It’s new.
It seems rushed.
You are pregnant (or want to be).
Or you are breastfeeding.
You are nervous about whether to have it.
So here is my advice…

I cannot tell you whether you SHOULD have the vaccine.
I also cannot tell you WHICH vaccine you should have (presuming you even have a choice).
What I can tell you is what QUESTIONS you need to ask YOURSELF about the vaccine and about your own situation.
Then you can make a balanced decision about what to do in your own situation.
The Commonwealth Govt has quite a good guideline that I include a link to in the bio.

Questions you need to ask yourself:

Do I believe and trust the science?

The science behind vaccination is well established. Sure, this is a new virus. Sure, some of the vaccinations are based upon new approaches. However, none of the vaccinations include the ‘live virus’*, simply genetic replications of parts of the virus. It is not possible to ‘get’ COVID from the vaccination.There is no scientific reason to suspect that having the vaccination in pregnancy can cause harm to the developing fetus.
*some vaccines overseas are trialling a modified form of the live virus

How does the Immune System work?

You don’t need a year 9 science lesson but, frankly, if you want to make a considered decision then you need to understand the basics.
The three prongs of the system that protects us from infection are:

  • The Innate immune system – an inborn system of immune responses we are born with. Cells recognise patterns for specific infectious particles. The capacity for infection recognition seems to be genetically transferred from parent to offspring. This system of protection against infection is, therefore, inborn and works immediately to protect the newborn before the longer timeframe required for the Cell-mediated and Antibody system to become effective. They are slower to get established but then become much more effective, fast and specific.
  • The Cell-mediated immune system. Includes cells that search for infected cells and ‘T’ cells of different types. Cells in this system work together to kill virally infected cells and clear the infection and its aftermath. Proteins from potentially infected cells are presented to the T cells that kill the virus-infected cell. This system also supports the production of antibodies in the humoral system. However, whilst antibodies can PREVENT infection, the cell-mediated system is needed to fight and clear the infection.
  • The Humoral (or Antibody producing) immune system. Antibodies are produced against invaders. These include different types of antibodies: IgG, IgA, IgM, IgE. Most importantly, memory antibody cells are created that remember specific invaders and rapidly mobilise to protect us when a second exposure to infection occurs. This is the basis of vaccination.

What are vaccinations? Are they all the same?

In essence, they all aim to trick the body’s immune system into recognising certain parts of a virus (in the case of coronavirus it is the funny little spikes on the surface of the virus – the ‘spike protein’) and provoke the immune system into making antibodies and other strategies to potentially destroy the invading virus. Most importantly, the immune system can respond very rapidly if ACTUAL infection with coronavirus occurs).
There are different vaccination platforms:

  • Inactivate vaccines (Influenza and polio vaccines)
  • Live attenuated vaccines (Measles)
  • Protein or protein subunit vaccines (diphtheria, tetanus, Hep B)
  • Recombinant protein vaccines (HPV vaccine – ‘Gardasil’)
  • Vector vaccines (The Astra-Zeneca vaccine)
  • DNA vaccines
  • RNA vaccines (a completely new approach. Includes the Pfizer and Moderna vaccine)

The vaccines have been developed super-fast. Has there been enough testing?

We are so fortunate to have government agencies such as the Therapeutic Goods Authority (others include the FDA in the USA) that rigorously assess substances for their safety and efficacy before they are released for use in Australia. Being certain about a particular drug or vaccine takes time to evaluate. However, sometimes the threat posed by a communicable disease is so extreme that agencies must respond rapidly and take a balanced risk approach to authorising use of medications. Like Covid vaccines. However, this is a serious business and the TGA is very strict in Australia and does a thorough analysis of all the information. They carry the burden of making good decisions on our behalf. They do a good job.

How is the COVID vaccine tested for safety?

Essentially, getting new drugs or vaccines from concept to market involves 3 phases of pre-licencing testing:
Phase I assess safety, dosage and immune response in small numbers of people
Phase II larger numbers of people – hundreds – are enrolled to identify optimal dosing (how much, how often, how far apart)
Phase III thousands of people are enrolled to see how effective the vaccine is against the disease.
To get to the end of phase III usually takes about 10 years. The process has been truncated by overlapping the phases or combining them to save time but not compromise safety.
The crisis of coronavirus has compelled agencies to fast-track approval for testing and scientists are working double-speed to get results analysed and published.

Why aren’t pregnant women included in the vaccine trials?

They never are. There is a myriad of reasons why pregnant women are not put into trials, at least until a drug is already shown to be extremely safe in non-pregnant people or after following up pregnancies where a drug has been given ‘by accident’. The historical experience of drugs such as thalidomide has forever traumatised pregnant women, doctors, insurers and drug manufacturers. Nobody wants to take the risk that a new ‘trial’ drug might cause fetal abnormalities.

WE are fortunate that many pregnant women in the USA have been brave enough to have the vaccine, based on the theoretical safety of the vaccine based on the science. We are all waiting for the follow up information from studies of these women.

Is there a reason why I SHOULD NOT I get the vaccine?

Theoretically there is a RARE risk of a serious allergic reaction (as for ANY medication). This has been reported at about 5 reactions per 1 MILLION doses and usually in people with pre-existing allergic reactions. COVID-19 vaccines have not been ‘tested’ on pregnant women. It might not work anyway.

What side effects might I experience?

Soreness at the injection site
Lymph node enlargement
Muscle soreness

Am I in a risk group to contract COVID-19?

