The Ontario government has moved pregnant individuals up on the vaccine priority list amid concerns over severe illness from COVID-19.
"In response to emerging data on the increased risk of severe illness for pregnant women, all pregnant individuals will be eligible to register for vaccination appointments under the highest risk health conditions in the Phase 2 prioritization guidance starting today," Alexandra Hilkene, spokesperson for Health Minister Christine Elliott, confirmed on Friday morning.
The change was flagged on social media on Thursday evening by Dr. Isaac Bogoch, a member of the province's vaccine distribution task force, and Chatham-Kent Public Health.
1. Ontario has prioritized pregnant individuals for #COVID19 vaccination (see below).
Really glad to see this happen - it's the right move.
(Expecting to hear further sign-up details from other Public Health Units shortly)@TaliBogler *I think they mean "highest risk" below. https://t.co/CN1w2hMvCp
— Isaac Bogoch (@BogochIsaac) April 23, 2021
The government said pregnant people can book a vaccine at a local immunization clinic through the provincial booking line if they live in a public health unit that is using the provincial system. For regions that aren't using the provincial system, individuals can book directly with the public health unit.
The government noted that people do not require a letter from their health care provider in order to receive the vaccine and that the current dose interval of 16 weeks that is in effect for most groups will apply to pregnant women as well.
The Society of Obstetricians and Gynaecologists of Canada (SOGC) welcomed the news.
The SOGC applauds the decision of the Ontario government to prioritize pregnant individuals for COVID-19 vaccination. https://t.co/0cw6TK5DYA
— SOGC (@SOGCorg) April 23, 2021
Earlier this week, the SOGC issued a statement saying that "preventing COVID-19 disease among pregnant individuals must be considered a priority and vaccination is a central tool to protect individuals from severe COVID-19 infection."
The group said data shows that pregnant individuals are at "increased risk for hospitalization, ICU admission, mechanical ventilation and death compared to non-pregnant individuals," and that many regions are seeing more pregnant women being admitted to hospital and ICU.
"For many pregnant individuals in Canada, the risk of being unvaccinated and susceptible to COVID-19 is substantial," the SOGC said, adding that it supports the use of all four COVID-19 vaccines that have been approved in Canada during pregnancy and breastfeeding.
Mount Sinai Hospital said that as of Friday, pregnant people with COVID-19 accounted for four out of 20 ICU beds at the hospital. But the peak was seven, said Dr. Wendy Whittle, medical director for labour and delivery at Mount Sinai Hospital.
She compared this to a total of five pregnant women in ICU during the first and second waves.
"It's a shocking and dramatic increase in the number of sick and critically ill women in pregnancy," Whittle said. "This wave people are sicker and much more symptomatic and so we've seen a dramatic increase in the number of admissions to hospital, and then of those within hospitals, deteriorating and requiring admission to the intensive care unit, requiring oxygen support and even mechanical ventilation."
Dr. Constance Nasello, president of the Ontario Society of Obstetricians and Gynaecologists and chair of the Ontario Medical Association's section on obstetrics and gynecology, said the number of pregnant people in ICUs at some Toronto hospitals is "unheard of."
"Normally in the province of Ontario, we might see one or two patients a month that require ICU admission and that’s in the whole of Ontario, so it’s a rare occurrence that we actually have to put somebody into an ICU, so this is something that is really extraordinary," said Nasello, noting that an ICU admission can increase the risk of the mother needing a cesarean section or of prematurity for the baby.
She said doctors have been pushing hard for pregnant women to be able to get the vaccine.
"Pregnant women need to be prioritized to receive the COVID-19 vaccine because the risks are higher to a pregnant woman and her baby if they end up in an ICU unit and this third wave really clearly demonstrates that," said Nasello, who practises in Chatham. "I'm grateful on behalf of Ontario OB/GYNs and family doctors that do obstetrics that we were able to accomplish this through advocacy."
She said studies show pregnant women who get the vaccine "seem to have a good immune response in 2–3 weeks and that they also pass the antibodies through the umbilical cord to the fetus."
Dr. Tali Bogler, chair of family medicine obstetrics at St. Michael's Hospital, said the province's announcement was the right move. She has been advocating for pregnant women to be able to get the COVID-19 vaccine since late last year — this included giving front-line workers the choice to get vaccinated and getting pregnant women in a priority category for the vaccine.
"The problem is that ... in many provincial jurisdictions, the vaccine rollout has not gone as smoothly as we all want so we're not yet at that at-risk category and in the meantime we're seeing higher numbers of pregnant people in the ICU," said Bogler. "So this was like the last piece of advocacy that really we need to up these pregnant individuals ... to get vaccines as soon as possible."
Bogler, who is also co-founder of the "Pandemic Pregnancy Guide" Instagram account, which has more than 25,000 followers, said this has allowed her to have a "a pulse on the energy and the fear that pregnant people have right now."
She said there are two camps — those who are more cautious about getting a vaccine during pregnancy and those who want the vaccine. She said the latter appears to be larger now than ever before during the pandemic.
"I think what happened is people were seeing what was being shown in the media, people heard the stories of pregnant people in the ICU, and there was panic, literally panic," she said. "You could feel it and hear it ... and just wanting to get vaccinated so they can protect themselves and their families and there was true panic over the last two weeks not being able to access the vaccine."
Bogler said though there is a bit more data on the use of mRNA vaccines in pregnancy, she recommends any of the vaccines.
"If you have a high risk of exposure, you live in a hot spot region like Toronto or your family members are working outside the home ... you should get any vaccine, including AstraZeneca," she said. "But if you live in less of a hot spot area or less exposure and you have access now to the mRNA vaccine, well then you probably should go get it, because we have lots of data signalling that it's very safe."
Whittle agreed, saying "we consider both the mRNA vaccines and the vector-based vaccines to be completely safe at any gestational age at any time, and the risks attributed to AstraZeneca vaccine are not increased in pregnancy," she said, referring to rare cases of blood clotting that have been documented after the AstraZeneca vaccine. "The risk associated with a vaccine is far less than the risk associated with just being pregnant in the first place in terms of the risk of developing a clot so it's really important message that any vaccine at any time."
Whittle said she was "very grateful and thankful that pregnant women are recognized amongst the priority groups" and that really it comes down to keep a mother and her baby safe.
The move comes after the province suggested earlier this week that it didn't have any plans to bump up pregnant women, who were previously in the at-risk category, on the vaccine list.
Asked on Monday whether the province was planning any changes to prioritization for pregnant women, the health minister said "not at this moment, no, we have a plan in place for the rollout of the vaccine."
But Elliott went on to say that if a woman's primary care physician believed it was important to immunize her quickly, "then of course we would follow the physician's advice and that would be up to the woman and her partner to speak with their primary care doctor about that."
The comments created some confusion about whether pregnant women could receive the vaccine.
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