WHO Updates Guidance On The COVID Vaccine During Pregnancy
The agency's new vaccine guidance for those who are expecting more closely aligns with the U.S. Centers for Disease Control and Prevention.
Updated guidance from the World Health Organization (WHO) says pregnant people can get a COVID vaccine without specific risks that might outweigh the benefits of the vaccine. The shift in counsel represents a departure from the agency's previous stance that expectant parents should only obtain the vaccine if they are high-risk and puts WHO guidance in closer alignment with advice from the U.S. Centers for Disease Control and Prevention (CDC).
On Jan. 29, the WHO updated its guidance for pregnant people considering the Moderna COVID vaccine to note that although little research had been done on vaccine safety in pregnancy, the vaccine's technology was known to be safe. Still, the agency only recommended the vaccine for pregnant people with a high risk of exposure to COVID or who have a high risk of severe illness.
"Based on what we know about this kind of vaccine, we don't have any specific reason to believe there will be specific risks that would outweigh the benefits of vaccination for pregnant women," WHO guidance on the Moderna vaccine read. "For this reason, those pregnant women at high risk of exposure to SARS-CoV-2 (e.g. health workers) or who have comorbidities which add to their risk of severe disease, may be vaccinated in consultation with their health care provider."
Early guidance from the WHO on the Moderna vaccine noted the agency did "not recommend the vaccination of pregnant women," the New York Times reported. But because the WHO's stance on vaccinating pregnant people against COVID differed from the CDC, which noted pregnant people "may choose to be vaccinated" and encouraged them to consult their doctor, expecting individuals were left to weigh conflicting advice.
Additionally, Dr. Anthony Fauci, a leading infectious disease expert in the United States, has recently said the nation has seen "no red flags" in the roughly 10,000 pregnant people who have been vaccinated so far. "We had a lot of pregnant women vaccinated, the FDA followed them and will continue to follow them," USA Today reported Fauci said during a media roundtable held during the IAS COVID-19 Conference: Prevention. "Even though we don't have good data on it, the data that we’re collecting on it so far has no red flags."
According to the Times, health experts had previously expressed "dismay" at the WHO's decision to emphasize vaccines' potential risks to pregnant people over their known benefit. "There are no documented risks to the fetus [from the vaccines], there's no theoretical risks, there's no risk in animal studies," Dr. Anne Lyerly, a bioethicist at University of North Carolina Chapel Hill, told the Times. "The more that I think about it, the more disappointed and sad I feel about it."
Others noted the health agencies' difference of opinion on vaccines and pregnant people stemmed not from different interpretations of data, but from a lack of data altogether. "The reason for that recommendation isn't that the vaccines have been shown to be unsafe in pregnant women, it's that there's not data to show they are safe in pregnant women," Dr. Archelle Georgiou told KSTP. "So in the absence of data, they've come out saying that unless you're in a high-risk group — health care workers, essential worker, front-line worker — that you shouldn't have the vaccines."
A large part of the issue is that pregnant people were not included in vaccine trials conducted for either the Pfizer-BioNTech or Moderna vaccine. It's a problem many health organizations have long been railing against. According to The New Yorker, the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, the National Institutes of Health, and the National Academy of Medicine have all been calling for the inclusion of pregnant individuals in vaccine trials for more than 20 years.
But vaccine makers are hoping to have more data regarding COVID vaccines and pregnant people soon. According to the Times, Pfizer plans to establish a vaccine trial in pregnant individuals while Moderna is expected to launch a registry of pregnant people who obtained its vaccine to monitor and document side effects.
It should be noted, the WHO does not appear to have updated the language in its guidance on the Pizer-BioNTech COVID-19 vaccine, which was issued Jan. 8. In that guidance, the agency noted it "does not recommend the vaccination of pregnant women at this time" due to " insufficient data." However, the WHO did note that "vaccination may be considered in discussion with [a] healthcare provider" by pregnant people with "an unavoidable risk high of exposure" such as a healthcare worker.
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