Why pregnant women should get vaccinated, and what to say if they're hesitant

A vaccine-hesitancy expert says there are three main reasons why pregnant women in Canada aren't getting vaccinations.

Dr. Noni MacDonald is a well-known pediatrician who specializes in infectious diseases and teaches at Dalhousie University. She also chairs the World Health Organization's Decade of Vaccines working group, which is reviewing whether progress is being made in international immunization rates and aims to develop a 10-year global vaccine plan.

On Tuesday, she spoke about vaccine hesitancy at the Society of Obstetricians and Gynecologists of Canada's conference in Halifax.

She also spoke with CBC News reporter Elizabeth Chiu about why pregnant women in Canada don't have high vaccination rates and what can be said to help them overcome their hesitations.

This interview has been edited for length and clarity.

What vaccines are recommended for pregnant women in Canada?

Vaccines for pregnant women are very important, both influenza vaccine and pertussis vaccine (tetanus, diptheria and pertussis). Study after study has shown us how important this is and that it can improve not only the health of the pregnant mother so she doesn't end up being hospitalized, but for the baby.

For influenza, it can improve birth weight, it can decrease hospitalizations for serious respiratory illnesses in the first six months of life.

And [it's] the same thing with pertussis. What many people may not understand is that for pertussis or whooping cough, the highest rate of mortality is in babies that are under three months of age. And yes, we start immunizing them at two months of age, but it's not really protective until they've had two or three doses of the vaccine, so one of the best ways you can protect your baby against whooping cough is for that pregnant mother to be immunized.

It's really a twofer, a benefit for the mother and a benefit for the baby, so it's a two-for-one vaccine.

What is vaccine hesitancy with pregnant women?

Hesitancy has been clumped into three big categories. One of them is complacency, "I just don't see myself at risk, I've got other things that are much more important, so I'm not going to go and get immunized."

The other one is about confidence. That's the safety stuff or trust in the system.

But the other one about convenience and constraints, that's a big deal. For example, suppose you had your checkup at your prenatal visit with your family doctor and they weren't able to immunize you because they didn't have the right vaccines, and then you had to go and make another appointment to come back or go somewhere else to get those vaccines. That may mean if you were a by-the-hour worker that you had to take another morning off work to go and do this, that's a real problem. Access is a big deal.

How do you overcome the hesitancy?

You have to find out why somebody is being hesitant. There's no magic bullet, there's no fairy dust to sprinkle. You need to find out what their concerns are and what it would take them to move to a yes.

Some people are afraid of needles. That's very different than if it's a convenience issue. For some people, it's "I never thought this was very important." They're not that concerned about safety, it just didn't rise up high enough in their list. So, then you need to talk about the benefits of the vaccine and the benefits to the mother and to the unborn baby, and for when the baby's delivered. But that's not going to help somebody where their problem is they've got real safety concerns.

What's the rate of vaccination?

In Canada, we've never had high uptake rates of vaccination of pregnant women. We've been trying to grow that, but it's not where it needs to be. Depending on where you are in the country, you might be at 40 to 50 to 55 to 60 per cent for influenza vaccine, and we would like it to be over 80 per cent. So, we're better than we were 10 years ago, but we're not where we need to be.

In the United States, they're having a significant outbreak of measles, they may even hit 1,000 cases before the year is done. And they actually have a higher overall immunization rate for measles than we do, so we're just a sitting duck here should measles come in with any kind of vengeance.

Where do people get correct information?

I hope you'll send people to the good information on the websites for the Public Health Agency of Canada, the Society of Obstetricians and Gynecologists, and the Canadian Public Health Association. Immunize Canada also often has good stuff.