Why Pregnant Women Need to be Prioritised in COVID-19 Vaccination Drive

While the Centre had already given its nod for jabs for lactating women, it is still holding deliberations in the case of pregnant women. However, research shows that there are no safety issues in the case of pregnant women as well.

The disparate human tragedies unfolding before us are competing for space in the daily headlines. I cannot claim one is more deserving than the other, but every last one should be recorded. They will serve as a forewarning when calamities such as this pandemic breathe down our necks, again. These human stories also expose the systemic snags that were ingrained but always escaped notice.

Dhriti (name withheld), 32, was a first-time mother. Her daughter, 10 days old. It was well past midnight. Her lips blue from cyanosis, she lied gasping for breath in a minivan as other ambulances rushed past in a frenzy. She heard her brother spelling out her “SpO2” in a muffled voice to her parents over the phone. She had been denied admission into multiple hospitals. On their way to the next destination, unruffled by the impending knowledge of her future, she nonchalantly pointed out at the Qutub Minar. She had always liked it as a symbol of permanence, puncturing the sky for centuries.

Also read: Prioritising COVID-19 Vaccine for Vulnerable Groups Saves Lives, Study Finds

Her brother, unable to contain his anguish, lashed out saying that they will sue every hospital that denied her treatment. When else will her law degree come in handy? Dhriti had studied law at IIT-Kharagpur and had recently settled down in Delhi with a job and a husband. Finally, when a bed was arranged, her SpO2 read 40. Oxygen at “full pressure” wouldn’t suffice anymore; she needed a ventilator and there was none to be found. Dhriti died.

Vulnerability to virus and safety of vaccines 

United Nations Children’s Emergency Fund (UNICEF) had reported in May last year that 20 million babies are to be born under the shadow of the pandemic between March and December 2020. The shadow has overextended, and its umbrage is nowhere ready to wane.

A baby is half of both parents but during pregnancy, the maternal immune system goes through intricate changes. Her body morphs to regulate the lymphocytes, monocytes, etc., to ensure that the baby is not treated as a “foreign object” and rejected like a transplanted organ in the body while simultaneously ensuring that the baby receives the immunity it needs through the placenta. But, in this process, the mother is left vulnerable to viruses.

Averaging 70,000 live births in India each day, a significant number of pregnant and postnatal women are at risk of severe outcomes from COVID-19. This may consequently render numerous children motherless, and families dismembered, languishing in trauma and custody battles.

Vials labelled “AstraZeneca, Pfizer – Biontech, Johnson & Johnson, Sputnik V coronavirus disease (COVID-19) vaccine” are seen in this illustration picture taken May 2, 2021. Photo: Reuters/Dado Ruvic/Illustration.

To shield the low-immunity status of the body, flu vaccines are recommended to pregnant women in the US. Following the same logic, a recent report in the Indian Express stated that the American Journal of Obstetrics and Gynaecology found that COVID-19 antibodies were transferred from the mother to their foetuses.

A separate study, by Pfizer-BioNTech, doused the safety concerns of vaccinating pregnant women. Center for Disease Control and Prevention (CDC) also recommends pregnant women to take vaccines, NPR.org reported.

A team at the University of Chicago Medicine School had to say that the risk of severity of illness and fatality is high for pregnant women. They agree that while there is no known risk of the vaccines but there is a paucity of safety data given that pregnant women are typically excluded in clinical trials.

The Johnson and Johnson study states that “Covid-19 vaccines should not be withheld from pregnant persons.” All evidence from clinical practice — whether published or anecdotal — suggests no safety issues.

Also read: Vaccine Lottery: Indian States Grapple With How to Share COVID-19 Jabs

There is a strong case for prioritising vaccines for pregnant women from the average of 2 million doses being administered daily. The National Technical Group on Immunisation (NTAGI) has recommended lactating women to be vaccinated any time postpartum and a choice given to pregnant women pre-delivery.

The Centre in its wisdom has okayed jabs for lactating mothers but is deliberating on pregnant women. Safety should still be a concern given the variety of vaccines and variants. A mechanism should be developed for the collection of safety data. A prompt and robust system is desired for pregnant and lactating women for Covid care and management of adverse events post-vaccination if any.

We can all agree on the prevalent systemic ignorance of women’s issues in society at large. Let alone a postpartum woman’s vulnerability to viral infections. Dhriti’s in-laws responded late to her symptoms, dismissing it initially as post-pregnancy weakness. This opens our eyes to the need for awareness campaigns for pregnant and lactating mother’s vulnerability.

The Government of India, in my humble opinion, should consider allocating funds from its Beti Bachao, Beti Padhao Yojana to this cause. The Co-Win app can also be upgraded to facilitate easier and visible vaccination booking. India can and should afford her mother a delivery and postpartum recovery with dignity.

Anurag Deb is a student of Mechanical Engineering at Purdue University, United States. He is involved in Clinical Translational Research and have previously worked in the Silicon Valley at Beigene managing clinical trials.