Review: Facilitations and obstacles to the introduction of vaccinations in pregnancy

Review: Facilitations and obstacles to the introduction of vaccinations in pregnancy

Researchers at St George's University of London have identified the key barriers to vaccinating against whooping cough, flu and Covid-19 in pregnant women and set out recommendations to combat vaccine hesitancy. The results come from the first review of their kind and were published today in the journalPLUS ONE.

Pregnant women are at increased risk of viral infections due to changes in their immune system during pregnancy. Vaccinations - especially against influenza (flu), pertussis (whooping cough) and Covid-19 - are therefore strongly recommended. When pregnant women choose not to receive these vaccinations, they not only put themselves at increased risk of illness, hospitalization and death, but also prevent their baby from receiving better protection from birth.

Although the NHS and WHO strongly recommend these vaccines in pregnancy, uptake remains low in the UK: only 51% of pregnant women receive two doses of the Covid-19 vaccine, 60% receive the whooping cough vaccine and only 30% receive the flu vaccination.

To better identify key barriers and facilitators to vaccine uptake among pregnant women, researchers conducted the first systematic review of qualitative, interview-based studies published between 2012 and 2022 in high-income countries with established vaccination programs throughout pregnancy. The countries included the UK, Australia, New Zealand and the USA.

Their search yielded 2,681 relevant articles, of which 28 peer-reviewed articles covering 1,573 women were included in the review. The majority of studies (78%) focused on influenza and whooping cough.

The review found that the main barriers to vaccine uptake among pregnant women were concerns about the safety and effectiveness of vaccines, lack of knowledge about the benefits and necessity of vaccines, fear of harmful effects to themselves and their baby, lack of understanding of the seriousness of these diseases, lack of vaccination, lack of support from healthcare professionals, and barriers to physical access to vaccines, while balancing other health appointments and priorities.

Now Dr. Mohammad Razai and his team outlined key recommendations that they hope will be incorporated into public health strategies. They focus on the “five Cs” – confidence, complacency, comfort, communication and context. More specifically, their calls [1] include:

• Machen Sie Impfungen zugänglicher, indem Sie sie beispielsweise in Routinebesuche vor der Geburt integrieren, indem Sie Impfprogramme am Arbeitsplatz anbieten, nur einen Termin für alle Impfungen haben und Termine außerhalb der Arbeitszeit anbieten
• stärkere und proaktivere Empfehlungen von vertrauenswürdigen medizinischen Fachkräften
• verbesserte Gesundheitsinformationsressourcen und öffentliche Gesundheitskampagnen, um die Risiken für Mutter und Kind besser zu kommunizieren. Die Kommunikation sollte in mehreren Sprachen erfolgen, um eine bessere gesundheitliche Gleichstellung zu unterstützen
• Stellen Sie sicher, dass Geburtshelfer, Hausärzte und Hebammen Kommunikationsschulungen erhalten, die ihnen dabei helfen, mit Mythen aufzuräumen und zeitnahe, genaue und evidenzbasierte Informationen über Impfungen in der Schwangerschaft bereitzustellen.
• Unterstützen Sie die Gerechtigkeit, indem Sie auf sozioökonomisch gefährdete Gruppen abzielen

Vaccination skepticism among pregnant women remains very high, but vaccination against whooping cough, flu and Covid-19 during pregnancy is crucial. Today, people should no longer be hospitalized or even die from diseases that are preventable with safe and effective vaccines.

Our work has brought together the views of over 1,000 pregnant women and we hope that the key recommendations we set out will be applied to public health strategies in the UK and beyond. We believe these measures are critical to address vaccine hesitancy and increase protection for expectant mothers and their children.”

Dr. Mohammad Razai, senior researcher and clinical academic general practitioner, Population Health Research Institute at St George's, University of London

The team is currently developing community interventions to increase vaccination rates among women with low vaccination rates. This includes training midwives to advise pregnant women on vaccinations and sharing real-life stories to inform decision-making.

Dr. Razai's in-practice fellowship was funded by the National Institute for Health and Care Research (NIHR).

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