• Elana Jaffe, Ilona Telefus Goldfarb, and Anne Drapkin Lyerly.
• Elana Jaffe is with the Center for Bioethics, Department of Social Medicine, School of Medicine, and the Department of Maternal, Child, and Family Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill. Ilona Telefus Goldfarb is with the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Anne Drapkin Lyerly is with the Center for Bioethics, Department of Social Medicine, and the Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill.
• Am J Public Health. 2021 Mar 1; 111 (3): 498-503.

AbstractThe increased risk of harm from COVID-19 infection in pregnancy highlights the importance of including pregnant people in COVID-19 vaccine development and deployment. Promising vaccines being developed include replication-competent platforms, which are typically contraindicated during pregnancy because of theoretical risk. However, replicating vaccines are administered in and around pregnancy, either inadvertently because of unknown pregnancy status or when recommended.The historical cases of Ebola virus, yellow fever, and rubella demonstrate that contradictory messages around the safety of live vaccines in pregnancy have critical public health costs. First, restricting study or use of replicating vaccines in pregnancy may delay or deny access to the only available protection against deadly diseases. Additionally, not vaccinating pregnant people may slow epidemic control. Finally, uncertainty and worry around the safety of live vaccines may lead to terminations of otherwise desired pregnancies after inadvertent vaccination in pregnancy.If one of the vaccines deployed to combat the current global COVID-19 pandemic is replication competent, historical cases offer important lessons for ethical and effective protection for pregnant populations.

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