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When the province announced the AstraZeneca vaccine was being made available to people 40 to 54 years old this week, one pregnant Halifax woman found herself both excited and anxious.
We’ve agreed not to name the 41-year-old research scientist because she hasn’t yet informed her colleagues about her pregnancy, currently at the 17-week mark.
Being pregnant in a pandemic hasn’t been easy. But being pregnant and discovering you’re eligible for the AstraZeneca vaccine but are unable to find satisfactory information about its safety for pregnant people has been particularly stressful.
“I’m eligible as of today (Friday), but as a scientist I’m asking these questions. Is this the right vaccine for me? Is it going to be as effective for my own health and for my baby’s protection,” she said in an interview.
“Should I be waiting for another vaccine, an mRNA (Pfizer or Moderna) vaccine to become available? It’s a really difficult decision to make, especially given that rates of COVID in Nova Scotia are climbing now and are at their all time high.”
Even for someone whose job involves research, she said the sheer amount of information, contradictory information, and misinformation about vaccines and pregnancy can be overwhelming.
“I guess it’s the lack of clear evidence and maybe mixed messages,” she said.
“We get our data and news from so many different mediums right now and even though we know what credible sources are out there, there seems to be different countries or different provinces or different places who are adopting different practices.”
That left her wondering what’s best for her, as she fears not being vaccinated will put herself and her unborn child at high risk. The spike of cases in the Halifax area has only added to her anxiety.
“That weighs on you, too,” she said. “It’s trying to know what to do when a vaccine becomes available where there is maybe not as much evidence for pregnant women versus waiting for another one where there’s more evidence.”
During those early stages of her pregnancy she wasn’t “hugely concerned” about contracting COVID-19 due to the lower case numbers in the province. Past pregnancy losses meant she and her husband were instead focused on getting to the 12 or 13-week stage of gestation, their so-called safety zone.
Shortly after celebrating that milestone, cases started climbing in the province.
“It really does make me nervous because I see these reports of pregnant women who are ending up in the ICU and having complications or the baby having complications,” she said.
“And having two children already who are quite young, that really terrifies me. Not just for myself and this baby, but for my entire family.”
The Halifax Examiner reached out to the Canadian Centre for Vaccinology based in Halifax to get more information on questions we’ve received about COVID-19 vaccines in pregnancy and in general.
On Friday we spoke with Canadian Centre for Vaccinology investigator Dr. Karina Top. Top is also a pediatric infectious disease physician and associate professor at Dalhousie University. Here is our conversation, edited for brevity and clarity.
Halifax Examiner (HE): Are you hearing from pregnant people concerned about COVID-19 vaccination?
Dr. Karina Top (KT): Certainly we’ve had lots of discussion around vaccination and pregnancy from the beginning, and especially because obviously a lot of health care workers are women, and many in the child reproductive years. So that was a big question at the very beginning of the vaccine campaign because we really had no data.
And now there’s been more and more information coming out about the risks of getting COVID during pregnancy, both for the pregnant person and for the baby. That’s heightened the concern. As well, we’re now in the throes of a third wave out here. There’s always concern, obviously, around the safety for the pregnancy and for the infant of getting any medication or a vaccine in pregnancy.
HE: At what stage do you recommend that pregnant people get vaccinated?
KT: Right now there’s actually been some early data suggesting that vaccinating during pregnancy may actually help protect the infant from COVID. So we know that women who’ve had COVID during pregnancy can transfer some of those antibodies that their body makes against the virus to their infant. And there are certainly studies looking at that in terms of vaccination. But there’s every reason to think that that may help with some protection.
So to maximize that benefit to the baby then, you want to vaccinate a bit later in pregnancy. But that needs to be balanced against the risk of someone getting COVID in the meantime and the risk of them having severe complications from COVID during their pregnancy. The risk of severe COVID also increases as you get later into pregnancy, because of the changes that the body goes through to adapt to a pregnancy means that with any infection that can affect the lungs, pregnant women are a bit more susceptible just because their lung function is affected by the pregnancy.
From when you get vaccinated, it takes about two weeks for the vaccine to really start to have an effect, so you want to juggle that timing. But I would say people that are later in the second trimester, so during the second half of pregnancy, that’s a good time to look at getting vaccinated.
HE: For greater clarity, what exact time span in the second trimester is a good time?
