The science is clear: pregnant Ontarians should get the COVID vaccine. Why are so many rejecting it?

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Alison Larroc’s parenting journey has unfolded in lockstep with the pandemic.

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Their eldest daughter was born in March 2020, just days after the Ontario government declared a state of emergency, forcing her to spend those early days of lockdown at her Ottawa home.

Larroc found out she was pregnant again the following February. Thrilled by the news, she and her husband begin to dream about their growing family. But as her pregnancy progressed, so did Ontario’s third COVID-19 wave.

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With cases rising, Larroc researched whether he should get the coronavirus vaccine. She recalls agonizing over the decision, adding to her concern as she faced conflicting reports and recommendations on whether COVID vaccines were encouraged in pregnancy. At the time, her own obstetrician couldn’t say with confidence that getting a COVID vaccine was the right call.

In early May, after hearing horrific reports of pregnant individuals ending up in the hospital, Larroc decided it was time to get vaccinated. But when the needle went into his hand, he still could not believe it.

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“I was so scared,” said Larroc. “I was crying. The nurse saw I was upset; she must have seen my pregnant belly. She said, ‘It’s good that you’re here. I’ve seen pregnant women in the ICU, and I don’t want you to be one of them. be one.’

“That was a really important moment for me. It confirmed that I was making the right decision.”

It’s been six months since Ontario prioritized pregnant people for the COVID vaccine after warnings from health care providers who were seeing an alarming number of pregnant patients coming to the hospital seriously ill with the virus .

Since then, there has been a continuous effort to vaccinate this vulnerable population.

Pregnant people with COVID are at significantly higher risk of serious illness requiring hospitalization and intensive care. During the third wave, some hospitals in Ontario saw more pregnant people in intensive care units than in the previous two waves combined. And in recent weeks in Alberta, amid that province’s devastating fourth wave, ICUs reported a surge of pregnant patients, some of whom gave birth while unconscious on ventilators.

With data accumulating around the world so far showing no safety concerns for pregnant people receiving the COVID vaccine, dozens of physician groups and health agencies are prompting pregnant people to get vaccinated.

Yet a worrying number have not been vaccinated.

As of October 3, an estimated 60 percent of pregnant people in Ontario were fully vaccinated, according to the most recent data published by the nonprofit research group ICES. During the same period, about 80 percent of the province’s vaccinated population was fully vaccinated. Doctors, midwives and epidemiologists say it is important to close this gap.

“It is extremely worrying that we are still seeing such a low uptake,” said Dr. Tali Bogler, president of Family Medicine Obstetrics at St. Michael’s Hospital.

“I am very concerned for my patients – my colleagues’ patients – that about half of them are actually vulnerable to COVID and there is a real risk of getting sick in their pregnancy. It really scares me.”

Researchers and health care providers emphasize that some pregnant individuals are anti-vaccine. Instead, many people come with vaccine hesitations, ranging from those with mild concerns to the fear of putting their fetus or unborn baby at risk.

“It is unfortunate that some are being labeled as anti-vaxxers,” said Dr. Rohan D’Souza, associate professor of obstetrics and gynecology at McMaster University.

“Many of them are keen to have other vaccines during pregnancy. But they have these genuine… concerns about the COVID-19 vaccine, which often stem from misinformation and concern about how they have been conveyed the message of safety.”

During her first trimester, Larroc read everything she found on COVID vaccines for pregnant people. She still remembers how frustrating it was to see conflicting advice from trusted health organizations.

First, the World Health Organization and the UK-based Royal College of Obstetricians and Gynecologists urged caution for pregnant individuals seeking a COVID vaccine.

In Canada, when vaccines first arrived, the National Advisory Committee on Immunization (NACI) recommended that pregnant people stop getting vaccinated until they have given birth, citing the need for more evidence. Give – until it is determined that the benefits outweigh the potential risks. And the Society of Obstetricians and Gynecologists of Canada recommends that they be given the option of vaccination. (Everyone has recommended vaccination since then.)

Although she knew that the COVID data was constantly evolving, Laroque found it difficult to adjust to varying situations.

