Three key strategies to improve maternal immunization rates


Even before the COVID-19 pandemic, pregnant women were at high risk of negative health outcomes from certain vaccine-preventable infectious diseases such as influenza and whooping cough. The pandemic has taught us two valuable lessons: pregnant women are an important group to include when assessing disease impact during an outbreak, and pregnant women should not be excluded from vaccination when Safe and effective vaccines are available for the general population. It is important for the medical community to better understand and act on these lessons so that we can use vaccines to prevent serious illness in pregnant women and their babies.

As a pediatric and infectious disease researcher and professor, I want to share three key strategies that can be addressed now to improve maternal immunization.

One strategy to increase maternal immunization is to routinely include pregnant women in studies assessing the impact of vaccine-preventable diseases that affect women and their babies. They should also be included in clinical trials of new vaccine technologies. This is important for ensuring overall maternal and child health – and even more critical for preparing for the unlikely event when we face another pandemic. Appropriate funding and support can make this effort a national priority.

Despite the fact that pregnant women were initially excluded from vaccine clinical trials, we have already seen tremendous progress on the issue of including pregnant women in lifesaving research during the COVID-19 pandemic. Through these efforts, we were able to determine the risks and benefits of vaccination against COVID-19 during pregnancy.

However, vaccination against COVID-19 in pregnant women is lagging in the United States, and other infectious diseases that affect pregnant women or their newborns could also benefit from development, testing , accelerated approval and distribution of vaccines. Examples include:

  • Cytomegalovirus (CMV), which is generally harmless to most women but is the most common infectious cause of birth defects
  • Group B streptococcus, which is a well-known cause of neonatal sepsis
  • Respiratory syncytial virus (RSV), which is a major cause of infant deaths in the first months of life.

The development and implementation of vaccines against these diseases has been difficult to date.

We also need to improve public awareness of the importance and safety of vaccination for pregnant women and infants, especially in underserved communities in the United States and around the world that lack reliable access to Health care. Worldwide, almost half of all deaths of children under the age of 5 occur in their first month of life. Too often these babies and their mothers die of a serious disease that could be prevented by vaccines.

Faced with the decision to get vaccinated against COVID-19, many pregnant women have shared their fears that the FDA’s COVID-19 vaccine approvals are premature and dangerous. We need to build trust between healthcare providers and their patients and share our research with the public in an unbiased and understandable way.

Finally, it is necessary to put in place concrete actions to strengthen maternal vaccination against vaccine-preventable diseases. In addition to academic champions of maternal immunization, support from professional organizations, industry, funders, regulators, and patient and vaccine advocacy groups is critical to improving maternal and child health. I recently discussed these strategies with my colleagues at the World Vaccine Congress.

Advancing this cause often feels like an endless climb. But I remain optimistic because of all that we have achieved in recent years, and I know that we are making progress. We still have a lot of work to do, but mothers and children everywhere deserve nothing less.

Flor Muñoz, MD, is associate professor of pediatrics and infectious diseases at Baylor College of Medicine and director of transplant infectious diseases at Texas Children’s Hospital in Houston, Texas.


Muñoz disclosed funding for the research from NIH/VTEU, CDC, Gilead and Pfizer. She has ties to special groups, including AAP-COID, ACOG Immunization Expert Group, COVAX-CEPI, and GAIA-SPEAC, and she serves on the Data Safety Oversight Committee for various NIH projects, Pfizer (for RSV ), Moderna (various vaccines), Meissa (for RSV) and Virometix (RSV).


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