Maternal immunisation: how driving uptake can protect more infants from their first breath
This article has been independently authored but was commissioned by Pfizer Ltd. Content was written by Dr. Chrissie Jones, Dr. Fatima Husain and Vanessa Greening with review by Pfizer Ltd to ensure compliance with regulations. The authors have not received any payment for writing this article.
In 2012, pertussis (whooping cough) caused 14 infant deaths across the UK1. In response, vaccination against pertussis was recommended during pregnancy to protect infants against pertussis, right from birth2. This has proved to be highly effective1, and has prevented 1,400 – 4,300 infant hospital admissions and 41 – 96 infant deaths from 2012 to 2017 in England3.
Vaccination during pregnancy boosts the production of protective antibodies, which are transferred from the mother to the baby during pregnancy4. These maternally-derived antibodies help protect the newborn who is particularly vulnerable during the first few months after birth4.
The maternal pertussis vaccine programme has been a success, but we can do better. Since the COVID-19 pandemic, annual pertussis vaccination coverage has fallen slightly to 64.7% from 70.5%5 and concerningly, there is significant variation across the country. Uptake reaches nearly 80% in Shropshire, but only around 30% in North London5. Factors in the equity of vaccine uptake include age, ethnicity, and socioeconomic status6. Reasons for vaccine hesitancy include poor communication of vaccine safety and potential benefits, lack of long-term safety data, lack of recommendations from trusted sources and mistrust of healthcare providers6. We need to use this understanding to ensure that everyone receives appropriate education on the vaccines recommended in pregnancy to improve uptake across the whole population.
How does maternal immunisation align with policy priorities?
One of the 10-year ambitions in the Women’s Health Strategy for England is to reduce disparities in outcomes and experiences of care for mothers and babies7.
Additionally, the NHS is accelerating preventative programmes that engage those at greatest risk of poor health outcomes within local maternity systems8.
Effective communication utilising multiple channels, training for all relevant staff to increase access and uptake of recommended vaccines to a diverse population, and broadening opportunities for women to receive recommended vaccines in different locations, including antenatal clinics and selected community hubs, would support these NHS priorities.
How can we best communicate with pregnant women?
To drive change, we need to deliver clear, consistent, and sustained messaging to decision makers, healthcare providers and to the public about the potential benefits and possible side effects of vaccination during pregnancy for both the mother and baby.
Women discuss decisions around health in pregnancy with those they trust: family, friends, community members as well as healthcare providers6. To be successful, campaigns must harness this. Testimonials from a diverse range of peer ‘vaccine champions’ that are relatable can help women consider their options. Sharing messages over social media, alongside traditional channels, allows us to reach audiences where they are already searching for answers.
Of all information sources, midwives and GPs have a particularly significant role and their ability to communicate messages confidently and empathetically holds significant potential to drive progress6.
It will be crucial to invest in a range of communication strategies and tailored programmes based on different needs, to optimise the message and outreach to a diverse population.
We call on the UK government to support improving vaccination coverage in pregnancy - especially for those communities with a historically low uptake of vaccination during pregnancy.
As science continues to research maternal immunisation as a method of preventing other serious infections that impact society’s youngest and most vulnerable, we must aim to reach the whole population of expectant parents, so that all can potentially benefit from these advances, now and in the future.
Date of prep: January 2023
1 Amirthalingam G, Campbell H, Ribeiro S, Fry NK, Ramsay M, Miller E, Andrews N. Sustained Effectiveness of the Maternal Pertussis Immunization Program in England 3 Years Following Introduction. Clin Infect Dis. 2016 Nov 12;63(suppl 4):S236–43. Available from: http://cid.oxfordjournals.org/lookup/doi/10.1093/cid/ciw559
2 UK Health Security Agency. Pertussis : the green book, chapter 24 [Internet]. Available at : https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/514363/Pertussis_Green_Book_Chapter_24_Ap2016.pdf.
3 Sandmann, F et al. Infant Hospitalizations and Fatalities Averted by the Maternal Pertussis Vaccination Program in England, 2012–2017: Post-implementation Economic Evaluation. Clinical Infectious Diseases, 2020:71:1984–1987
4 D’Heilly, C., Switzer, C. and Macina, D. Safety of Maternal Immunization Against Pertussis: A Systematic Review. Infectious Diseases and Therapy, Infect Dis Ther. 2019 Dec;8(4):543-568
5 UK Health Security Agency. Pertussis vaccination coverage for pregnant women in England, January to March and annual coverage 2021 to 2022 [Internet]. The United Kingdom. Available at: https://www.gov.uk/government/publications/pertussis-immunisation-in-pregnancy-vaccine-coverage-estimates-in-england-october-2013-to-march-2014/pertussis-vaccination-coverage-for-pregnant-women-in-england-january-to-march-and-annual-coverage-2021-to-2022.
6 Husain, F. et al. COVID-19 vaccination update in 441 socially and ethnically diverse pregnant women PLoS ONE 2022:17: e0271834: https://doi.org/10.1371/journal.pone.0271834
7 Department of Health and Social Care. (2022). Women’s Health Strategy for England. [online] Available at: https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england#fertility-pregnancy-pregnancy-loss-and-postnatal-support
8 NHS England (2021). NHS England, Equity and equality: Guidance for local maternity systems. [online] www.england.nhs.uk. Available at: https://www.england.nhs.uk/publication/equity-and-equality-guidance-for-local-maternity-systems/.
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