Vaccination of pregnant women must be prioritised

THE death of singer Siti Sarah Raissuddin, who succumbed to Covid-19 just days after giving birth to her fourth child at 28 weeks of pregnancy, is a tragic incident that leads us to seriously question the Covid-19 vaccination policy for pregnant mothers in Malaysia. Siti Sarah was not vaccinated, as were many maternal deaths from Covid-19.

To prevent any more unnecessary maternal deaths due to Covid-19, we are calling for the current guideline of “first dose to be administered between week 14 and 33 of the pregnancy” to be expanded to “first dose to be administered at any stage of pregnancy”.

In the Second Edition of the Clinical Guideline for Covid-19 in Malaysia (published April 13, 2021), it is stated that vaccination for pregnant women can be done between 14 and 33 weeks of pregnancy. The second dose can be administered to a woman who finds out she is pregnant after getting the first dose. However, the second dose should be deferred until 14 weeks of gestation.

It took two months for the relevant committee to improve and come up with the Third Edition (published July 12). However, the guideline on vaccination for pregnant women was retained.

The committee continues to ignore the guidelines used in other countries despite the increasing risk of maternal deaths due to Covid-19 in Malaysia.

In the United Kingdom, the Royal College of Obstetricians and Gynaecologists (RCOG) states that Covid-19 vaccine is considered to be safe and effective at any stage of pregnancy.

In Australia, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australian Technical Advisory Group on Immunisation have explicitly stated that pregnant women should be routinely offered the vaccine at any stage of pregnancy.

Likewise, the American College of Obstetricians and Gynaecologists (ACOG) recommends that “all pregnant women be vaccinated against Covid-19.” Data from 36,000 vaccinated pregnant women in the United States shows no obvious safety concerns.

We are unable to find the basis for the “Week 14-33” recommendation in Malaysia, and we welcome clarifications from the relevant committees and decision-makers on this because it has created confusion across the country.

We have anecdotal evidence of women in their 30th week of pregnancy who were keen to be vaccinated but were turned down by public health clinics and advised to wait for notification through MySejahtera. These notifications may only appear at 33 weeks, which means they have missed the window for vaccination.

We’ve also seen two pregnant women rejected by vaccination centres for first-dose jabs at 35 weeks and 38 weeks respectively. This occurred despite the women declaring their expected date of delivery in MySejahtera and given vaccination appointments.

One of them even brought a supporting letter from her doctor. Imagine the risk they took coming to the vaccination centre, which is usually crowded.

We urge the government to facilitate Covid-19 vaccinations for this group of vulnerable women. The existing network of nearly 2,000 public health clinics nationwide can be mobilised for this. Mothers should be vaccinated during their antenatal check-ups at clinics instead of at PPV to reduce their exposure to Covid-19 infection. We must make things easy for them.

We therefore urge the relevant committees to quickly modify the Third Edition of the guideline and deploy public health clinics to vaccinate pregnant women.

DR IMAN JEFFREY and DR SAADIAH SULAIMAN

Shah Alam