COVID-19 VACCINATION & PREGNANCY – Global disparities in public health guidance for the use of Covid-19 vaccines in pregnancy  

BMJ Global Health, 24 February 2022;7(2):e007730   (Open access)

by Eleonor Zavala, Carleigh B Krubiner, Elana F Jaffe, Andrew Nicklin, Rachel Gur-Arie, Chizoba Wonodi, Ruth R Faden, Ruth A Karron


Introduction – Gaps in information about the safety and efficacy of Covid-19 vaccines in pregnancy have led to substantial global variation in public health guidance regarding the use of Covid-19 vaccines in pregnancy over the course of the pandemic.

Methods – We conducted systematic screenings of public health authorities’ websites across 224 countries and territories every 3 weeks to track the development of policies on Covid-19 vaccine use in pregnancy. Policies were categorised using a 1–5 permissiveness scale, with 1 indicating policies that recommended use, and 5 indicating policies that recommended against use.

Results – As of 30 September 2021, 176 countries/territories had issued explicit guidance on Covid-19 vaccine use in pregnancy, with 38% recommending use, 28% permitting use, 15% permitting use with qualifications, 2% not recommending but with exceptions, and 17% not recommending use whatsoever. This represented a significant shift from May 2021, when only 6% of countries/territories with such policies recommended the use of Covid-19 vaccines in pregnancy (p<0.001). However, no policy positions could be found for 21% of all countries and territories, the vast majority being low and middle income. Policy positions also varied widely by vaccine product, with Pfizer/BioNTech and Moderna vaccines being most commonly recommended or permitted.

Conclusion – Our study highlights the evolution of policies regarding Covid-19 vaccine use in pregnancy over a 5-month period in 2021, the role of pregnancy-specific data in shaping these policies and how inequities in access for pregnant women persist, both within countries and globally.