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Woman preparing to go out wearing a surgical mask

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Pregnant people of all races are at increased risk for serious COVID consequences. Bearing that in mind, you would expect them to be prioritized for the vaccine with seniors, but in 36 states thus far, they haven’t been. The impact of COVID-19 is felt by us all, but expectant mothers are more likely to be hospitalized and potentially die from the virus. The pharmaceutical companies and medical system’s way of protecting them has turned into a trifling discrimination, associated with even more preventable deaths in the Black community. The vaccine timeline is quickly progressing and over 2.4 million doses are administered, per day. We are all waiting — with bated breath — to share space maskless again. But before this vaccine campaign wanes, we must address Black mamas and pregnant people in this paradox of paternalism.

Equity is providing a just and fair distribution of a good or resource. Health equity is an important concept; it requires that we provide resources commensurate to the need so that all groups can have fair and just access to wellness, opportunity, networks, resources and supports to reach our full potential. When there is a significant difference between the health outcomes of two groups, Black birth outcomes and Latinx birth outcomes for example, it indicates an inequity in lived experience or their access to treatment. The goal to have an equitable rollout of the coronovirus vaccine is compromised.

Prioritizing our elders and high-risk folks is sensible because they have comorbidities that cause unpredictable reactions with the coronavirus. The first doses of the COVID-19 vaccine went to them, healthcare workers, frontline workers, and people with serious chronic conditions. Pregnancy is not an illness, but based on outcomes data, pregnant people who contract COVID-19 have a higher probability of being symptomatic and dying. COVID-19 infection was also proven to have an impact on preterm birth. Pregnant people experience higher risk, and pregnant people are everywhere. They are working at the local grocery store, driving city buses, taking their children to school, on college campuses, and caring for their elders. Giving them priority access is a level of early protection and it’s necessary.

Protection is the paradox. Pregnant women are routinely excluded from vaccine trials. It is accepted in research methodologies and bioethics that drug trials should not be conducted on pregnant people because the effect on the fetus is unknown. This exclusion is a smart decision on the pockets of private businesses because drug trials with pregnant women have gone awry in the past. However, the World Health Organization suggests the COVID-19 vaccine is safe for all. Moderna, Pfizer and Johnson & Johnson were either trying to protect pregnant people from potential harm to their changing bodies or protect themselves by ensuring they’d be the first companies in the world to get groundbreaking mRNA vaccines in arms. The priority is debatable; who is being protected in this process? Pregnant and birthing people, or pharmaceutical companies?

The second barrier for pregnant women are the phases of vaccine rollout. The Biden-Harris Administration has set the ambitious goal of getting every adult free access to a COVID-19 vaccine by May 1. Many states are opening eligibility of vaccination to Group 3, already. I am in Group 3 in my state of North Carolina and I just learned that I am eligible for the vaccine because I am a public health worker. I am considered a second-line healthcare professional, even from the comfort of my home. I am a healthy Black woman and ready to get this vaccine. However, I cannot fathom that another healthy Black woman who is pregnant may be waiting for the final group to be notified.

State policymakers can make an equitable choice to move pregnant women to the forefront of vaccine eligibility. Adding them to a state’s priority list is a simple change, so the political and bureaucratic undertones are visible. This paternalistic posture with pregnant women’s lives is disturbing, especially since “health equity” has clearly laid out the rules of engagement. When health equity is not an option, there is some inevitable discrimination in its place.

Moderna, Pfizer and Johnson & Johnson would rejoice to have another market to conquer with vaccines. In the spirit of capitalism, how are pregnant people still not an immediate priority for medical research and health communication? Women are already devalued in society, Black people are at higher risk for COVID-19 and Black women are experiencing poor outcomes due to systemic racism. We must be sensitive to protecting these mamas and prioritizing a range of the best options for them.

The double-sided coin of not being included in the pharmaceutical trials, yet being at higher risk for severe complications from COVID-19 can be an overwhelming concept for policymakers and for mamas. With appropriate education, pregnant and birthing people will know the implications of taking the vaccine, and policymakers will give mamas an early choice, through eligibility.

Carmen Green, MPH
VP of Research & Strategy
Sociology, University of California, San Francisco
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