The Vaccine Blog
youmevaccines@gmail.com
The Vaccine Blog
youmevaccines@gmail.com
“What I did not prepare for was a scenario where everything goes south…”
Olympic athlete Alysson Felix on disquieting (worrying) pregnancy-related complications…
After an ultrasound showed abnormalities, Alysson said that “that`s when my heart kind of sank and I was like, wow, this, this must be something, you know?”
After further testing, she was diagnosed with severe preeclampsia at 32 weeks pregnant
She says that “my husband was coming from work and he met me there and we were sitting together and he doctor came in and, um, she just said that things were still concerning and that they wanted to admit me to the hospital.”
Alysson says that “that's really the point where things got scary….”
“Doctors and nurses were coming in and they were concerned, and I remember at one point the doctor rushing in and saying that you know, we cannot wait any longer, we`re gonna have to rush you in for an emergency C-section.”
“You know, I am scared, I'm terrified, but I'm not really concerned about myself. I`m just worried about this little tiny baby who, you know, is not ready to enter this world yet.”
All she was concerned with was “I want a healthy baby”
Pregnancy
Often one of the happiest times in a person's life.
But it can also be hugely disquieting (worrying), as I`m sure is clear from Alyssa`s story. Especially when issues come up unexpectedly, some can become overwrought (very anxious). That is, pregnancy is a highly vulnerable time for both mother and fetus.
It's understandable, then, that vaccines can be disquieting for gravidic (pregnant) individuals. This is despite research strongly supporting their effectiveness during pregnancy. To be clear, I fully support vaccines and all public health measures.
However, concern about them is ever-prevalent with misinformation circulating widely online.
These, along with other factors, can cause concern. And this is true whether this is a first pregnancy or whether the person is multiparous (has had multiple pregnancies.)
With this, I`ll first discuss the major concern of gravidic (pregnant) populations
I`ll then discuss several other reasons and strategies for overcoming vaccine hesitancy during pregnancy.
I share a lot of stories like this and study the topic of hesitancy, and there's one question that tends to come up a lot. That is, “which factor is most associated with refusal to get vaccinated during pregnancy?” Maybe not exactly phrased like this, but definitely similar.
The last sentence of Alysson`s story captures the answer to this really well. “I want a healthy baby”.
And that's exactly it
That's exactly the point
Gravidic (pregnant) people are understandably concerned for their own health, and the health of the fetus. It might be a first pregnancy or she may be multiparous (she has had more than one pregnancy). Regardless, the principle applies.
Picture yourself pregnant with your first child, or in a situation similar to Alyssa`s. It's reasonable to assume that you would have a thought process similar to hers. You would be thinking on a very individual level ie. What if something happens to me or my baby?
With this, the next point should make sense
The factor that is disquieting (worrying) for pregnant individuals is the perceived risk to the fetus, as well as themselves. Simply, pregnant individuals worry about how vaccines might affect themselves, and/or the developing foetus. And the research shows this time and time again.
And one more, to really cement the point.
Similar results have been found in different types of studies all over the world in gravidic (pregnant) individuals. So, we can be confident that this is a strong motivator for vaccination decisions in most pregnant individuals. Therefore to alleviate disquieting feelings pregnant individuals have about vaccines, we simply need to show them more data and information on vaccine safety.
Problem solved?
Not quite…
You can't understand an issue (ie. vaccine hesitancy in pregnancy) by only looking at one element of it.
That is, people are multidimensional.
Especially when it comes to complex issues like this.
With that, it's important to look at other factors that contribute to vaccine hesitancy during pregnancy.
Before this, it's important to note that people can be very diverse. Even people from the same communities. Therefore there won't always be a single answer to “which factor is most associated with refusal to get vaccinated during pregnancy.”
With that, these reasons should be seen as general trends rather than assumptions about individuals. Also, people's reasons for concern vary with time, place and the specific vaccine in question.
