What Will It Take to Get Pregnant Women Vaccinated?

I’ll never forget the day I witnessed my first stillborn birth.

In the 1970s, before starting medical school, I spent 6 weeks at a rural sickbay in Haiti. Despite its meager resources and daily heartbreaks, I quickly gained respect for l’Hôpital le Bon Samaritain. Day in, day out, the staff gave their all while battling diseases most American doctors only studied in textbooks.

One afternoon, a seasoned nurse called my name. “Come quick!” said Belle. “There’s something you need to see.”

Following Belle to a dimly lit room, I found a young woman in labor. But something was clearly wrong: despite her efforts to push, every few minutes the patient’s back would arch in a massive spasm while her legs stiffened and her fists clenched. Although the agonizing attacks delayed the delivery, eventually the fetus emerged. At that point, the exhausted sufferer — her own life still in peril — was hastily taken to another facility better equipped to help her.

To an experienced clinical eye, Belle later told me, it was clear the mother had tetanus, a disease whose neurologic effects sometimes lasted for weeks and required not just sedation but artificial ventilation. And, Belle hastily added, given her impoverished upbringing in rural Haiti, it was very likely the pregnant woman had never been vaccinated against tetanus. Otherwise, she should have had antibodies to counter Clostridium tetani‘s devastating toxin that so grievously harmed both her and her fragile, unborn child.

Decades later, I still share this story when teaching UCLA undergrads about global health and our continuing need to reach as many people as possible with life-saving vaccines. Even here at home, our current rates of success in vaccinating pregnant women with several recommended shots hover around 50%. Another concern? Sadly, over 30-plus years of teaching, most of my otherwise savvy students show up knowing very little about the diseases for which they themselves received multiple shots growing up.

Standing Back and Surveying Progress

For a moment, let’s stay in the classroom. After speaking to my students about my experience in Haiti, I always stress our progress in vaccinating pregnant women and children in low- and middle-income countries. Over time, tetanus has become far less of a worldwide threat to these two groups than certain other blights — in particular, vaccine-preventable respiratory ills. The good news? We have also made progress against some of the latter classic foes like measles and pertussis. In addition, according to fresh data supporting the benefits to newborns and infants of vaccinating pregnant moms against both COVID-19 and respiratory syncytial virus (RSV), we can now fight these additional respiratory threats in a highly vulnerable cohort.

Another stunning achievement I review with students is the 50-year arc of childhood vaccination. Before I started medical school, the percentage of children fully vaccinated during their first year of life against six key diseases — polio, tetanus, diphtheria, measles, pertussis, and tuberculosis — was only 5%; today, that global metric exceeds 80% even before factoring in further vaccines many youngsters now receive against hepatitis B, Haemophilus influenzae type B, yellow fever, and other serious infections.

So why, given this inspiring history, do we continue to fall short in vaccinating women of reproductive age? Without a doubt, trusted providers must facilitate discussions with vaccine-hesitant pregnant woman, especially when it comes to COVID-19. But could we be missing other teachable moments earlier in life?

Compelling Stories and Facts Can Plant Seeds

I admit it: I intentionally started this piece with a long-ago scene I observed at age 21, which from that day forward remained burned in my brain. Why? Because I believe that moving stories and visuals combined with solid, irrefutable facts are under-used when trying to reach anyone from an adolescent to a vaccine-hesitant expectant mom.

Here’s another personal epiphany that underscores what simple data can teach us about vaccinating pregnant women. In 1957, as a young child in Los Angeles, I suffered my first-ever bout of pandemic “Asian flu,” as it was called at the time. I recovered uneventfully. However, years later, I learned that 1957’s pandemic H2N2 strain also caused nearly 20% of deaths among pregnant women in Minnesota. In 2009, a similar, nationwide trend was observed: although pregnant women were only 1% of the population, they accounted for 5% of all H1N1 pandemic flu-related deaths.

In short: during pregnancy, women become immunosuppressed and sometimes die from common infections they would otherwise withstand. Is this fact widely appreciated by today’s youth, or — for that matter — many pregnant women? I think not.

Pertussis (whooping cough) provides a different but equally important lesson because the disease most often kills infants during their first few months of life. Simply put, because protection is often short-lived, previously infected or -vaccinated women sometimes lack antibodies that would otherwise cross the placenta and protect their newborns before the babies have a chance to respond to their own vaccines. For this reason, CDC currently recommends that expectant moms receive a pertussis-containing vaccine each time they become pregnant, even if their pregnancies are spaced only a year or two apart.

Ironically, many of the eight in 10 deaths from pertussis that occur in U.S. babies under 2 months of age never cause them to whoop. The worst-affected sufferers simply weaken, turn blue, and asphyxiate. But a brief video of an emaciated infant here or abroad using every last ounce of strength simply to breathe can still make a profound impression. As can a simple chest x-ray clouded with infiltrates due to COVID-19 in a mother or a child on a ventilator.

So, what are some practical solutions? One option is to train high school teachers to teach the history of vaccination. One easily accessed resource can help. I’ve also shared CDC vaccine schedules with college students. Yes, some of the childhood tables are complex and take time to discuss, but the list of safe, effective killed vaccines currently recommended for women during and after pregnancy (in a nutshell, they include pertussis, flu, COVID-19, and RSV) is not hard to cover.

Who knows? Perhaps one of these days, certain school districts will even create programs that bring doctors into classrooms to share first-hand experience and stories of the life-saving benefits of vaccines given not just in pregnancy and childhood but at every stage of life. Let’s not underestimate our youth! That early education could save lives down the line.