KT: Probably between about 20 and 30 weeks is a good time. And obviously right now for most people who are in the age group where they could be getting pregnant, they’re a few weeks away from being eligible for vaccination. With the pace of rollout, we think that people into their 30s will be eligible for the vaccine by the end of May. So in the next month. That’s kind of the optimal time, but that needs to be balanced against a lot of other other factors.
The good news is that so far we haven’t seen any safety concerns. There are animal studies that have been done that don’t show any effects of the vaccine on fertility or reproduction or on the fetus. And there’s early data that was just published last week out of the US of about 30,000 pregnancies — pregnant people who have been vaccinated and were being followed up over time — and there are no safety concerns coming out of that. There are a fair number of people who are vaccinated in the first trimester, the first three months, and the rates of miscarriage in people who have been vaccinated is very similar to what we expect in the general population.
Obviously, the vaccines have only been around for four months so there aren’t that many pregnancies that have been completed. Especially for women who were vaccinated earlier in pregnancy, they would still be pregnant. So we’ll need more time, but so far, I think people can be reassured that the vaccines do appear to be safe in pregnancy and actually have extra benefit for the infant.
HE: So would you recommend that a 15- or 16-week pregnant person with a low risk of exposure to the virus wait until after that 20 week-mark or later to get vaccinated?
KT: Yes, I would suggest if they’re able to lower their risk of exposure to COVID as much as possible they wait a little longer. In terms of the safety data, the data out of the US is all based on Pfizer and Moderna. AstraZeneca is not approved there yet. So I haven’t seen data on AstraZeneca, although that has been used in Europe in younger populations. But I think if you’re just on the cusp, someone around three or four months pregnant, maybe waiting a few more weeks might maximize your benefit as long as you can manage the risk of COVID.
HE: Are you currently recommending a certain type of vaccine for pregnant women? And if so, does that recommendation differ by a woman’s age?
Really, there’s no concern about any particular vaccine during pregnancy. But, you know, obviously there’s been a lot in the news around that syndrome of clotting and bleeding (with AstraZeneca). In Nova Scotia, AstraZeneca is now opened up to people 40 and over. But most people who would be pregnant would be younger than that and would not be eligible for AstraZeneca. But getting Pfizer and Moderna they are essentially very similar vaccines and both are highly effective and appear to be safe from the early data that we have.
HE: Are there any risks for pregnant people aged 40 and older with the AstraZeneca vaccine?
KT: There aren’t any specific risk factors for the clotting and bleeding syndrome that we’re seeing. So people who’ve had that condition have not had any particular risk factors for having blood clots. So we do know that being pregnant is associated with a higher risk of blood clots in general. But the number of cases is really low and so I don’t want to make recommendations for an individual person. But I guess that would be the one consideration, and the fact that in terms of safety, we know a little bit more about the safety of the mRNA vaccines.
HE: Is there anyone who should not get a COVID-19 vaccine?
KT: The actual contraindications or exclusions from vaccine are very, very few. And it’s really someone who’s had a severe allergic reaction or anaphylaxis to a COVID vaccine or a component of the COVID vaccine. So there are very, very rare cases in people who would already be followed by allergist who have an allergy to polyethylene glycol (PEG) in the vaccine. But someone who’s had anaphylaxis before to a medication or injectable medication should check with their doctor for more details.
And then for the AstraZeneca, if anyone has had this clotting/bleeding syndrome, which there’s been a very small number of cases reported so far, they would be advised not to get any further doses of that vaccine.
HE: Should people get vaccinated even if they’ve already had or suspect they’ve had COVID-19?
KT: Yes. Absolutely they should. So certainly the mRNA vaccines give you higher antibody levels against the virus than having been infected naturally, and we don’t know how long the effect of immunity from previous [infection] lasts. And so getting the vaccine will hopefully ensure that you’re protected longer term.
HE: I received a message from someone concerned the AstraZeneca vaccine may not be as effective at preventing asymptomatic transmission. They asked if they’d still need to wear a mask and isolate when travelling, and if we’d have two classes of vaccinated people. What are your thoughts?
KT: What I would say is that we all need to be wearing masks whether we are vaccinated or not for the foreseeable future. And right now we’re experiencing a third wave because of variants. We’re still learning about how well these vaccines work against the variants. All of them.
The AstraZeneca has been shown to be very effective in the UK where the UK variant has been the major strain, and that’s the one that we’re battling right now in Nova Scotia. So I wouldn’t see it as two classes of vaccinated people at all.
