With the surge of the Omicron variant in the United Kingdom, it is vital that we reinforce our efforts to protect the most vulnerable. But there is a group that remains particularly exposed to the threat of disease.
Pregnant women, who are at a much greater risk of serious illness and pregnancy loss from Covid-19, are one of the least vaccinated groups in the country – despite an overwhelming amount of evidence that the vaccines are effective and safe for them.
Protecting this group is a matter of urgency, and the gravity of the situation highlights shortcomings of the current vaccination strategy.
What are the risks to pregnant women?
One of the most important facts scientists have learnt about Covid is that it is not only a disease of the lungs, but a disease of the blood vessels. When Covid is severe, it can cause blood clots and constrictions to our arteries and veins, which make it harder for our heart to supply oxygen to our body.
Blood circulation is even more important during pregnancy, because it is needed to supply oxygen and nutrients to a growing baby. It’s believed that this is why Covid increases the risk of many painful outcomes such as pre-eclampsia, pre-term birth and stillbirth.
Early research from Sweden suggests that the problem also leads to respiratory distress syndrome in newborns. It is possible there are even more risks to the child later on, that we don’t know about yet.
Alongside these risks, women who are pregnant are three times more likely to be admitted to ICU with Covid than women who are not pregnant, and around 70 per cent more likely to die from the disease.
Each individual case is heart-breaking. And in a pandemic – when so many are vulnerable to being infected – they start adding up very fast.
During the Delta wave in the United Kingdom, around a third of young and middle-aged women who were in critical care for Covid were, or had recently been, pregnant. Ninety-eight per cent were not vaccinated.
Of course, it is reasonable to be concerned about any medication that is given during pregnancy, and this should be taken seriously. But when properly analysed, many of the claims about the risk of the Covid vaccine on pregnancy have been thoroughly debunked.
Some viral rumours suggested early on that vaccines would cause miscarriage because part of the coronavirus resembled a protein in the placenta called syncytin-1. They argued that the antibodies we developed against the virus would also cause our body to attack the placenta, and that this would be a risk from the vaccines.
There are fundamental blunders in this argument. First, it is simply false that the virus resembles the protein in the placenta. The similarities between them are actually negligible – far below what is considered a potential risk. It would be like saying this article resembled the Shakespeare play Macbeth because both contain the words “woman”, “blood” and “disease”. And even if there was a resemblance, that alone would not be enough to cause such a risk, because our immune system undergoes training to avoid a response to it.
What about other risks of the vaccines during pregnancy?
Almost two years into the pandemic, we have a wealth of data showing that the vaccines are safe and effective for pregnant women. By October this year, more than 80,000 women in England had been vaccinated while pregnant, and almost 200,000 had in the USA.
Studies that have analysed this data have come to the same conclusion. There have been no safety concerns linked to the vaccines during pregnancy. Studies have found no increased risk of miscarriage, preterm birth, stillbirth, low infant birth weight or foetal abnormalities, among the women who are vaccinated while pregnant.
While it is possible that vaccines might have long-term effects that we haven’t seen yet, the same goes for the risks of Covid to the foetus. And we already know that Covid increases risks to them in the short-term.
One reason these vaccines are safe is that none of them use a live, functioning virus. Most Covid vaccines contain the code for only one of its proteins – the spike protein. Without the other proteins, the vaccine is unable to function the way the virus would.
To understand why, we can compare how they spread in our body.
The virus can invade our cells, multiply and enter the bloodstream, where it works to trigger a chain of reactions that damages our blood vessels. But the vaccine is incapable of this: it is injected into thick muscle and drains into our lymph, rather than our blood. The spike protein then simply sits on the surface of our cells and, without the rest of the virus’s proteins, it cannot act to trigger such damage. Even the small amounts of spike protein that do reach the blood are quickly destroyed by the liver.
Put together, we now have lots of evidence that the vaccines don’t increase the risk of miscarriage. They don’t cause preterm birth, stillbirth, or reduce infant birthweight. There is no evidence that they cause infertility.
But all of this is still an understatement of their safety. From what we know, not only are the vaccines free of these risks, they actually reduce them, by protecting women from Covid, which is especially harmful during pregnancy.
This is why it’s so alarming that much of this group is exposed to the risk of a new wave of Covid-19. Less than 10 per cent of women who gave birth in June had been vaccinated at the time – below half that of their age group. The figure only reached 22 per cent by September.
And there have been stark differences when it comes to income and ethnicity. In the summer, 27 per cent of pregnant women in the highest-income areas had been vaccinated, but only 8 per cent in the lowest-income areas had been. While 18 per cent of white pregnant women had been vaccinated, only 6 per cent of black pregnant women had been.
There are plenty of ways we can expand vaccine coverage. On 16 December, the Joint Committee on Vaccination and Immunisation (JCVI) moved to make pregnant women a priority group for Covid vaccination, which is a good start but should have happened much sooner. To dispel hesitancy, we can communicate much more widely about the heightened risks of Covid during pregnancy and the protection that vaccines provide, strongly recommend that pregnant women get vaccinated during their routine gynaecologist appointments, and set up vaccination centres near antenatal clinics.
But we can be more ambitious. Research has shown that the Omicron variant can partly escape our immune response, and that three doses or more will be needed to restore the efficacy of vaccines, which were designed for the original variant of Covid. Scores of pregnant women have not even had their first dose, let alone their second.
We therefore need to update the vaccines to match the Omicron variant as soon as possible. In an ongoing emergency like this, it is reckless to wait for enough people to take three doses of a vaccine, months apart, for them to receive good protection against the new variant – when an updated vaccine could achieve this with fewer doses and save time, resources and lives.
This same argument applies worldwide: the low coverage of vaccines among pregnant women is matched when it comes to gaps in protection across the world. For every hundred people who live in low-income countries, only nine doses of vaccines have been taken altogether.
It will be far too late, for far too many people, if we maintain our current strategy. As the virus evolves, so should our response. The lives of so many depend on it.