Nine days before a pregnant dentist in Delhi lost her life after contracting COVID-19 she left a video message saying, "Please wear a mask for you and your dear one's safety...". Her husband took to Twitter to share the news. "I lost my pregnant wife and our unborn child to covid," he wrote. In his Twitter thread, he shared the video that his wife Dr Dimple Arora Chawla had made.
The video triggered many questions on social media about why pregnant and breastfeeding women were not receiving the COVID-19 vaccine in India.
After India first approved Serum Institute of India's Covishield and Bharat Biotech's Covaxin on January 2, the Health Ministry released a list of contraindications on January 14 which would act against the vaccines. In the notification, the Health Ministry asked people having any of these contraindications to not take the vaccine. This listed included pregnant and lactating women. The reason these groups were kept out is because clinical trials of both the vaccines did not include any pregnant or lactating women. This list was last updated on March 25, 2021.
However, after the US started vaccinating its pregnant and lactating mothers with the Pfizer and Moderna mRNA vaccines, questions about why India is not including them have been raised by many including health experts. There are reports to suggest that pregnant women have been infected by the virus and it has been deadly in some of those cases as well.
Mumbai's B.Y.L Nair Hospital which has been the referral centre for COVID-19 positive pregnant women in the city has conducted over 1,000 deliveries till the beginning of May, 2021. It has also seen a total of 38 COVID-19 deaths. The National Technical Advisory Group for Immunization, a body that is advising for COVID-19 has recommended that the government start vaccinating women who are pregnant or breastfeeding. However, the Ministry of Health is yet to take any decisions on it.
Why Are Pregnant and Lactating Women Not Getting Vaccines In India?
Neither of the vaccines approved and available in India so far included pregnant or breastfeeding mothers in their clinical trials. As the Oxford-AstraZeneca vaccine was not tested on pregnant and lactating women, even in UK, they have not been included to receive the vaccine.
Brazil stopped vaccinating pregnant women with the AstraZeneca vaccine after a death was reported in a pregnant woman post receiving the vaccine. Both UK and Brazil, however, continue to administer the Pfizer vaccine to pregnant and lactating mothers.
Why Are Pregnant and Lactating Women Getting Vaccines In US?
US' Centre of Disease Control and Prevention has asked pregnant women to receive the vaccine as it believes that pregnant women are more at risk of having a more severe experience if tested positive.
While recommending the Johnson and Johnson single-dose vaccine for pregnant women, the CDC also advised them to be more careful due to reports of the formation of clots in women.
What Do Experts Say?
The Federation of Obstetric and Gynaecological Societies of India (FOGSI), one of the premier bodies of obstetricians and gynecologists in the country issued a press release on April 28, 2021 requesting the Ministry of Health and Family Welfare to allow pregnant women to be vaccinated
BOOM contacted Dr. Alpesh Gandhi, President, FOGSI, about their stand on vaccinating pregnant and lactating mothers. "We stand with the NTAGI recommendation and have also released a press release requesting the same. It's a benefit ratio where the benefits of vaccinating both pregnant and lactating women outweigh the risks involved with post-vaccine complications."
Furthermore, Dr. Gandhi stated that the mother's breastmilk could be a potential route for the transfer of antibodies from mothers to children thus pushing for lactating women to receive the vaccine, too.
"It is also to be noted that one of the vaccines uses a viral vector while the other uses an inactivated virus, both of which will not replicate the SARS-CoV-2 virus in the body. These vaccines are essential because COVID-19 is causing issues in pregnancy and decreasing oxygen saturation," explained Dr. Gandhi. This reasoning is supported by the CDC as it recommends its mRNA and viral vector vaccines for pregnant women since they do not possess replicating SARS-CoV-2 in the vaccines.
The NTAGI has recommended the Ministry of Health to initiate vaccinations for pregnant and breastfeeding women. BOOM contacted Dr. N. K. Arora who is heading the committee as to why the team decided to go forth with this recommendation when there is no available data suggesting the efficacy of both the available vaccines for pregnant and lactating mothers.
Dr. Arora said that he will want to wait for the recommendations to be made public before discussing the reasoning behind their recommendations. The NTAGI recommended three changes to the Ministry of which the Ministry accepted extending the duration of the second dose of Covishield to more than 12 weeks.