COVID shots and pregnancy: The high cost of confusion
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Pregnant patients could have trouble getting the COVID-19 vaccine.
Why it matters: They're a group at higher risk of severe illness from COVID-19.
- Recent data confirms what earlier research suggested: mRNA COVID vaccines protect pregnant patients and pass antibodies to the baby through the placenta.
Catch up quick: Health Secretary Robert F. Kennedy's vaccine advisory panel voted that people — including those who are pregnant — should make their own individual decision about whether to get a shot in consultation with their health care provider, instead of broadly recommending the shot. That recommendation must ultimately be approved by the CDC.
- Back in May, Kennedy announced that the CDC no longer recommended the COVID vaccine for healthy pregnant women.
- The CDC website had previously said, citing several studies, that the mRNA COVID-19 vaccines "reduce the risk of severe illness and other health effects from COVID-19," and "might help prevent stillbirths and preterm delivery."
Zoom out: Despite Kennedy's insistence that "everybody" can get a booster, without the CDC's approval, insurance coverage and accessibility of the vaccine for many pregnant women could be in jeopardy.
- Some states have scrambled to come up with their own vaccine guidelines driven by evidence-based recommendations from national medical organizations.
- But changing the COVID-19 vaccine recommendation to "be determined by individual decision-making" could make it "highly likely that the COVID-19 vaccine will not be covered by insurance, which removes patient choice," says Veronica Gillispie-Bell of the American College of Obstetricians and Gynecologists. It could also threaten access to free vaccination programs for those who are uninsured, she says.
Zoom in: To ensure that her patients who want the booster can get it, Gillispie-Bell, who practices in Louisiana, tells Axios she's had to recommend they go to specific pharmacies that will administer it.
- "That's not how public health is supposed to work," she says. "Everybody should have access without any type of extra privileges."
- She's also had to write a prescription for the COVID vaccine to a patient who's not pregnant. Going forward, "it could be that a doctor's prescription is not enough. We don't know yet."
Between the lines: Beyond access difficulties, safety concerns keep some pregnant patients from getting boosted.
- A patient might say yes to getting the ACOG-recommended flu shot and Tdap vaccine — despite not knowing what Tdap means — but hesitate about the COVID shot "because there's been so much misinformation about that particular vaccine," Gillispie-Bell says.
What they're saying: "It's apples and oranges when you're comparing theoretical complications with the vaccine, and actual pregnancy effects," says Jane van Dis, an OB hospitalist who practices in New York. "COVID is no joke for pregnant bodies."
- For example, Van Dis says, COVID can lead to complications like postpartum hemorrhage and what some medical professionals call "COVID placenta," a life-threatening complication when the placenta gets stuck to the uterus.
The bottom line: The lack of clear federal guidance forces pregnant patients to rely on uneven state policies and individual pharmacy and doctor decisions.
