Like many of his colleagues at a hospital in Toronto, the emergency physician wondered if the new virus circulating in the world could be spread by tiny particles in the air and if his department would be short of protective equipment. Almost a year later – and four months after starting maternity leave with her third child – Cleiman has a new concern. Although she is a frontline healthcare worker who has cared for COVID-19 patients during her pregnancy, she can no longer get the vaccine against the virus because she is breastfeeding.
“Many vaccination centers across Canada do not allow pregnant and breastfeeding women to be vaccinated, including at the hospital where I work,” she told CBC News. “It was quite disappointing, to say the least. ”
On Tuesday, the Ontario Society of Obstetrics and Gynecology (OSOG) and the Section of Obstetrics and Gynecology of the Ontario Medical Association (OMA-OG) released a statement urging provincial officials to “immediately allow a equitable access to pregnant and breastfeeding women at risk ”for COVID-19 vaccination.
“High-risk pregnant people, such as frontline healthcare workers, may choose to receive the vaccine and they should be supported,” said Dr Constance Nasello, OSOG President.
Within two days, more than 1,000 healthcare workers also signed an online petition, calling on Ontario to change its recommendations that anyone who is pregnant or breastfeeding should not receive the vaccine.
Denying women the right to choose to be immunized not only puts our frontline workers and our community at greater risk of contracting this preventable disease, but it undermines a woman’s ability to take decisions about one’s own health, ”the petition reads.
Provinces, hospitals taking different approaches
The push comes amid an ongoing controversy over the country’s patchwork approach to COVID-19 vaccination policies.
Ontario’s position relates to a key issue: Pregnant women did not participate in trials of the Pfizer-BioNTech and Moderna vaccines now approved in Canada, so there is no safety data available and the effectiveness of either option for this group.
This has led to various policies and recommendations for people who are pregnant or breastfeeding – but these differ from province to province and are not always applied in the same way, even from hospital to hospital within. the same region.
The Toronto University Health Network, which operates several hospitals, is among those currently adhering to the recommendations of the Ontario Ministry of Health.
“Right now, our medical advisory committee’s consent and enrollment form and medical directive follow the ministry’s advice and exclude pregnant women,” said Gillian Howard, spokesperson for the network.
But not all health care networks take this approach, including the Toronto East Health Network (TEHN), which operates the Michael Garron Hospital in the east end of the city.
“We recommend that pregnant women have a risk-benefit discussion with their obstetrics provider about the vaccine and COVID-19 infection so that they can make an informed and personal decision regarding the vaccination,” explained the doctor. TEHN spokesperson Shelley Darling.
“If they have done it and consent to it, they can get the vaccine. ”
Quebec, like Ontario, does not currently vaccinate pregnant women, with the province saying that vaccination of “pregnant women will be determined based on future studies on the safety and effectiveness of vaccines in these people.”
British Columbia takes a different tone, saying that while none of the approved COVID-19 vaccines are recommended for pregnant women until further research is conducted, those interested should speak to a care provider health and make their own decisions.
“For some people, the risk of being infected with COVID-19 may outweigh any potential risk associated with receiving a COVID-19 vaccine,” it read.
It is the same position as that of the federal government.
Canada’s National Independent External Immunization Advisory Committee recommends that while the vaccine is not routinely offered to populations excluded from clinical trials – which also include people with weakened immune systems or autoimmune diseases – it can be administered depending on the level of risk. and informed consent.
Benefits greater than risks, according to doctors
Nasello and OSOG maintain that the benefit of vaccine protection during pregnancy in preventing COVID-19 is “greater than the risk of taking the vaccine.”
“Obstetricians have always had to make science-based decisions about drug use during pregnancy and breastfeeding,” Nasello said in a statement. “Pregnancy is a particularly dangerous time for women. ”
New evidence shows a higher rate of ICU admissions and serious illness among pregnant women with COVID-19, OSOG noted in its statement.
An analysis of hospital admissions data released in December by the University of British Columbia looked at pregnancies in British Columbia, Alberta and Ontario during a period of the pandemic from March to September and found that pregnant women with COVID-19 were at increased risk of hospitalization.
Of more than 350 Canadian pregnant women hospitalized during this period, 11% were admitted due to COVID-19 – a percentage that was several times higher than the COVID-related admission figures for all women of reproductive age – the study found.
“They should be on the front lines, unless we have very strong evidence that they shouldn’t be – and we just don’t have that evidence right now,” the researcher and policy expert said. of Public Health Alison Thompson, Associate Professor. at the University of Toronto.
Thompson acknowledged that ethics can be tricky when it comes to vaccinating groups not involved in clinical trials.
It was a mistake not to include various groups in this early research, she said, which now leaves policy makers without key data to make decisions about who should and should not get vaccinated.
But Thompson said Canada could get around this information gap by using vaccine registries to track impact, examining new evidence as vaccines roll out more widely, and basing decisions in part on success. previous vaccines.
“We know that there are vaccines that are safe for pregnant women, the immunocompromised, the elderly and others that are not usually included in clinical trials,” she continued.
A spokesperson for the Ontario Ministry of Health told CBC News the province “is actively consulting appropriate medical specialists and reviewing the evidence currently available and will update the advice accordingly.”
Cleiman says change can’t come soon enough, especially since many frontline healthcare workers are women.
“These options are just not acceptable … to deny women who have given so much their vaccination,” she said.