Lift Up Your Hearts!

I realize that for very few of my readers is the question of whether or not a pregnant woman should get a COVID-19 vaccine of any importance. Nonetheless this is worth a post just because it is one of those laugh-or-cry articles.

The source is the School of Public Health at Johns Hopkins, which I generally respect. Here's a link to the whole article for those of you who seriously want the information. It's a serious business and an important decision to make.

For everyone else, however, here are a few snippets that caught my eye and inspired me to write. The bolded emphasis is my own.

Globally, over 200 million people are pregnant each year. Whether they should be offered the new COVID vaccines as they become available is an important public health policy decision. Whether pregnant people should seek vaccination is a deeply personal decision.

Note the term "pregnant people." The article goes out of its way, to the point of being very annoying, to avoid the term, "pregnant women." Exactly how many pregnant men have there been in the history of the world? I do, however, appreciate the acknowledgement that it's a personal decision, although later on the article seems to find a problem with that.

Evidence to date suggests that people who are pregnant face a higher risk of severe disease and death from COVID compared to people who are not pregnant. For instance, pregnant people are three times more likely to require admission to intensive care and to need invasive ventilation. The overall risk of death among pregnant people is low, but it is elevated compared to similar people who are not pregnant. Some studies suggest that COVID in pregnancy might be associated with increased rates of preterm birth.

There are still significant unknowns: How do risks vary by trimester? What are the risks of asymptomatic infection? Further, most current information about COVID and pregnancy comes from high-income countries, limiting its global generalizability.

Although there is not yet pregnancy-specific data about COVID vaccines from clinical trials, the vaccines have been studied in pregnant laboratory animals. Called developmental and reproductive toxicity (DART) studies, research with pregnant animals can provide reassurance about moving forward with vaccine research in pregnant people. 

All three of these vaccines offer a very high level of protection against severe COVID. There is little reason to believe these vaccines will be less effective in pregnant people than they are in people of comparable age who are not pregnant.

The next sentence is the one that made me sure I had to write about this. It's the kind of thing I would have shared on Facebook, except that I'm trying to reduce my Facebook presence, so it goes here instead. With more words, naturally.

Professional societies, such as the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal-Medicine, and the Royal College of Obstetricians and Gynaecologists, all support COVID vaccination in pregnancy when the benefits outweigh the risks.

What, pray tell, does that say that has any usefulness? Who in his right mind would support something when the risks outweigh the benefits? So how is this a meaningful statement at all?

The absence of pregnancy-specific data around COVID vaccines continues an unfair pattern in which evidence about safety of new vaccines for pregnant people lags behind. This unfairness is ethically problematic in at least two important ways.

So, it's unfair because we don't have enough data on the effects of the vaccines in pregnancy? Would they have held back the vaccines until sufficient data had been gathered so that the information was "equal" for everyone? That would truly have been unfair to pregnant women, because letting the rest of the population get vaccinated helps them whether or not they feel safe getting the vaccine for themselves.

First, people may be denied vaccine, or may face barriers in accessing vaccine, because they are pregnant.

I agree that's a problem. Because the data is insufficient, in absence of a clear danger to mother and/or child in getting the vaccine, it should not be withheld from a woman who feels comfortable with it.

Second, even when pregnant people are eligible for vaccination, because public health authorities have not explicitly recommended COVID vaccines in pregnancy, the burden of making decisions about vaccination has shifted to pregnant people. 

And where else should it be? Medical advice should not be handed down like commandments from heaven. People need the best information available, and the freedom to make their own decisions—even wrong ones.

Come to think of it, even commandments from heaven come with the free will to ignore them.