key: cord-0830729-rxgzr5u2 authors: Lamptey, Emmanuel title: Overcoming barriers to COVID-19 vaccination of pregnant women date: 2022-02-04 journal: Gynecology and Obstetrics Clinical Medicine DOI: 10.1016/j.gocm.2022.01.007 sha: 71c742b376f91a8899b2363ccbb1f62b23c2d032 doc_id: 830729 cord_uid: rxgzr5u2 COVID-19 in pregnancy is associated with an increased risk of severe maternal illness, ICU admissions, mechanical ventilation and deaths. Vaccination is the best way to protect pregnant women against these known risks of infection in pregnancy. There is an urgent need to prioritize strategic responses to optimize vaccination among expectant mothers. In this paper, we reviewed potential patient and healthcare provider barriers to COVID-19 immunization and propose effective strategies for overcoming them. low acceptance of COVID-19 vaccination in a sample of pregnant women 19 . Lack of safety data on COVID-19 vaccines in pregnancy and the possibility of harm to the fetus were the major reasons for hesitancy 19 . In another survey of 135,968 pregnant women between December 14, 2020, to May 8, 2021, by the CDC, 16.3% ( 22, 197) had received one or more doses of the vaccine with 5.3% ( 7154) initial dose and 11.1% ( 15,043) completed dose 20 . While poor awareness persists as an impediment to vaccination programs and acceptance, the situation is not the same for the COVID-19 vaccines. Information regarding the vaccine is rapidly evolving, well-tolerated and pregnant people do well with the vaccine 21 . However, some pregnant women are still declining the vaccines because they are awaiting more evidence to reassure them that the vaccine is safe for their babies. A study done in the UK reported 58% of expectant mothers refusing the jabs due to insufficient evidence of safety 22, 23 . A related study conducted between February and May 2021 by the Royal College of Obstetricians among 1500 pregnant women stated that 40% plan not to get vaccinated, and 20% remained undecided because they need more evidence of reassurance 22 . The hang-out for more robust evidence or data has left many pregnant women unsure about whether they should get vaccinated. Women waiting for sufficient scientific information before accepting the vaccine are inadvertently exposing themselves to increased risk of severe illness or death from the virus 24 . Assessing these attitudes and practices unveils that pregnant women are more vaccinated in some countries than others. Germany's standing committee on COVID-19 vaccination in pregnant women recommended the jabs only in some individual cases, with reasons that there are not enough data to support such a move as safe 25 . Pregnant women in India are still ineligible for COVID-19 vaccination due to government concerns and lack of safety data 26 . There are currently little safety data available for pregnant women on the two commonly approved local COVID-19 J o u r n a l P r e -p r o o f vaccines in India, namely, covishield and covaxin 28 . Also, lactating and pregnant mothers have been initially excluded from mass vaccination campaigns in most countries due to the same reasons, even though evidence for safety and efficacy is emerging 27 To overcome these barriers, awareness campaigns must be intensified than before to enhance the likelihood of acceptance among the pregnant population. Increasing risk perception and severity among pregnant and non-pregnant women is essential. For instance, pregnant women who contract COVID-19 are at risk to be admitted to ICU requiring ventilators due to cardiovascular and respiratory changes occurring in pregnancy 33 . A woman who contracts the infection is of great concern, especially with the delta variant. Some pregnant individuals will get vaccinated when they view themselves as being at high risk of significant suffering or complications should they get infected with COVID-19 34 . These campaigns should target young women, pregnant mothers, With all these multifaceted strategies, there will still be some pregnant women declining vaccination. Willingness to consider vaccination varies by patient, and healthcare providers should actively listen to and validate the concerns and fears of these patients because getting vaccinated is a personal choice. Alternative methods for preventing COVID-19 infection in pregnancy should be advised, and care must be continuously be provided. These include wearing a mask, physical distancing and good nutrition to build natural immunity. In the event of emerging vaccine hesitancy, the most trusted influencer of vaccination decisions is the healthcare provider 52 . However, some obstetricians -gynecologists and other healthcare workers are not leading by example by getting vaccinated. If healthcare providers are not vaccinated, they will not encourage eligible patients to be vaccinated as well 53, 54 . Findings from a survey in Israel revealed that the percentage of people who intend to obtain the COVID-19 vaccine was 78% among physicians and 61% among nurses 55 . In a related development, the acceptance of the COVID-19 vaccines among nurses in Hong Kong was low 56, 57 . Whereas in the United States, only 36% of health professionals expressed interest to take the vaccine when they are made available in late 2020 58 . To boot, there are other reasons compelling healthcare providers from accepting the COVID-19 vaccine or recommending them to their pregnant population. Lack of safety data for the vaccine in pregnancy, unawareness of current guidelines, and concerns of potential teratogenicity (adverse effects) on maternal physiology and the fetus among other things point inadequate knowledge of vaccine recommendation. J o u r n a l P r e -p r o o f Along with these reasons, studies have shown that some healthcare professionals have negative perceptions with safety concerns about the COVID-19 vaccines in general. In Nepal, healthcare workers had poor perception scores about the vaccines, and they were not willing to be vaccinated 59 . Vaccine hesitancy was noted among nurses of an inner-city hospital in New York City, and the major concern cited was the remarkable speed with which the vaccines move from bench to bedside 60 . These gaps in knowledge and perceptions contribute to a low rate of vaccination in the general and pregnant population. Given the role as a source of care for pregnant women 62 , people look to them for information about vaccination; hence, nurses, physicians, pharmacists, and other healthcare workers must accept the vaccine and get vaccinated 63, 64 . They must set a good example and practice what they preach 63 ，64 . Centers for disease control and prevention Global changes in maternity care provision during the COVID-19 pandemic: A systematic review and meta-analysis Change in the incidence of stillbirth and preterm delivery during the COVID-19 pandemic The indirect impact of COVID-19 on women Influenza vaccination during pregnancy. 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