key: cord-0745806-brrq8zzc
authors: Sarwal, Yamini; Sarwal, Tanvi; Sarwal, Rakesh
title: Vaccination of pregnant women against COVID‐19 in India and Indonesia: Moving beyond the opt‐in to the opt‐out option
date: 2021-09-24
journal: Int J Gynaecol Obstet
DOI: 10.1002/ijgo.13930
sha: 3cf6077777e726841b0270efdcf68bfa65a787fb
doc_id: 745806
cord_uid: brrq8zzc

In view of the continued threat of COVID‐19, and to synergize with routine antenatal care, COVID‐19 vaccination should become a default part of routine antenatal care with an opt‐out option.

Amid rising concerns voiced by health professionals, 1 gender experts, 2 researchers, 3 and the press on allowing vaccination for pregnant women against COVID-19, and 167 days after the start of the campaign, the government of India on July 2, 2021, provided approval for the vaccination of pregnant women against COVID-19. 4 Earlier, on May 28, 2021, the National Technical Advisory Group on Immunization had recommended vaccination for pregnant women subject to safety precautions. The group remarked, "considering the current situation of the pandemic, pregnant women should not be excluded from vaccination because exposure probability is very high and therefore the benefit far outweighs the risk"; however, the group also suggested that pregnant women should be fully informed about the fact that "the long-term adverse reactions and the safety of the vaccine for fetus and child are not yet established... The vaccine may be provided at any time during pregnancy." 5 In an early advisory, the Indian Research Body (ICMR) had issued "Guidance for Management of Pregnant Women in COVID-19 Pandemic," merely recommending infection prevention and control measures. 6 Lactating women were allowed to receive COVID-19 vaccinations in May 2021. 7 Since pregnant women are at higher risk of severe COVID-19 infection, a decision on vaccinating them was necessary. Even though no evidence existed to suggest vaccination would cause harm during pregnancy, little data on the safety of the vaccine was available. 8 The argument regarding the safety of the COVID-19 vaccine in pregnant women was largely settled with regards to mRNA vaccines and remained inclusive for those vaccines derived from adenovirus agents. The evidence pertaining to the immunogenicity of the COVID-19 mRNA vaccine in pregnant women and transport of such antibodies to infant cord blood and breast milk made a convincing and sound argument regarding safety and efficacy for newborns. 9 Agencies and associations around the world, like the to June 2021, it is reasonable to assume that 2% of this total (approximately 8000) were pregnant women, comprising one fifth of usual maternal deaths. The recent decision on allowing vaccination of pregnant women, along with its zealous implementation, will help track any rise in the incidence of maternal mortality in India-for instance, the Ebola epidemic in Africa lead to a 75% increase in maternal mortality across various countries. 10 The decision to allow vaccination of pregnant women against COVID-19 is a step towards achieving target 3.1 of the Sustainable Development Goals, which aims to reduce the global MMR to <70 per 100 000 live births.

The authors have no conflicts of interest.

YS and RS together conceptualized the idea. YS and TS searched the literature and wrote the original draft. RS edited the draft and gave final shape to the manuscript. All authors contributed to and approved of the final version of the manuscript.

https://orcid.org/0000-0002-4950-6091

Economic Times. Policy rethink to allow pregnant women get jabs needed: experts. 2021

Prioritizing pregnant women for COVID-19 vaccination

Pregnant women now eligible for COVID-19 vaccination

MoHFW Minutes of meeting NTAGI

ICMR Guidance for management of pregnant women in COVID-19 pandemic

COVID-19 vaccination recommended for all lactating women

WHO. Safety of COVID-19 vaccines. 2021. Accessed

Immunogenicity of COVID-19 mRNA vaccines in pregnant and lactating women

Of the Republic of Indonesia C. Gov't rolls out COVID-19 vaccination scheme for pregnant women, lactating mothers, children

MoHFW Operational guidance for COVID-19 vaccination of pregnant women