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Australia Pregnant women still largely ineligible for Pfizer COVID vaccine, despite health authority recommendation

22:40  20 july  2021
22:40  20 july  2021 Source:   abc.net.au

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Pregnant women are struggling to access to COVID-19 vaccines, despite a recent change in health advice recommending they be offered the Pfizer vaccine because they have an increased risk of severe illness from COVID-19.

In June, updated guidelines from the government's expert advisory panel on vaccines — ATAGI — and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) recommended the Pfizer vaccine be offered at any stage of pregnancy.

"This is because the risk of severe outcomes from COVID-19 is significantly higher for pregnant women and their unborn baby," they said in a joint statement.

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But in most parts of Australia (Tasmania or the Northern Territory being the exception), pregnant women under 40 are currently ineligible to get the Pfizer vaccine because they are not considered a priority group by the federal government.

Some women are getting access to the vaccine by meeting other eligibility criteria, such as if they have an underlying medical condition.

But others, like Talia Hagerty, are struggling to get vaccinated.

When the official health advice recently changed, Ms Hagerty quickly went searching for ways to get a Pfizer jab.

She first enquired at her GP clinic, but they were only offering the AstraZeneca vaccine, with priority given to patients receiving their second dose.

So she called the national vaccination hotline and visited several COVID-19 vaccination websites to book an appointment, but was unsuccessful.

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"The eligibility requirements don't include pregnant women because we're not a priority group, and I'm not old enough," said the 34-year-old New South Wales resident.

"Any of the online links that are circulating … if you indicate that you're pregnant, [that] will not [qualify] you to book an appointment."

Waiting for eligibility to change

Across the country in Western Australia, 34-year-old Megan Stone faces a similar dilemma.

She missed the window to get vaccinated when the Pfizer vaccine was offered to Western Australians aged between 30 and 49, before the WA government decided to prioritise people in their 50s just nine days later.

At the time, Ms Stone registered her interest, but held off making a booking because pregnant women had not yet been given a clear recommendation to get vaccinated.

Despite checking the box to be notified if she became eligible, she did not receive any updates when the advice for pregnant women changed — which happened during that nine-day window.

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"I just happened to not be watching [the news] like a hawk, and, of course, was disappointed," she said.

Her GP, following the federal government's eligibility requirements, also won't administer the vaccine.

"I am disappointed [but] still hopeful that perhaps it's because the federal government's been so slow with everything and now that the advice has changed, maybe they will put pregnant women into Group B or C," she said.

According to a spokesperson from the Department of Health, pregnant women are encouraged to discuss COVID-19 vaccination with their health professional, even though they are not considered a priority group.

"Many pregnant women may be eligible for COVID-19 vaccination for other reasons, for example, occupation," they said.

The spokesperson did not directly respond to whether the government intended to change the COVID-19 vaccine eligibility criteria, but said pregnant women are able to be vaccinated at GP practices and state-run vaccine clinics where there is enough Pfizer available.

"All Pfizer sites have been encouraged to facilitate the vaccination of pregnant women who are not otherwise eligible if they have capacity," the spokesperson said.

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Where doses are in excess, they said, "Practices have been asked to use strategies to minimise vaccine wastage such as maintaining a waiting list of eligible patients or vaccinate patients or staff who are eligible and present in the practice".

Latest evidence indicates vaccines safe in pregnancy

Previous advice had been that women who were pregnant and at a high risk of catching COVID-19, or who had medical conditions that make them more vulnerable to the disease, should consider getting vaccinated.

But COVID-19 vaccination was not routinely recommended to all pregnant women if levels of community transmission were low.

That's because at the time of initial guidance there was limited evidence confirming the safety of COVID-19 vaccines during pregnancy, as pregnant women were not included in the first clinical trials.

But over time, that advice has changed, as real-world evidence from other countries found mRNA vaccines such as the Pfizer jab are safe to administer during pregnancy.

A US study of over 35,000 pregnant women who had an mRNA COVID-19 vaccine did not identify any safety concerns, and found complications such as premature delivery and stillbirth occurred at a similar rate to what is seen in the general population.

At the same time, research shows pregnant women have a higher risk of becoming seriously ill from COVID-19 (including being hospitalised and admitted to ICU), and their babies also have a higher risk of being born prematurely.

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It's not yet clear whether there is an optimal time to have a COVID-19 vaccine during pregnancy, but pregnant women are encouraged to discuss the timing of vaccination with their GP or health professional.

Pfizer remains the preferred vaccine, as there is still limited data on the safety of viral vector vaccines — such as the AstraZeneca jab — during pregnancy.

What if I'm breastfeeding or planning to get pregnant?

For breastfeeding women, the Pfizer vaccine is also recommended, and authorities say it may even provide indirect protection to babies.

"There is also evidence of antibody in cord blood and breastmilk which may offer protection to infants through passive immunity," RANZCOG and ATAGI said.

As for women who are trying to become pregnant, health officials say there is no need to delay vaccination or avoid becoming pregnant after vaccination.

Vaccination does not affect fertility, and getting vaccinated before conceiving means you are likely to have protection against COVID-19 throughout your pregnancy.

"There is no evidence that women who become pregnant after receiving the vaccine are at increased risk of [foetal abnormalities], miscarriage or maternal illness," RANZCOG said.

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