2021, STIKO recommended against vaccinating people during pregnancy.
It said that only those who had preexisting conditions resulting in a higher risk of a severe COVID-19 infection should be considered for vaccination, but only after a risk-benefit-analysis and after the person had been fully informed.
Basically, that's vaccination only in individual, exceptional cases, and at the person's own risk.
STIKO said it lacked sufficient data to make a general recommendation in favor of vaccinating pregnant people because they only rarely take part in clinical trials.
So, it's not necessarily that the committee has spoken out against-vaccinations for mothersto-be, it just says it can't recommend it for everyone who is pregnant.
It's a case of not for and not against. But it's precisely that stance that expectant mothers find confusing.
Gynecologists want rapid vaccination
Intensive care professionals and gynecologists are stepping up the pressure. A group of 11 expert organizations in Germany have published a "position paper" (link in German), arguing that pregnant women are at higher risk of severe COVID-19 and that there is now enough reliable data on the safety of mRNA vaccines.
Stefan Kluge sees it the same way. Kluge heads the University Hospital at Hamburg-Eppendorf
(UKE).
He said they are seeing a growing number of COVID cases among pregnant women in intensive care. He told the dpa news agency there were five such cases in the past two weeks alone.
"These cases are especially dramatic. We must start vaccinating pregnant women in Germany," said Kluge.
More severe cases during pregnancy
We've known that pregnant women are a high-risk group since September 2020.
A meta-study, published in the British Medical Journal reviewed the data from 190 studies, involving 68,000 women.
The results were unambiguous: About five times as
many cases among pregnant women were asymptomatic, but the risk that they would need intensive care or artificial respiration after an infection was twice as high.
The risk of death due to a COVID-19 infection was equally high, at two in every 10,000 cases.
Preexisting conditions such as diabetes or obesity, or indeed being over the age of 35, could increase the risk further.
On average, pregnant women are about as at risk as people aged 70 to 84 years.
More worries than before
Anja W. said that if pregnant women were now to be considered as risk patients, protecting them should be a top priority. As a working doctor, and pregnant at the same time, she feels especially vulnerable.
"I'm living through this pregnancy feeling more worried than I was during my first pregnancy," she said. "I'm still working at the hospital and trying, as best as I can, to protect myself against a SARS-CoV-2 infection."
"I would have welcomed better advice from the German Society for Gynecology and the Robert Koch Institute [Germany's government agency responsible for disease control and prevention — Editor's note] for pregnant people in the workplace," she said.
Expert organizations for gynecology in Germany, who want to see vaccinations for pregnant and breastfeeding women, cite the V-safe COVID-19 Vaccine Pregnancy Registry at the US Centers for Disease Control and Prevention (CDC).
The CDC says there are no indications that a COVID-19 vaccine would cause complications for pregnant women. It says there are also no concerns regarding the production of antibodies or people's tolerance of a vaccine.
mRNA vaccines preferred
Pregnant women are advised, however, to give preference to mRNA vaccines. So, that's the
BioNTech/Pfizer and Moderna vaccines.
Pregnant doctor Anja W. would prefer a mRNA vaccine herself. "Pregnant women have a higher risk of thrombosis as it is, and I would want to reduce the risk of sinus thrombosis, so I would prefer a mRNA vaccine," she said.
Difficult risk-benefit analysis
But many people — pregnant and willing to be vaccinated — are still not getting a jab, because doctors are said to be shying away from the risks.
It's left to pregnant women to decide whether the risks are greater of a COVID-19 infection or as a result of a vaccination.
Anja W. hopes there will soon be clearer advice in Germany for pregnant women. "Only by then," she said, "my second child will already have arrived."
able comes from ongoing research on COVID-19 measures and vaccine hesitancy conducted by various German public health agencies, the University of Erfurt and the Yale Institute for Global Health in the US.
Sarah Eitze, a researcher at the University of Erfurt, told DW that, at the time their latest data on parents was collected (late February), 50% would have decided in favor of a vaccination. Interestingly, when they appealed to ideas of herd immunity (as opposed to the strict selfinterest of protecting their children), they saw a big increase in acceptance.
"The decision depends strongly on the possibility of protecting others through the vaccine," Eitze said. "The acceptance increased to over 70% if the participants were told to imagine the vaccine protecting against the spread of the virus."
These percentages may actually be higher now, since these surveys were done before Pfizer released its jubilant results (which have yet to be peer reviewed) from a phase-III trial on 12- to 15-year-olds. In that trial, not a single one of the roughly 1,000 young adolescents who received the Pfizer/BioNTech vaccine developed COVID-19 symptoms. Not one.
Though the sample size was small, it was also large enough to make an early comparison to the non-vaccinated group, where 18 of the 1,000+ participants got COVID-19.
General vaccine willingness high in Germany
But a few other insights come from the research of Heidi Larson, who's the director of The Vaccine Confidence Project and a professor at the London School of Hygiene & Tropical Medicine.