With this said, some reasons linked with higher rates of vaccine hesitancy include being an ethnic minority, lower socioeconomic status, and a lack of healthcare provider recommendation. It has also been found that a low perceived risk of disease is linked with higher rates of vaccine hesitancy. That is, people who do not see infectious disease as risky are less likely to vaccinate. Meaning, if they haven't seen it (the disease), it is less disquieting/ worrying for them.
Other studies have found that level of educational attainment is a factor. That is, a higher level of education is linked with a higher likelihood of accepting vaccination. There have been different results among studies. Higher education is related to a better understanding of scientific information and a better income, both of which point to a higher likelihood of accepting vaccination. However, some studies have shown different results, and variables such as the area of education have rarely been factored into such research.
There are some important caveats to note here;
Some people may have just one of these factors holding them back. Others may have two, three, more, or even all of them. Each of these factors will likely hold different weights in a person's final vaccination decision.
Still other people could have completely different reasons not captured in research.
An entire blog post could be written on just this. However, for now I`ll say that personal experiences can be a huge reason why an individual does not vaccinate or undergo another medical procedure.
The point is, it is very challenging to capture the diversity that occurs from person to person in research papers. They tend to capture general trends as I said, rather than individual specifics. Of course research is highly valuable. However, in my experience, appreciating people's diversity at the individual level is key to changing minds.
So, what do we do with this information?
How do we go about overcoming vaccine hesitancy during pregnancy?
These are short questions with long and complex answers.
The first thing I will say is that there's a reason why I've emphasized the differences between individuals so much. There's a key point there. The approach taken needs to be tailored to the audience you`re talking to. This is true regardless of whether it's an individual, a small group, or a larger community.
4.1 - Tailored messaging
A good place to start with this tailoring is by asking the question; where is your audience regarding vaccines?
Let's break that down.
Are they completely resistant to vaccination (ie. antivax)? On the fence ie. “vaccine hesitant”? Are they overwrought (anxious) about some vaccines, but have no problems with others? Or do they predominantly accept vaccination, with some concerns? This is an important question to ask yourself before designing any vaccination messaging campaigns. Generic messaging just isn't effective when you're trying to engage individuals.
I`ll describe a good example of why tailored messaging works. Although not specifically focused on vaccine hesitancy in gravidic people, it demonstrates the principle really well.
They carried out a values-based campaign to increase vaccination rates. Essentially, they took into account the lifestyle the community lived and what their key concerns were when designing the campaign.
Signs were displayed throughout the town with images of several of the town's residents. Some were billboards erected for a month, with others being large signs on public buildings. Alongside this were slogans such as “I use cloth nappies, I home birth, and I immunise”. “I immunise” was the key phrase contained in every sign or billboard.
The idea was that vaccination can align with their values and lifestyle. They will not be strange, odd, or ostracised if they choose to vaccinate. In other words, it attempted to normalise vaccination within the town of Fremantle.
But did it work?
The researchers distributed an online questionnaire to answer this, to which 304 people responded.
The answer?
Yes….to an extent.
It had an overall positive response with 77% of participants. However, it did polarise attitudes about vaccines and cause some to feel more negatively towards them. As I mentioned before, there is no catch-all answer unfortunately. People are very diverse, even within groups. Different people find vaccines disquieting for different reasons. This is especially true for gravidic (pregnant) people who can have very specific concerns.
With that said, campaigns like this give important insights into how to effectively approach this problem.
4.2 - Clear, consistent messaging
The repetition of the phrase “I immunise” also demonstrated the next point I`ll discuss. Clear, consistent messaging. This is well-known to be positively associated with vaccine uptake across the research. It's also well known from psychology research that consistent messaging over time, in accessible language, is memorable.
Technical jargon should not be used. Now is not the time to describe antigenic stimulation of pattern-recognition receptors, and their binding to pathogen-associated molecular patterns as part of innate immunity. However, also avoid language that is too simple and insults the audience's intelligence.
