Clinicians have also begun to report a particular side effect of Covid during pregnancy, which they are calling Covid placentitis. Placentitis is inflammation of the placenta, typically caused by an infectious agent, and is linked to stillbirths. And, more worryingly, the cases are not appearing in patients with the most severe presentations of Covid—they’re appearing in those with mild to moderate cases.
Up until July 2021, more than 99 percent of pregnant people admitted to hospitals in the UK with symptomatic Covid-19 were unvaccinated. But poor vaccine uptake can’t be blamed on just the spread of misinformation. In fact, some of it can simply be boiled down to garbled public health messaging. Public health bodies in different parts of the world have repeatedly changed tack: First the vaccines weren’t offered to pregnant people. Then they could opt to get vaccinated, but it wasn’t actively recommended to them. It took a full eight months after vaccines first became available for them to be recommended to pregnant people in the US.
The inconsistency has meant that pregnant people were left unsure who to listen to or what the current advice was. (The term “pregnant people” includes trans and non-binary parents.) “What we weren’t very good at was making sure that every time the message changed, everyone got the memo,” says Viki Male, an immunologist studying pregnancy at Imperial College London. It doesn’t matter if a public health body updates their guidance—if news of the change doesn’t reach the intended audience, it won’t help.
A survey conducted by the company at which Shah works, Maven Clinic, asked 500 nationally representative pregnant people in the US about why they were not vaccinated. Over 60 percent simply did not know that getting vaccinated was recommended during pregnancy. (Even today, the webpage concerning the UK’s Medicines and Healthcare Products Regulatory Agency’s public assessment of the Pfizer vaccine currently warns that “sufficient reassurance of safe use of the vaccine in pregnant women cannot be provided at the present time” and that women who are breastfeeding should also not be vaccinated—both untrue.)
Male points to Canada as a country that handled it better: Authorities clearly communicated any changes in policy, she says, and as a result, the percentage of fully vaccinated pregnant people is significantly higher compared to the US and the UK. In the province of Ontario, for example, almost 60 percent of people who were pregnant in September had received at least one dose.
While health authorities were keeping mum, pregnant people were told to turn to trusted experts instead: their midwives, primary care providers, and ob-gyns. But the messages they received were mixed. In the Maven Clinic survey, a third of the respondents said they had been advised against the vaccine by medical providers. Another survey of pregnant people in the UK conducted by Pregnant Then Screwed, a maternity campaign charity, found that over 40 percent said they had been made to question the safety of the vaccine by health professionals.