Yes, because you are a human being who lives in a community. As we all realise now, it can pop up anywhere, anytime, amongst anyone. Nobody is completely safe.
However, some groups are more likely to be exposed:
Healthcare workers, aged care workers
And some groups are more likely to get severe or fatal disease:
Elderly, people with pre-existing illnesses.

Should I just avoid COVID rather than get the vaccine?

Sure. This is the ideal situation. It is just not realistic.
Unless you plan to live alone in a remote cave, you will be potentially exposed.
Are you confident you will be one of the lucky people who gets no symptoms?

I would rather avoid this new vaccine (besides, I am not in at at-risk group) so do I really need it?

Are you confident that you will not unwittingly pass it on to your family members?
Are you confident that all the people you have contact with in your daily life will not get sick?
How will you feel if you pass it on to someone who gets sick or dies? How would you feel if that person was your partner, your child, your parents? Will you feel you did everything you could to protect them? Or will you rationalise the risk (they probably picked it up from someone else…)

Should I have the COVID vaccine if I am breastfeeding?

Yes is the short answer.

Breastmilk has loads of antibodies and other substances that support the newborn immune system. However, it is important to know that many of these antibodies are not actually available to the newborn.
Almost as soon as a human baby is born (other species are different), the gut closes to the absorption of IgG antibodies into the bloodstream. The main antibody that protects the newborn through breastmilk is IgA. This provides protection of the newborn’s mucosa (cells that line the gut and the respiratory system) against infection. It has been shown that breastfeeding protects newborns against gut infections (eg rotavirus, other diarrhoeal illnesses) and respiratory infections (pneumonia, RSV, COVID….(?) that attack across mucosal surfaces. However, newborns are not protected against all infections through breastmilk. Other factors in human milk support the newborn’s innate immune system. Antibodies are present but not all will be available to the newborn. Even if the mother is immune to diphtheria, for example, the antibodies in the mother’s blood will be excreted into breastmilk but they are not necessarily available to the newborn for its own protection (hence why vaccination is still critically important for babies whether they are breastfed or not).

Therefore, COVID vaccination will likely provide some factors that will help the breastfed newborn (and will not hurt the baby). However, the best protection for a baby is to have a mother that does NOT get the virus.

The vaccine might be SAFE but is it EFFECTIVE?

There are some differences in the effectiveness of the vaccines, based on information gleaned SO FAR from studies.

Pfizer – 95% effective after the second dose (a good vaccine but the need for extremely cold storage makes it difficult to deliver)
Moderna – 94% after second dose
Astra-Zeneca – 90% Some published data put this at a lower number – about 74% but further tweaking of the dose/ timing has improved the efficacy (this is currently the only vaccine that will be manufactured in Australia)

So in summary, I suggest you consider the following logical approach:

Am I a human being?
Yes (episodes of squealing like a pig when excited, working like a dog or screaming like a banshee does not diminish your humanity despite what your partner might say at times).

Do I live in a community?
Yes (Yes, you do, even if you hate and avoid your neighbours or annoying family*). *think Megs and Haz.

Am I wanting to get pregnant?
If yes, then have the vaccine as soon as you are eligible. (If you are an anti-vaxxer or a conspiracy theorist you have already made up your mind. You can discuss it with your own doctor but not me because I will be fully booked when you call for pregnancy care. I will be washing my hair that month and will only be available for existing patients and non-A-Vs). If you are open to vaccination but still have doubts, then wait a bit but be extra careful with the COVID avoidance principles.

Am I breastfeeding?
As above, I think yes – definitely get the vaccine.

Am I pregnant?
Your choice.

My advice is:

If in first trimester: then avoid until after 14 weeks UNLESS you are at high risk of ACTUALLY getting COVID. Given the low community transmission currently, it is reasonable to wait until after 14 weeks when most organogenesis (organ development) in your baby has been completed.

If beyond first trimester: your options are to avoid vaccination until after birth. I have seen stories on social media frightening women into not having the vaccination due to concerns about women not being included in the studies. However, as per my information above, the theoretical science and the experience to date would support the safety of the vaccine in pregnancy. FURTHER, as per the information above regarding breastfeeding, not all antibodies are available to newborns through breastmilk. HOWEVER, the mainstay for newborn protection against infection is the PASSIVE TRANSFER of antibodies – including IgG – ACROSS THE PLACENTA. These antibodies ARE available to newborn because the antibodies have already entered their bloodstream across the placenta. These antibodies will only last 2-4 months but will provide specific protection against infection until the newborn’s own immune system has had time to gear up. Hence, a pregnant woman who is vaccinated against COVID will create antibodies that will passively transfer to the fetus and still be available to the newborn baby. Many scientists believe this is will be the mainstay of newborn protection against COVID, at least as important, or even more so, that any breastfeeding protection.

Am I at higher than average risk of contracting COVID? If you are in an at-risk group, then being able to avoid contracting it may be difficult. Current levels of low transmission are not a guarantee the little blighter has gone away. If anything, the increasing vaccination rates are likely to lead to a much greater level of community complacency. Then we will see new outbreaks. Further, vaccination will allow more overseas travellers to return, bringing their pesky new COVID variants with them. As we know, our first line of defence (screening and hotel quarantine) is hardly watertight (and definitely not COVID-tight!).

Therefore, if you are at risk of COVID, cannot isolate, have other children (running around in the community and licking everything then bringing their germs home with them) or want to provide a higher level of protection to the newborn, it is reasonable to consider pregnancy vaccination. I admit that I, personally, would be vaccinated in pregnancy between 14-36 weeks (so the antibodies can form and cross the placenta), having now read the scientific papers. It is YOUR choice, however, and you should do what YOU feel most comfortable doing.
Of course I am willing to discuss your personal situation with you during a visit.