“Canada has a different vaccine strategy for pregnancy than some other places, which caused me a lot of concern,” she said. “I was initially skeptical; Like how confident are we that this is the right thing to do? The recommendation to vaccinate pregnant women (in Ontario) scared me because there was no global decision. “

Dr. John Snellgrove, maternal-fetal medicine obstetrician at Mount Sinai Hospital, said inconsistent advice from various health organizations stems from the long-standing practice of excluding pregnant people from early vaccine trials, including COVID vaccines. Huh.

As a result, there was little safety data for pregnant people once the vaccine became available. This in turn forced some health organizations to recommend for the first time against COVID vaccination in pregnant populations, Snellgrove said.

“Some of the hesitation we are seeing now is related to those decisions,” he said. “I think the initial advice could have been written in a different language, something like: ‘We don’t have data on this particular group of people, but we have no reason to suspect it would be harmful.’

“Instead, it was cast in a more negative light.”

Health organizations around the world have since emphasized the importance of getting a COVID vaccine during pregnancy. Ontario’s Ministry of Health advises pregnant people to get vaccinated as soon as possible, and late last month the US Centers for Disease Control and Prevention issued an urgent advisory for those who are pregnant, breast-feeding or pregnant. We are considering a vaccine to “prevent serious disease”. death and adverse pregnancy outcomes.”

Despite these outspoken statements, Remi Ijiwunami, a registered midwives in Midwives of Mississauga, said some pregnant people remain concerned. They are afraid of harming their unborn child and want to see more long-term data, she said.

For them – especially those who have not been affected by COVID – it seems easier to hide from the virus than to face their discomfort about a vaccine.

“The perception of that potential risk – hypothetical things that could all be wrong – weighs more heavily in their minds than the actual known risk with COVID, increased risk of hospitalization and ventilation and death. It is,” Ijiwunami said.

For this reason, she and her midwife’s colleagues know that it can take several conversations with a pregnant person to talk about their fears.

“As with everything in pregnancy – ‘Do I take a Tylenol?’ ‘Should I have a genetic test?’ ‘Am I going to get vaccinated?’ – People who are pregnant are constantly balancing risks and benefits,” Ijiwunami said. “We try to give them the space and time they need to make decisions.”

Although Sarah Bankuti and her family are “very pro-vaccine,” Leslieville’s mom — currently 36 weeks pregnant — was terrified of getting a COVID jab last spring during her first trimester.

Two years earlier, their eldest daughter, Alice, was diagnosed with a brain tumor when she was only 10 months old, and Bankuti feared the cancer would strike her family again. She didn’t want to do anything, not consume anything that would affect her pregnancy, including getting vaccinated against COVID-19.

“I know there was nothing I could do to prevent Alice’s tumor; I know it,” said Bankuti, author of a children’s book series for children with cancer. “But it’s still always in the back of my mind.

“When I got pregnant again, I was very careful. Especially in the first trimester; you’ve been told this is the time to be most careful. I was so worried just to get a vaccine I didn’t know that much about I didn’t want it to have a negative effect on my child.”

His conversation with his obstetrician, Dr. Tara McLeod, helped convince Bankooty that the COVID vaccine provides the best protection for him and his unborn child.

“I was very honest with him about how I was feeling,” Bankuti said. “She took the time to listen to how I was feeling and walked me through the scientific evidence. She didn’t rush me and that meant everything to me.”

Bankuti got his first shot in late April and the second in June. Now, weeks before her second child is due, Bankuti is happy she is safe, especially now that Alice is undergoing chemotherapy.

Sara Bankuti and her 2-year-old daughter, Alice, in their Toronto neighborhood.  Alice was diagnosed with a tumor at 10 months, and initially Bankuti didn't want to do anything, eat anything she thought would affect her current pregnancy, including getting a COVID vaccine.

Over the past six months, McLeod, an obstetrician and gynecologist at Michael Garrone Hospital, has spoken with dozens of anxious pregnant patients.

In each conversation, McLeod says that she takes the time to listen to their specific fears, then explains to them how vaccines work. She also shares the experience of one of her own unrelated pregnant patients who became so ill with COVID that they required ICU care. And she tells patients that she herself was sick with the virus and was out of work for six weeks.

“I tell them I have it and I don’t want it on anyone.”

While many of her patients are now fully vaccinated, McLeod has a few holdouts that worry her. She hopes with each appointment and…

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