Every two years, Larson's team collects data for the EU — and in it, there's information about parents' willingness to immunize their children with the MMR vaccine (measles, mumps,
rubella, given between ages one and six) and the HPV vaccine (human papillomavirus, usually given at age 11 or 12).
That data, she told DW, "[W] ould capture willingness for child and adolescent vaccines." And, by extension, it may serve as a proxy survey on parents' willingness to administer COVID-19 vaccines to their kids.
What those surveys showed is that roughly 91% of Germans feels the MMR vaccine is either safe or important for their children. Another 77% said the same for the HPV vaccine. All in all, good news.
Not all vaccines are created equal
Or is it? The clear percentage gap between those two vaccines suggests that, when we're talking about a "willingness to vaccinate children," that discussion is dependent on which vaccine you're talking about — or rather, on the "risk" parents are trying to avoid by vaccinating their kids, versus the risk (perceived or real) of the vaccination itself. (Note: At the time of publication, there have been no unexpected side effects in adolescents vaccinated with Pfizer/BioNTech, according to the company and, independently, statements by Israel's health ministry.)
Second, a survey like the one above that includes both men's and women's willingneess may not actually capture the truth, or the reality, of how a parent decides to vaccinate (or not vaccinate) a child.
That's because when it comes
to vaccinating children, mothers tend make the call more often than fathers do, as researchers have found.
And in the case of COVID-19, that could present a problem.
A survey conducted in December by the US magazine National Geographic showed a pretty staggering gender gap when it comes to taking a COVID-19 vaccine.
At that time, 69% of American men said they were prepared to get a COVID-19 jab, compared just 51% of women. That's a big difference. In Germany, a similar gender gap — though not quite as pronounced — has been recorded.
In an interview with DW in December, Heidi Larson chalked it up to two factors: women accurately perceiving that this virus was less risky to them (compared to men), and the prevalence of online misinformation.
Larson said that in general, women do more research into vaccines then men, because mothers are more likely to look up information about vaccines for their children than fathers are. "And in their searching for more information, they've likely been sent down different social media strands that have taken them to some pretty negative information. So I think that they're probably more aware of some of these anxiety-provoking images, and sentiments, that are circulating online."
Default to nothing
Then, there's a final psychological hindrance that Sarah Eitze says has been known about for decades.
"What I can say is that health decision-making for others is, in general, more risk averse," she told DW. "So every time we make decisions for other persons, we weigh benefits and risks and try to reduce risk as much as possible. Furthermore, with preventive behaviors ( such as vaccinations) we also tend to be more risk averse (compared to treatment decisions)."
In other words, if I choose to vaccinate my child, and it directly causes discomfort or even harm? Then it's my fault. But if I do nothing, and they get infected? Then maybe it's just… fate?
(Full disclosure: I'm a father of two and will vaccinate both of my kids based on the data we know. But I'd be lying if I said I didn't have a fear, somewhere inside me, of making the wrong decision.)
This "default" setting in human psychology implies that, despite declaring a "willingness" to do something in a survey, things may turn out differently when it comes time to actually schedule an appointment.
Numbers in constant flux
So, how many Germans will actually vaccinate their kids? Your author's best guess is between 50% and 60%. That number assumes some of the roughly 50% of German parents who've said they're "willing" to vaccinate will not actually follow through — either because of "default to nothing" tendencies or the fact that mothers tend to make more childcare health decisions and have lower COVID-19 vaccine acceptance rates than men.
But it also assumes that some of the roughly 18% of parents who've said they're "undecided" (or who were undecided as of late February) will make up a part of that gap and may even overshoot it.
Obviously, these numbers would most likely go down if there was negative vaccine data on adolescents and children in
the future — or up if there are new requirements regarding reentry into German kindergartens, elementary schools or high schools, as well as airlines, restaurants and other businesses.
What about kids and teens themselves?
Back at the playground in Bonn, the mother of a very vocal 1-year-old boy cites those final points as her primary incentive for vaccinating.
"We wouldn't be afraid to go out," she tells DW. "We wouldn’t be afraid to visit his grandparents anymore. If he's vaccinated, we would have a normal life again."
When the boy's scream interrupt her train of thought, she jokingly says that yes, it is lunchtime, but that... you know, maybe he's also voicing his support? Maybe he's "pro-vaccination?"
Would he be, though? It's an interesting question. With all this discussion about parents, how do children and adolescents feel about all of this?
On the way out of the park, I ask a 13-year-old who's on his way to the basketball court to be honest with me. Does he actuallywant to get vaccinated? If he could make the choice himself?
"Yeah," he says. "Because of course, I want to help contain the whole coronavirus pandemic."
The verb he uses is "eindämmen," meaning "to contain." It's a big word for a 13year-old. Or maybe we all just have new vocabularies now.
And is he scared of the vaccine? Of the stuff inside it?
"Nah. ' Cause they're doing lots of tests on it."