Why Are So Many Pregnant People Still Unvaccinated?

When I got my second Moderna shot in July, at 18 weeks pregnant, I felt a rush of gratitude tinged with a side of anxiety. In spite of all my research, plus conversations with medical experts and trusted loved ones assuring me it was safer to get the COVID vaccine than COVID itself, the vaccine was still not yet officially recommended for pregnant people. That milestone finally took place in August, when the CDC released data confirming the vaccine’s safety for those who are pregnant and breastfeeding—cue my sigh of relief.

Yet many in this demographic remain unconvinced and unvaccinated: As of August, data shows that only about one in every four pregnant people report vaccination, yet there’s been a surge in severe cases of pregnant people with the virus since July—as reported by doctors and evidenced by an uptick in ICU admissions and deaths—highlighting the devastating impact of COVID-19 among pregnant people, who have an increased risk of severe illness from the virus, along with higher chance of preterm birth and poor pregnancy outcomes.

While the percentage of pregnant people getting vaccinated is rising (albeit at a snail’s pace), it’s clear that dire headlines, doctor’s warnings, and official recommendations are not enough to combat many pregnant people’s concerns about the vaccine. The nine-month gap between its initial availability and formal safety sign-off exacerbated matters, creating a vacuum filled with confusion and misinformation.

“When the vaccine was first available last December, it was not surprising that pregnant people were more hesitant, particularly as pregnant people were left out of the clinical trials [for safety reasons],” says Cynthia Gyamfi-Bannerman, M.D., chair of the department of obstetrics, gynecology, and reproductive sciences at the University of California San Diego School of Medicine and UC San Diego Health and a member of the Society for Maternal-Fetal Medicine’s COVID-19 task force. “However, as we have accumulated more safety data, and with the particularly infectious delta strain, it does surprise me that more pregnant people are not choosing vaccination.”

Among the reasons commonly cited by pregnant people for their decision are the lack of data about the vaccine’s safety (we have more research now than before, but it’s still been studied for less than a year); a fundamental distrust of government and other institutions promoting the vaccine; and a bone-deep instinct that it’s not the best move for their bodies and babies.

“As a former immunologist and current pharmaceutical professional, I do not feel the approved vaccines are right for me based on the lack of available data to make an informed, risk-based decision,” says Monika, 32, of Chester, New Jersey, who is seven months pregnant with her second child. “Mathematically speaking, the risks of a known variable, such as the potential effects of COVID during pregnancy, cannot exceed those of an unknown variable, such as the potential vaccine-associated risks—that is yet to be determined as more substantial data is collected over time.”

Other people’s skepticism is rooted in a sense of general unease, fueled by distrust of the system endorsing the vaccine. 

“My decision has been driven primarily by my intuition and what is right for me and my family,” says Nicole, 32, an entrepreneur in Manahawkin, New Jersey, who is currently four months pregnant with her third child. “When the vaccine was released, the way it was presented and incentivized just did not seem right to me…. Pregnancy is not a time to experiment. In the face of persistent public doubt, the need for more data and education on the vaccine and its effects on various demographics is critical. While clinical trials of pregnant people are still underway, the body of evidence supporting the vaccine’s safety and efficacy is encouraging—and growing. 

“Getting vaccinated during pregnancy is the best way pregnant people can give protection to their newborn against COVID,” says Gyamfi-Bannerman. “Data shows there is no effect on fertility or miscarriage rates.” Beyond potentially keeping babies safe through protective antibodies, the vaccine provides crucial protective measures for vulnerable expecting parents: “Pregnant people with COVID do worse than their nonpregnant counterparts, including higher need for ventilator support and higher death rates,” she adds.

Still, this information may not be enough to convince the majority of pregnant people to get the shot—at least not yet. “Generally speaking, as long as my health is maintained through nutrition, exercise, and mindfulness, I will continue to rely on that to keep me healthy,” says Monika. Similarly, Nicole is not open to getting the vaccine in the future, saying she “believes in our immune systems and our bodies’ ability to heal.”

When asked how to help more pregnant people feel comfortable getting the vaccine, Gyamfi-Bannerman pointed to the need to continue focusing on the proven benefits of vaccination. “There are plenty of pregnant people who have been vaccinated with great outcomes,” she says. “I hope that rates will continue to rise. We need more protection to mitigate the deaths we are seeing in pregnant unvaccinated people. It would be great to have long-term data, but we have evidence of safety for now.”