60: Vaccinating Pregnant People

Dr. Kristina Box, Indiana’s State Health Commissioner, discusses the complex task of vaccinating hesitant pregnant people against COVID-19; ASTHO releases advice from community groups gathered to explore possible responses to vaccine misinformation...

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Dr. Kristina Box, Indiana’s State Health Commissioner, discusses the complex task of vaccinating hesitant pregnant people against COVID-19; ASTHO releases advice from community groups gathered to explore possible responses to vaccine misinformation and disinformation; Courtney Youngbar, a senior analyst on ASTHO’s Environmental Health team, shares why One Health Day is important for people and animals alike; ASTHO lists new job openings; and Dr. Georges Benjamin, Executive Director of the American Public Health Association, tells us what he’s thankful for this year.

ASTHO Brief: Community Partners Offer Key Insights to Health Departments for Increasing Vaccine Confidence

CNN webpage: How to Protect Pregnant People from COVID-19

ASTHO webpage: Public Health Review podcast

ASTHO Blog Article: United for One Health

CDC webpage: One Health Day

ASTHO webpage: Job Opportunities in Public Health and at ASTHO

APHA webpage: Public Health Thank You Day

ASTHO logo



This is Public Health Review Morning Edition for Wednesday, November 3rd, 2021. I'm Robert Johnson.

Here's today's news from the Association of State and Territorial Health Officials.


Vaccine hesitancy has increased during the COVID-19 pandemic as many people have chosen not to be vaccinated because of bad information posted on social media channels.

ASTHO recently hosted a forum to discuss the drivers of misinformation and disinformation. Representatives from faith and community-based organizations, universities and colleges, healthcare systems, and others were part of the conversation.

Read their advice in a new ASTHOBrief, available online right now.


Many pregnant people are among the vaccine holdouts.

Dr. Kristina Box recently co-authored an article for CNN talking about ways to get them vaccinated. We hear from Indiana state health commissioner in today's morning conversation.

We know that pregnant people are not getting their COVID vaccinations at the same rate as others in the community. Why do you think they're avoiding getting the shot?


Well, I think that pregnant women are appropriately concerned about anything and everything that they put into their bodies while they're pregnant.

You know, as an OB provider, I warn them about certain foods that they eat, like soft cheese or certain fish that may concentrate mercury; I warn them about drinking alcohol and too much caffeine and certain medications that they shouldn't take.

So, it's only normal that they would be concerned about taking a new vaccine.


You recently co-authored an article for CNN about this topic, and the headline was "How to Protect Pregnant People from COVID-19." Can you tell us about that now?


So, I truly, in my heart, believe that getting vaccinated is the best way; and then layered mitigation with masks when women can't be vaccinated or during the Delta time, you know, the vaccinated when they're inside, because Delta has still infected people that are fully vaccinated—although, fortunately, that's not near as common.

And I think part of this is that, early in pregnancy, there was just a question about whether COVID really was more severe in a pregnant patient, kind of the data was a little mixed. That data, however, now is very clear that pregnant women do suffer increased risk over non-pregnant women who are the same age when they get COVID.


Is this just about finding the right messenger or are there other things we should be doing to get more pregnant people to roll up their sleeves?


So, I truly believe that the general population is tired of hearing from public health on this; I think they're a little tired of hearing about this on the news every night. And social media, there's been a lot of misinformation about this.

I mentioned that, you know, there's no question now that the data shows that a pregnant individual who becomes infected with COVID-19 has a higher risk of being hospitalized and getting admitted to the ICU, has a higher risk of having to be intubated or be on a ventilator, and, unfortunately, a higher risk for death.

So, the messenger in this situation really needs to be the person that that pregnant woman trusts the most, and that is going to be their healthcare provider. Honestly, there's never been a vaccine more studied—not only with regards to its efficacy, but also with regards to the risks associated with it—than this vaccine. And so, they should feel very comfortable being able to say that the evidence really supports that the risks of this vaccine—which we truly have not identified any increased risk in pregnant patients at this point in time—that those risks are much smaller than the risk of getting infected with COVID, and really sharing that information with our patients.


The CDC went so far as to issue an urgent advisory on this topic a few weeks ago, but that's because it's a very important issue as it relates to fighting this pandemic, isn't it?



I think, number one, when we vaccinate a pregnant person—and this is what our pregnant people need to know—is that many of them would risk suffering disease or complications themselves if they thought it might protect their baby from something else, like a complication of the vaccine. What we need to do is turn that conversation around and to say, "What we know is that there are more adverse pregnancy outcomes associated with getting infected with COVID-19 in pregnancy and not being fully vaccinated than there are with taking the vaccine," assuredly. I mean, we've seen increased risk for pre-term birth, suggestions of increased risk for stillbirth and miscarriage associated with COVID-19 infection during pregnancy.

I also try to help women see that the best way for their baby to stay healthy is for them to stay healthy throughout their pregnancy, and women that are in the ICU and unable to eat and intubated have to take lots of medications and other things that we would prefer not to have to expose these babies to, even though we pick and choose the safest ones. So, by far, the healthy mom is what leads to the healthy baby.

And that's the dyad we're looking at.



Also today, Dr. Box talks about pregnancy and substance use in a new episode of the Public Health Review podcast.

That conversation is new this morning, and available on the ASTHO website and everywhere you stream audio.


Today is One Health Day, a chance to recognize the connections between the health of people, animals, and the environment.

Courtney Youngbar is a senior analyst on ASTHO's environmental health team.


It's thought that about 75% of emerging infectious diseases come from animals, particularly wildlife. And we've seen this before—we've this with Ebola, swine flu, avian flu, and now even COVID-19. In this case, you know, animals become sick, and sometimes that does spill over into humans.

So, animal reservoirs play a really important role in public health; and so, there is this great need for a One Health approach in order to prevent outbreaks like this that we've seen before, and to protect human and animal lives.


If you'd like to help raise awareness, you can tweet about the event using the hashtag #OneHealthDay.


Also, ASTHO wants you to know about several job openings listed on its careers webpage.

The organization is hiring for a director of disparities elimination, an advisor for state and community engagement, and an analyst for chronic disease prevention.

Look for the link in today's show notes.


Finally this morning, Public Health Thank You Day is Monday, November 22nd. To celebrate, we're asking everyone we interview what they're thankful for this month.

Here's how Dr. Georges Benjamin, executive director of the American Public Health Association, answers the question.


I got to tell ya, I'm thankful that I have good friends and colleagues who get up every morning and all they care about is protecting the public's health. And I'm just thankful for that.



That'll do it for today's report.

Remember to visit the show notes to find links to all the stories mentioned in the newscast.


Make sure to follow us on Apple Podcasts or Spotify. You can also listen on Alexa or Google assistant.

And, if you have time, we'd be grateful if you could leave us a rating and a review.


Join us tomorrow morning for more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition.

Courtney Youngbar MPH

Senior Analyst, Environmental Health, ASTHO

Kristina Box MD FACOG

State Health Commissioner, Indiana Department of Health