Also important is to not use derogatory language (would you listen to someone who called you an idiot? I wouldn`t). Websites of various healthcare authorities like the World Health Organisation (WHO) and the Centre of Disease Control and Prevention (CDC) are a good example of these principles. Clear and respectful communication.
There is also research to support this.
An article published earlier this year (22nd January 2025), investigated healthcare professionals` perspectives of challenges to vaccination uptake during pregnancy. The authors found that “clear, consistent communication and integrating vaccinations into routine antenatal care were identified as essential for improving accessibility and convenience.” In particular, advocacy from midwives can be particularly helpful.
Other studies have found this too
In April 2024, a study was published in PloS ONE investigating barriers and facilitators to vaccination during pregnancy. Discussing their findings, the authors highlighted the importance of clearly and consistently emphasizing the benefits and safety of vaccination. In particular, they mentioned that such messaging should come from trusted healthcare professionals.
4.3 - Messaging addressing their main concerns, from trusted community members
It's important to stay focused on what is important to your audience. This is true regardless of the healthcare intervention in question. In this case, gravidic people, safety and side effects are the key pain points as I discussed earlier.
But it's not just what you say, or how you say it. It's also about who says it. A religious community will generally have trust in a religious leader, for example. A more secular community, not so much. A community with a traditional or conservative lifestyle may benefit from a traditional leader delivering such messaging. Others may have strong confidence in community health workers, local government officials, or someone else entirely. Many communities have several such people. Also, in some cases, community trust can actually outweigh trust in larger institutions and organisations.
Regardless of the specifics, the important question to ask is - who has trust and influence in a particular community? They are generally the best person to approach about vaccine messaging (and messaging about any other difficult topic).
4.4 Messaging plus engagement
It's impossible to ignore the influence of social media on essentially every major issue now. Many people live their lives online now.
It's where people are
Pregnant individuals are no exception. Women who are gravidic (pregnant) for the first time may be looking for advice from multiparous women. The latter is likely also looking for information, as each pregnancy can require learning new things.
With this large-scale usage of social media, vaccine messaging here can allow positive impact to happen on a much larger scale than individual or community-based approaches to vaccine messaging.
It is also important to remember that misinformation can be mass-disseminated online in a matter of seconds, minutes or hours.
Online groups, youtube channels or other forums can gather up to thousands or even millions of followers. This can very quickly lead to mistrust of vaccines, healthcare workers and institutions on a very large scale.
In turn, far reaching impacts can happen very quickly. This can have very serious consequences for pregnant people and their children worldwide.
This is only if misinformation and disinformation are allowed to spread unregulated.
One way to regulate it is to engage with people's concerns expressed online. Of course, echo chambers are very much a reality. Despite that, engaging in conversations online can give insights into why vaccines are disquieting in a large sample of people.
There needs to be two-way communication, because it allows people to engage with the individuals behind the science. This is becoming hugely common, with scientific and healthcare professionals becoming well-respected online figures with significant followings.
4.5 - Integrate these approaches and iterate based on results
Also, one of these approaches in isolation isn't really enough to optimise messaging campaigns. People are multidimensional. So, any approach to changing their behaviour also needs to be.
People are also dynamic and change. Their thinking this week, this month or this year may not be the same as next week, month or year. So ongoing monitoring of the effectiveness of messaging is needed. This allows us to tweak things as needed.
All things considered, what can we conclude? When we talk about vaccine hesitancy in pregnancy, there is added complexity that isn't there when we discuss other groups, or even hesitancy as a concept. There are many other variables at play here that might not necessarily apply to the general population. These include the increased vulnerability of the pregnant person during pregnancy. There could also be others that I`ve missed.
Some are also overwrought (worried) about risks to the foetus. It is helpful to keep these principles in mind when designing vaccine messaging campaigns. Also, monitoring how these factors change over time will be important to adapting messaging campaigns over time.
Will there be a catch-all answer?
Most likely, no.
But can we adapt and iterate towards overcoming vaccine hesitancy during pregnancy?
Absolutely.
Thanks for reading
