Masks and vaccines are going to be two key and complementary tools in the fight against Covid-19 pandemic, globally. The use of masks prevents individuals from getting infection. Vaccines reduce the probability of moderate to severe disease and hospitalisation (in all those who get infected). These are licensed once their safety and efficacy is proven, through clinical trials. However, though Covid-19 vaccines prevent moderate to severe disease, they do not prevent a person from getting infected. That is the reason masks are recommended even for those vaccinated.
With the emergence of the Delta variant, there is an increase in Covid cases in the UK. Though infections are happening, there is only a minor increase in hospital admissions. This is real-world proof that vaccines work. Therefore, everyone who is eligible should get vaccinated. Israel had removed the need for wearing masks in public places after it had vaccinated its adult population. However, with the emergence of cases, the mandatory masking is back in public places in Israel. It is clear that the roles of masks and vaccines are complementary and likely to be, till the world is in the midst of the pandemic.
Safe for all
In India, all adults are eligible for Covid vaccination. However, initially, vaccination was not recommended for lactating and pregnant women. The reason was that they had not been a part of the Covid-19 vaccine trials and no data was available on the safety of vaccines in these two sub-groups. However, in the last six months, more than two billion doses of Covid vaccines have been administered globally. This has provided a better understanding and additional confidence in the safety of Covid vaccines for all age groups, including lactating and pregnant women.
On May 19, 2021, the Indian government recommended the use of Covid vaccines for lactating or breastfeeding mothers. The vaccination of lactating women was advised and supported by the Indian Academy of Pediatrics (IAP) and the Federation of Obstetric & Gynecological Societies of India (FOGSI).
Since then, on July 2, 2021, Government of India also recommended vaccination of pregnant women as well. The recommendation is based on emerging evidence that pregnant women are at higher risk of moderate to severe Covid-19, which could result in rapid deterioration of their health and may require more intensive care than their non-pregnant counterparts. The severe disease in this group poses additional risk to the fetus - higher risk of pre-term birth as well as adverse pregnancy outcomes such as neonatal mortality. Some pregnant women, i.e. those with pre-existing health conditions applicable to any other age group, high body mass index and advanced maternal age are at even higher risk.
Benefit outweighs risk
It is in this backdrop that the National Technical Expert Group on Immunization (NTAGI) in India considered that the benefit of Covid vaccination outweighs the risk for pregnant women. Professional associations such as FOGSI had recommended and supported the vaccination of pregnant women for a while. It is time that the vaccination of pregnant and lactating women is prioritised and any doubt or query effectively addressed.
All lactating women should get themselves vaccinated as early as possible. There is scientific evidence that the vaccination of a breastfeeding mother provides some protection to infants or toddlers as well. A sub-type of antibody, IgA, which is formed after vaccination, can be passed on to the child through breast milk. It is a double benefit. Breastfeeding mothers should continue to feed their child, before and after vaccination.
Now, as per the Government of India advisory, pregnant women can get vaccinated at any point of time in the pregnancy. In more practical terms, if one is planning to get pregnant, it is advisable to get fully vaccinated before planning the pregnancy. However, if someone gets pregnant after receiving the first or second shot of the vaccine, there is nothing to worry about. As per current scientific evidence, there is no known risk of any of the currently licensed vaccines to the fetus. Still, if needed, pregnant women can consult the nearest health facility medical officer or a gynaecologist for any specific query before planning to get vaccinated.
The right time
For pregnant women, a suitable time to get vaccinated would be the 13th week onwards in the pregnancy. In this period, a pregnant woman needs to get Tetanus Toxoid (TT) vaccination done; it would be advised to either get TT vaccine on the same day or after a gap of four weeks. The adverse events after Covid vaccination are minor and similar in pregnant women, as in other age groups. Pregnant women should get a second shot of the vaccine at the recommended interval. There is no specific preference and any currently licensed Covid vaccine can be taken.
Fighting misinformation is also a key in responding to this pandemic. There are many myths/wrong information circulating on social media and in the community about Covid vaccines. You should ask a medical doctor, read from reliable sources such as government websites to get verified information. (I am happy to respond to readers’ queries on email).
As the vaccination of the pregnant and lactating has begun, and there will be a large group of this population, state and district health systems should vaccinate them on a priority basis and in a hassle-free manner. Family members should support the vaccination of pregnant and lactating women as much as that of every eligible adult member. Then, even after vaccination, we need to keep following Covid-appropriate behaviour by masking, handwashing and observing physical distancing at public places. This is how we can fight the pandemic together.
The writer is a medical doctor, epidemiologist and India’s leading vaccine expert. He is the co-author of Till We Win: India’s Fight Against The COVID-19 Pandemic. His email address is firstname.lastname@example.org