AstraZeneca has been primarily used in the UK and with the mRNA vaccines there have just been more doses used worldwide so far, with hundreds of millions of doses given out in the US alone. So there’s just not as much data around asymptomatic transmission for the AstraZeneca. I haven’t seen anything to show that it’s less effective or not effective against asymptomatic transmission. I just haven’t seen the same amount of data for AstraZeneca compared to Pfizer and Moderna vaccines. I think it’s just a matter of time.
But all of these vaccines are highly effective against severe COVID, hospitalization, and death. Regardless of whether you get vaccinated, we’re all going to be wearing masks for a while and I’m not sure that that’s going to go away, to be honest, they are just so effective. I haven’t had a cold in well over a year.
HE: There’s a great deal of interest in statistics of research around vaccinated people and their ability to spread the virus. What do you know about this?
KT: Well, certainly we’re seeing that even one dose of the vaccine does significantly reduce asymptomatic infection with Pfizer and there’s some data with Moderna as well. So it’s not zero, and that’s partly why we still need to be wearing masks. But it does significantly reduce asymptomatic transmission and the vaccines are even more effective against symptomatic disease, so even mild COVID symptoms. So if people are still getting COVID after vaccination, it’s generally milder if they have symptoms or they have no symptoms.
In those situations, they’ll likely be shedding less virus, which means they’ll be less infectious. But they may still have the potential to spread it and these variants are very, very contagious, so it doesn’t take much. But I think we can say that so far it looks like people who are vaccinated are less likely to transmit, although the exact number is difficult to know. It really depends on the rate of infection in the community as well.
HE: What do you think about the high uptake for vaccines that we’ve seen so far in Nova Scotia?
KT: It’s great to see the level of excitement here and the level of demand for these vaccines. We’re seeing around the country as people are becoming more familiar with these vaccines, they’re starting to realize that this is really our way out of this pandemic and the restrictions that we’ve all been living under for the last 14 months or so.
I think it’ll be easy to get to that first 50 to 60% (of population getting vaccinated) because of the demand. Or I hope it will be. But getting to really high coverage, I think there are still going to be people who are resistant or just don’t feel they need it. And certainly people who have been able to avoid COVID because they live in more rural areas and don’t have a lot of contacts, people may not feel that it’s as much of a benefit to them or they may have challenges in accessing the vaccine.
HE: How has Nova Scotia done with the rollout thus far?
KT: I think Nova Scotia has done a really good job to try to make sure that no one was left behind in the vaccination program. But there still aren’t that many clinics available on weekends compared to during the week or evening hours. I think there may still be people who are struggling to access vaccination around work schedules and stuff. Once we move into children, that adds another layer…that means that there’s two people that have to go, you need a parent to take them or you need to find some other way to give it in schools or something.
I think there’s a lot of logistics that we need to look at to make it easy and convenient for people to access vaccine in order to get that really high coverage we need.
But at the end of the day, we’ve gotten this far by everybody doing their part in Nova Scotia, following the rules. We’re banding together now to get out of this third wave. The other really key thing to get out of this, so we can actually go out and have more freedom and travel, get out to see all our friends and family outside of Nova Scotia for the first time over a year, will be vaccination. I hope people will hear that message and go and sign up for the vaccine when they have the chance to.
HE: What would your message be to pregnant people and to members of the general population who are still leery about COVID-19 vaccines?
KT: We have lots and lots of information about these vaccines and less so in pregnancy, but it’s coming out all the time. These vaccines are safe. They’re very effective, especially against severe COVID. We’re seeing young people in hospital and ICU right now, and deaths in young people. Everyone’s at risk from these variants and vaccines will prevent those, will keep you out of the hospital, keep you from infecting other people.
We’re working very hard to make sure that we monitor the safety and take any (issues) and concerns seriously and are investigating them. That’s probably why you see so much information around these events. It is just to make sure that we’re informing the public and investigating any concern that comes up. And I think for pregnant women, we actually have the chance to protect two people with that one vaccine.
The information is constantly changing, and I know that’s confusing for people. But we’re just trying to share it as it comes out as we learn more. And we’re all still learning. But it’s really remarkable and it’s amazing that we have these vaccines that are so highly effective in such a short period of time and very, very safe. We’re very lucky in that regard.
HE: Is there anything else you think would be important to mention?
KT: Just that I think that the best vaccine is the one that’s in your arm. And it’s great to see the demand around AstraZeneca in that younger age group. I encourage everyone to sign up as soon as bookings open for their age group.
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