TODAY, we will no longer be able to hear the soothing voice of Siti Sarah who succumbed to Covid-19. This tragic incident is not an isolated incident. Siti, just like other pregnant women who passed away from Covid-19, was not vaccinated against the virus.

This leads us to the serious question of what this country’s policy is regarding the administration of the Covid-19 vaccine for pregnant women in Malaysia.

There are a number of concerns that need to be urgently addressed. If further ignored, it will lead to many more unnecessary Covid-19-related deaths among pregnant women.

The 2nd edition of the Clinical Guideline for Covid-19 in Malaysia that was published on the on April 13, 2021 mentions in page 69 that a pregnant mother can be vaccinated between 14 to 33 weeks of gestation. 

It further states that the second dose of vaccine should be deferred until 14 weeks of gestation if the woman finds out that she is pregnant after receiving her first jab. 

It took 2 months for the committee to improve the guidelines and come up with the 3rd edition, which was published on July 12, 2021.

However, despite the increasing deaths among pregnant mothers caused by Covid-19, the following sentence still remains at page 110 of the report: “First dose of the vaccine is to be administered between 14-33 weeks of pregnancy”.

The committee, also represented by six obstetrics and gynaecology (O&G) specialists, continue to ignore the guidelines applied in other countries. 

The Royal College of Obstetricians and Gynaecologists in United Kingdom has stated that the Covid-19 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 and the Australian Technical Advisory Group on Immunisation, has 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.11 (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 whose babies were born with congenital anomalies.”

Therefore, where was the “window period of 14-33 weeks” relied on by Malaysian health authorities extrapolated from? If there is no strong basis for this, we urgently call upon the committee to remove this from the guideline.

This deadly sentence creates fear among pregnant women which may deter them from receiving their vaccination, especially those above 33 weeks of pregnancy.

Another issue that also needs to be addressed there are not enough government clinics nationwide that offer vaccinations to pregnant mother. 
Therefore, we demand clear, simple, and straightforward guidelines as these guidelines are they are relied on by government clinics, staff nurses, vaccination providers, and O&G specialists nationwide.

There are still pregnant women in their 30th week of pregnancy who were turned down by government clinics and advised to wait for a vaccination notification on MySejahtera, which may only appear later on when they are at their 33rd week of pregnancy. 

This effectively means that they may not get vaccinated at all. 

Today itself, I know of two mothers who were refused their Covid-19 vaccination. One was in her 35th week of pregnancy, while the other was in her 38th week. 

This is despite them declaring their expected date of delivery on their MySejahtera app, and having received an appointment date for their vaccination. In fact, one of the women even carried a doctor’s letter with her.

It is my solemn plea that the government does everything in its disposal to ensure that this vulnerable group is vaccinated. 

Steps should be taken to allow pregnant women to receive their vaccinations during their antenatal check-up at government clinics so that they won’t have to be exposed to the risk of contracting Covid-19 at large vaccination centres. 

Malaysia started its vaccination programme late. There was a delay as the National Pharmaceutical Regulatory Agency took two months (December 23, 2020 to February 24, 2021) to enable the usage of the vaccines when millions of people around the world had already started receiving their Covid-19 jabs.

Worse still, the vaccination programme was only open to pregnant mothers in mid-June 2021, when the plan was already in its second phase. 

Matters are not any easier at this juncture either, with the vaccination restrictions imposed against pregnant women (only those between 14 to 33 weeks of gestation can be vaccinated)

Let us not compound the delay to avoid further unwanted deaths of unvaccinated pregnant Malaysians.

References:
1.    Australian Technical Advisory Group on Immunisation clinical guidance on Covid-19 vaccine in Australia in 2021;
2.    Covid-19 vaccines, pregnancy and breastfeeding – Royal College of Obstetricians and Gynaecologists; and
3.    Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons – The New England Journal of Medicine. – August 10, 2021.

* Dr Iman Jeffrey and Dr Saadiah Sulaiman read The Malaysian Insight.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.