Left In The Lurch: India's Pregnant Women Still Await Word On COVID-19 Vaccines

There is radio silence on the rollout of COVID vaccines for pregnant women in India. The vaccination drive, in chest-thumping itself as the largest one in the world, has passed over an entire high-risk population of expectant mothers who - along with their foetuses - have been left isolated to navigate their fears, confusions, tragedies by themselves.

"In a few days" is what pregnant women are repeatedly hearing from higher up administrations. Where countries like the United States, United Kingdom, Belgium, New Zealand, among others, have greenlighted vaccination for to-be mothers, India still awaits enough clinical trials and safety data for Covishield and Covaxin to permit its pregnant population to get jabbed.

The question is: How much longer can India's pregnant women afford to wait? The brutal second COVID-19 wave is flattening now but has left in its wake a trail of immeasurable tragedies here to stay, etched in memory with a threat to return in the soon-to-break third wave if vaccines aren't equally distributed.

Pooja Mishra was 32 weeks pregnant when she lost her baby. She had tested positive for the virus only days prior. Admitted to Delhi's Hindu Rao Hospital May 1 after her oxygen dipped, an ultrasound revealed the baby she was carrying didn't have a heartbeat. The family then shifted focus to her. To afford better treatment, she was moved to Lok Nayak Jai Prakash Narayan Hospital at the heart of the national capital, but showed no signs of improving. On May 5, within a week of losing her baby, Mishra died.

"I pray to God no one faces what we went through," her brother-in-law Aman tells SheThePeople in an interview. At the time Mishra was seeking treatment, Aman actively hunted for cylinders and beds on Twitter - the countrywide helpline all the needy were turning to. Searching for resources led him deeper and closer to the plight of the pregnant population left to fend for themselves.

"I helped five women get hospital beds. Out of them, two died. They were both eight months pregnant," he says. "Pregnant women should be prioritised for vaccines as soon as possible."

There is alarming data to support the cause of prioritisation of COVID vaccines for pregnant women.

A multinational cohort study published by JAMA Pediatrics in April this year said pregnant women have 50 percent higher mortality risk if they contract COVID-19. Pre-existing pregnancy conditions exacerbate COVID-19 complications for them. The study took into account over 2000 women across 18 countries.

The Indian Council of Medical Research (ICMR) on June 16 said total maternal deaths in India were 2 percent for both COVID-19 waves combined, majority of which were due to virus-related pneumonia and respiratory failure.

Experiences Of Loss And Panic: COVID Vaccines For Pregnant Women Need Of The Hour

The World Health Organisation (WHO) has cleared the road for permitting jabs for pregnant women, more so if they are high-risk and have comorbidities. But India seems to be treading painfully slowly.

Last week, Delhi journalist Priyali Sur's petition for COVID vaccines for pregnant women reached the Delhi High Court. She sought the issuance of fresh notifications that would include expectant mothers in the vaccination drive. Her petition was disposed. In her Change.org petition signed by over 70,000 persons in support of the cause, Sur says, "this is more about granting me and other pregnant women a right to choose for their health and their own bodies."

Sur is 36 weeks pregnant. She has once been infected and successfully recovered from COVID-19. "Being pregnant is already a condition in which the immune system isn't at its strongest. The question is how much more does the virus affect that. When I tested positive, I was worried about getting a blood clot," she tells SheThePeople.

"Thankfully my oxygen level remained above 95 and there was no fever beyond a day," she says. She was in southern India then, the rural parts, and the nearest hospital refused to take a pregnant patient. Sur says, "I was lucky I didn't have to get admitted." Many others don't share her luck.

Her WhatsApp, Sur says, was inundated with messages from pregnant women and their families, about hospitalisations and the lack of it, deaths before and after delivery.

Several such tragic incidents have gone viral in the past months. Kalyani Agrahari, eight months pregnant, was one of 135 teachers deployed on panchayat poll duty in Uttar Pradesh who died of COVID-19 in April, reports say. In another, Dr Dimple Arora Chawla died a day after she lost her baby; her husband shared a heartbreaking video of her struggling to breathe through words of caution about the deadly effects of the virus. Watch here.

Where Does The Health Community Stand?

There are, of course, others who have sailed past without much complication. Tarapur-based Sumitra Swain tested positive for COVID-19 last month. "Not a lot happened. I was running a fever and was hospitalised between May 23 and June 4," the 25-year-old tells SheThePeople. "The nurses, doctors, staff were very nice. They tended to me routinely and I was being served a high-protein diet."

Back in the national capital, Aman has another story to tell. At Hindu Rao, he said his sister-in-law did not seem to be receiving adequate attention. "No senior doctor at the hospital came to check in on her. Only junior doctors came, some clicked photos in their PPE kits. There was no solid knowledge about which medicines to give to pregnant COVID-19 patients. It was our biggest mistake, taking her there," he claims.

"Pregnant women talk to their gynaecologists or other healthcare providers. That's the best they know," Sur says. But there is a lack of "direct communication still on why pregnant women are not being vaccinated or what they should do to protect themselves. We need more guidance on that."

Void of data has also further prompted a slew of related questions as to the safety and efficacy of COVID-19 vaccines for pregnant women: Will it impact the foetus' health? Can it cause a miscarriage? Are there any long-term risks to the mother's health?

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There is hesitation even in the presence of the best-available prevention for COVID-19. Mumbai became the first city in India to open vaccinations for pregnant women, provided they bring consent from their healthcare providers. As per reports from June 2, there was zero turnout.

It's clear that the cloud of doubt will not be dispelled without ample ministry research, public data and thumbs up. But even as pregnant women and their gynaecologists press for urgency, there seems to be none. So how much information at hand are we working with right now?

Dr Sudeshna Ray, obstetrician-gynaecologist in Mumbai, says, "As per literature, the one vaccination to avoid in pregnant women is live attenuated vaccines. None of the vaccines against COVID-19 are live attenuated. Examples of live attenuated viruses are measles, mumps, rubella (MMR combined vaccine), rotavirus, smallpox, chickenpox, yellow fever."

mRNA vaccines Pfizer and Moderna, which use natural immune-building responses to protect from the virus, have been deemed safe for pregnant women across reports. "Trials for these vaccines for pregnant women began earlier in the US," Dr Ray says, adding that if solid certifications are in for them, "the same data can be advised for other vaccines available."

There is also the risk of pregnant women contracting COVID-19 when out for their routine, prenatal checkups. But, says Dr Ray, "the wait for vaccination should not come in the way of other medical treatment. By the time they get to the vaccine, they should not have missed out on other aspects of health."

Watch Dr Ray explain pregnancy precautions during the pandemic: