We will no longer be able to hear the soothing voice of Siti Sarah who succumbed to Covid-19 infection and left an orphan born at 28 weeks’ pregnancy – a tragic incident that follows many other pregnant mothers before her. She was unvaccinated against the virus as were the rest of maternal deaths with Covid-19.
This leads us to seriously question the Covid-19 vaccine administration policy for pregnancy in this country.
There are a few concerns that need to be urgently addressed and if further ignored, will lead to many more unnecessary maternal deaths due to Covid-19 infection.
In reference to the Clinical Guideline for Covid-19 in Malaysia that was published in the 2nd edition on 13th April 2021, it was mentioned on page 69:
“When can a pregnant mother be vaccinated? Between 14-33 weeks of gestation.”
“Should the second dose be administered to a woman who finds out she is pregnant after getting the first dose? Yes. However, the second dose should be deferred until 14 weeks of gestation.”
It took two months for the committee to improve and come up with the 3rd edition, on 12th July 2021, however the deadly sentence remains:
“First dose of the vaccine is to be administered between 14-33 weeks of pregnancy” – page 110, despite witnessing increasing deaths among pregnant mothers with Covid-19.
The committee, also represented by six O&G specialists, continues to ignore guidelines used in other countries, amidst increasing Malaysian maternal deaths. The Royal College of Obstetricians and Gynaecologists (RCOG) United Kingdom states: “The vaccine is considered to be safe and effective at any stage of pregnancy”.
Even The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australian Technical Advisory Group on Immunisation (ATAGI) explicitly mentioned that pregnant women should be routinely offered the vaccine at any stage of pregnancy.
Pregnancy outcomes following mRNA vaccination (Pfizer-BioNTech and Moderna) appear similar to comparator groups prior to the onset of Covid-19. The most common adverse outcomes among 724 livebirths in the study by Shimabukuro et al (June 17, 2021) were preterm birth (9.4%), small-for-gestational-age (3.2%) and major congenital anomalies (2.2%) – all consistent with published rates. None of the mothers had babies born with congenital anomalies.
Therefore, we would like to enquire on where the “window period of 14-33 weeks” was extrapolated from and if there is no strong basis to this, we urgently call upon the committee to remove this deadly statement from the guideline.
This deadly sentence cultivates fear among our mothers to get vaccinated, especially for those above 33 weeks.
More importantly, we demand a clear, simple and straightforward guidelines as these guidelines are being used religiously throughout the nation by our Klinik Kesihatan (KK), staff nurses and vaccination providers and even by some O&G specialists.
There are still mothers in their 30th week of pregnancy who were turned down by the KK and advised to wait for the notification in MySejahtera, which may only appear at 33 weeks, which means they may not get vaccinated.
Yesterday itself (personal communication), two mothers were rejected by vaccination centres for first-dose vaccination at 35 weeks and 38 weeks. This occurred despite having declared their expected date of delivery in MySejahtera and were given appointments. One of them even brought a supporting letter from their doctor. Imagine the risk they took with such exposure to the crowd at the PPV.
Please, please facilitate vaccination for this group of vulnerable mothers. There are only a few KK used as centres to vaccinate pregnant mothers, but KKs are not utilised like this throughout the nation, which should be the norm.
Let mothers be vaccinated during their antenatal check-up in KK and therefore they need not risk themselves to Covid-19 exposure by going to PPV. Make things easy for them, make things easy for our mothers.
Vaccination in this country was much delayed. Let us not compound the delay with more deaths of unvaccinated pregnant Malaysians. Please urgently modify the 3rd edition of the guideline now!
Dr Iman Jeffrey & Dr Saadiah Sulaiman are from Klinik Pakar Kulit & Alahan Annur in Bangi, Selangor.
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