Addressing the immunization gap for mother and child’s health

Emerging and re-emerging infectious diseases are infections that have newly appeared in a population (e.g., COVID-19) or have existed previously but are rapidly increasing in incidence or geographic range. The re-emergence of measles, diphtheria, and whooping cough (pertussis) is related to the inadequate vaccination of the population.

“There is a critical gap in the global vaccine response to emerging and re-emerging pathogens with regard to pregnant women and their offspring. This gap poses a threat to maternal and neonatal health outcomes,” warned Dr. Lorena Santos, president, Philippine Infectious Diseases Society for Obstetrics and Gynecology (PIDSOG).

Speaking during the Health Connect webinar dubbed “Championing Maternal Health,” Dr. Santos presented ways to prevent health risks during pregnancy that stem from this critical gap.

First, health information systems and disease surveillance systems should be strengthened and integrated to ensure that relevant data on maternal, obstetric, and newborn health outcomes can inform scientific and public health responses to emerging pathogenic threats.

Reliable health information and disease surveillance systems are essential to an appropriate and rapid response to the threat of emerging pathogens, Dr. Santos explained. Collecting relevant data on these health outcomes can advance the interest of pregnant women and their children by establishing baseline rates or specific outcomes to pregnancy and the postpartum period. This can enable detection of significant increases in adverse maternal, fetal, or newborn events, among others.

Second, develop and implement evidence-based strategies to promote confidence about vaccination in pregnancy ahead of outbreaks, including stakeholder engagement with healthcare providers, women, their families, and their communities. This approach should be a collective effort involving the Department of Health (DoH), healthcare providers, professional medical societies, community leaders, civil society organizations, vaccination advocacy groups, research institutes, and the media. Inadequate vaccine confidence leads to suboptimal uptake of safe and effective vaccines, and fake news spreads quickly.

The challenges associated with vaccine confidence can be especially pronounced among pregnant women and their health providers, given the concerns and mixed messaging about potential harm and the limited data on the safety and immunogenicity of vaccines in pregnancy. There is also the well-characterized issue of risk distortion, she added.

“Unless vaccine confidence among pregnant women and their health providers is enhanced, these suboptimal coverage rates will persist. Therefore, action must be taken in advance of any public health emergency,” Dr. Santos stressed.

Third, communication plans should be developed for clear, balanced, and contextualized dissemination of vaccine study findings, recommendations for use in pregnancy, and any pregnancy-specific adverse events.

“Adapting existing strategic risk communication resources for vaccination can help improve communication to mitigate pregnancy-specific concerns. The communication should be sensitive to the critical role of healthcare providers in increasing vaccine acceptance,” she explained.

Dr. Santos also underscored the importance of engaging with traditional and new media prior to and during outbreaks. “Media plays a very critical role in providing the general public with real-time information, including research findings, about the epidemic and the response to it.” The Health Connect Forum, being organized by the Philippine Foundation for Vaccination and Philippine Medical Association alongside the Pharmaceutical and Healthcare Association of the Philippines and Sanofi Pasteur, remains to be a platform for the media and the public to cascade medically verified information.

Lastly, whenever possible, the perspectives of pregnant women should be considered in designing and implementing vaccine studies in which pregnant women are enrolled in or in which women enrolled may become pregnant.

Community engagement and participatory-based approaches to biomedical research have been increasingly recognized as a good practice in the design and conduct of research involving human subjects, more so during outbreaks and epidemics.

“We need to solicit the perspective of pregnant women subjects from the communities where the research is being conducted,” Dr. Santos said. This can be important in various aspects of the study design, including determining what information and outcomes are the most important to pregnant women, ascertaining culturally relevant considerations for the consent process, and establishing frequency and location of study visits based on their daily demands throughout pregnancy.

Apart from addressing emerging and re-emerging infections, there is also a need for substantial efforts to advance maternal immunization which can protect both mother and infant from endemic as well as epidemic diseases. Dr. Santos appealed to the government to include pregnant women in the agenda when decisions about investment and funding are made.

Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP). PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.