Covid-19 Vaccine: A costly dilemma over pregnant women?

The government is yet to decide whether to vaccinate pregnant women despite a WHO recommendation to that end and an alarming rise in the number of pregnant Covid-19 patients.

The death toll too is higher among pregnant and lactating women compared to other patients.

According to two major hospitals -- Dhaka Medical College and Hospital and Mugda Medical College Hospital -- where most pregnant women are taking treatment in the capital, the infection rate in the Covid-19 gynaecology units had reached their peaks towards the end of last month.

The number of pregnant Covid-19 patients in ICUs has also increased.

On July 26, the number of pregnant Covid positive patients in Mugda Medical was 45, while the day before, the DMCH had 50 such patients (30 confirmed, 20 suspected).

Dr Robed Amin, spokesperson for the Directorate General of Health Services, said, "Since we have not received any recommendation from the National Technical Advisory Committee about vaccinating pregnant women, we are yet to take a decision."

He also said there's no specific statistics that pregnant women are dying more due to the delta variant and there's still no evidence the vaccine will not do any harm to them or the foetuses.

Dr Mohammad Shahidullah, chairman of the National Technical Advisory Committee (NTAC) on Covid-19, said the NTAC met last week regarding the issue and concluded that the pregnant and lactating mothers should have been vaccinated, as per the WHO interim.

"However, at the same time, we are waiting for the decision of the National Immunisation Technical Advisory Group [NITAG] and asked for its opinion, since it is the right body regarding vaccination decisions, and as far as I know, they're also positive regarding this issue... So, we are hoping that the government can shortly include the pregnant and lactating mothers in the Shurokkha app."

Understanding the urgency of the situation, the Obstetrical and Gynaecological Society of Bangladesh (OGSB) formed a committee on July 20 for recommendations on Covid-19 vaccination for pregnant and lactating women.

The committee sent a letter to the health ministry on July 24, requesting the government to include pregnant and lactating mothers in the vaccination programme.

Citing examples of the USA and Canada, OGSB President Ferdousi Begum said, "If we think about Bangladesh's situation, do the benefits not outweigh the risks? A good number of mothers have already died and what is more important is that they are spreading the virus, like everyone [with the infection]."

She also said although they do not have any comprehensive database on the delta variant's impact on the increase in infection rates among pregnant women, the forum's observation is that the number is increasing.

"We are assuming it [the increase in infection rate] is because of the delta variant."

On Thursday, rights organisation Law and Life Foundation served a legal notice on the government, requesting it to take necessary steps in 24 hours to provide Covid-19 vaccine to expecting mothers on priority basis in order to protect their health.

Citing information from the health ministry, the organisation said around 35 lakh women become pregnant per year, which means 35 lakh women carry existences of 35 lakh more people every year. "But thousands of expecting mothers and unborn children are dying due to Covid-19 infection."

The deaths of expecting mothers and their children can be reduced if they are vaccinated on a priority basis, the notice added.

As studies were underway, pregnant and lactating women were initially not included in the clinical trials of the vaccines.

Prof Dr Fahmida Khan, of Mudga Medical College's gynaecology unit, said since a woman's body undergoes many changes during pregnancy, it is common for the immune system to weaken during that time. This makes them vulnerable to infections like Covid-19.

She suggests that any woman, upon finding out she is pregnant, must stay indoors other than in times of emergencies.

"Most importantly, their family members must take necessary precaution while coming in contact with them and wear masks around them," she said adding that most pregnant mothers are staying home but are getting infected by family members who are having to go outside.

Dr Md Muniruzzaman Siddiqui, director of Mohammadpur Fertility Services and Training Centre and 100-Bed Mother and Child Health Hospital, discouraged pregnant women from even going to prenatal visits at the hospital, other than for emergencies like bleeding and/or pain.

He urged them to take teleconsultation services through hospital hotlines.

According to Md Nazmul Haque, director of DMCH, 14 pregnant women have died in DMCH between July 1 and July 25.

"It is very sad that so many pregnant women are being admitted with Covid-19 and then dying along with their babies. They also have to endure other pregnancy complications in the meantime… We are working to ensure better services for them."

WHO RECOMMENDATION

In an interim in February, the WHO recommended vaccination for pregnant women when the benefits of vaccination to the pregnant woman at high risk of exposure to Covid-19, and with comorbidities that place them in a high-risk group for severe Covid-19, outweigh the potential risks.

The interim recommendation mentioned that "pregnant women should be provided with information about the risks of Covid-19 in pregnancy, the likely benefits of vaccination in the local epidemiological context, and current limitations of the safety data in pregnant women. The WHO does not recommend pregnancy testing prior to vaccination or delaying pregnancy or terminating a pregnancy because of vaccination."

The recommendation was made since the available Covid-19 vaccines are not live virus vaccines, which are more likely to pose risks during pregnancy.

Besides, data from animal studies and post-introduction surveillance data have not shown harmful effects in pregnancy and the vaccine effectiveness was found likely to be comparable to non-pregnant women.

During an interview on June 24, WHO's Chief Scientist Dr Soumya Swaminathan said it's important that pregnant women in every country be explained the benefits versus the risks and be given the vaccine if they would like to take it.

The Centre for Disease Control and Prevention on June 29 also said that getting the vaccine can protect women from facing the adverse effects of the infection during pregnancy.

"If you have questions about getting vaccinated, a conversation with your healthcare provider might help, but is not required for vaccination," it mentioned.

After WHO's interim recommendations, countries like USA, Canada and the neighbouring India has already been offering Covid-19 vaccines to the pregnant mothers.