Vaccine hesitancy: a pregnancy related issue?

Photo of a pregnant woman in Olsztyn, Poland (Unsplash, 2019)

This article was exclusively co-authored for the The European Sting by Ms. Sophie Gepp and Laura Jung, students of Medicine in Berlin and Leipzig. Both of them finished a Public Health Masters at the London School of Hygiene and Tropical Medicine last year. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Vaccine hesitancy has become an increasing problem in Europe, which is directly reflected in the number of infectious disease cases. For example, more than 41 000 measles cases have been counted in the first half of 2018, which is far more than the total number of cases in any year of this decade [1]. A recent study shows that vaccine safety and effectiveness is perceived differently in European countries, and that these perceptions influence vaccine uptake [2].

But what does the term vaccine hesitancy mean and how is this behaviour distributed in society?

Vaccine hesitancy, as defined by the WHO SAGE Working Group, is a behavioural phenomenon, which “refers to delay in acceptance or refusal of vaccination despite availability of vaccination services” [3]. The term is used to illuminate the complexities present in the vaccine decision-making process, with hesitancy being context dependent and varying across time and place. Convenience, confidence and complacency are main influencing factors on vaccine hesitancy [3].

For one group, this decision-making process seems to be a particular burden – pregnant women.

Concerns that influence vaccine uptake during pregnancy may differ from those that affect routine vaccination. During pregnancy, women might be more cautions and feel responsible for the life of the foetus [4]. Studies show, that pregnant women tend to highly overestimate the teratogenic risk of medication [5]. They therefore have high information needs [6] and it is important for health care professionals to be aware of this.

In addition to the increased risk perception, various social norms exist during the time of pregnancy in different cultures which influence the decision-making of pregnant women [4]. Many women, who are in favour of routine vaccination, show concerns about immunisation during pregnancy.

Vaccinations during pregnancy, for example with the influenza or pertussis vaccine, are proven to be safe and effective. They can prevent serious complications for mother and child. For health care professionals it is therefore important to be aware of the concerns of pregnant women and provide the information they are seeking for. A vaccine-hesitant mother is not an anti-vaccer per se, but a woman in a difficult situation where she makes decisions for two and feels social pressure. This shows how complex the discussion around the anti-vaccer movement actually is. People who refuse or delay vaccines are part of a heterogenous group and there is no one-fits-all solution.

Only respectful communication strategies and evidence-based information can help us to overcome these problems and increase the numbers of vaccination. All health care professionals play a role in this and should take them seriously.

References

• http://www.euro.who.int/en/media-centre/sections/press-releases/2018/measles-cases-hit-record-high-in-the-european-region
• http://www.vaccineconfidence.org/wp-content/uploads/2018/10/EU_state_of_vaccine_confidence_2018.pdf
• MacDonald NE. Vaccine hesitancy, Definition, scope and determinants. Vaccine. 2015;33(34):4161–4. eng.
• Wilson RJ, Paterson P, Jarrett C, Larson HJ. Understanding factors influencing vaccination acceptance during pregnancy globally, A literature review. Vaccine. 2015;33(47):6420–9. eng.
• Nordeng H, Ystrøm E, Einarson A. Perception of risk regarding the use of medications and other exposures during pregnancy. European journal of clinical pharmacology. 2010;66(2):207–14. Eng.
• Hämeen-Anttila K, Jyrkkä J, Enlund H, Nordeng H, Lupattelli A, Kokki E. Medicines information needs during pregnancy, A multinational comparison. BMJ open. 2013;3(4). eng.

About the authors

Sophie Gepp and Laura Jung are the National Public Health Officers of the German Medical Students Association (bvmd) and have worked in other international organisations as UAEM before. Both of them have a keen interest in public and global health and are currently trying to make these topics more accessible for other students.

They study Medicine in Berlin and Leipzig. Both of them finished a Public Health Masters at the London School of Hygiene and Tropical Medicine last year. Laura also collaborated with the Vaccine Confidence Group and did her own study on vaccination during pregnancy.