Open access article
The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.
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NHS England has asked COVID-19 vaccination sites offering only the Oxford/AstraZeneca vaccine to cancel the first-dose appointments of pregnant women following new advice.
The Joint Committee on Vaccination and Immunisation (JCVI) advised on 16 April 2021 that it is “preferable for pregnant women in the UK to be offered the Pfizer-BioNTech or Moderna vaccines where available”.
This follows real-world data from the United States which showed that 86,956 pregnant women have been vaccinated “mainly with mRNA vaccines including Pfizer-BioNTech and Moderna, without any safety concerns being raised”.
However, the JCVI noted that there is “no evidence to suggest that other vaccines are unsafe for pregnant women, but more research is needed”.
As a result, NHS England said in a letter dated 17 April 2021 that sites not currently offering “an alternative vaccine to the AstraZeneca vaccine … should cancel first dose appointments if they know the patient is pregnant.
Instead, these patients should be directed “to a [primary care network] site or a vaccination centre that is administering the Pfizer-BioNTech or Moderna vaccine”.
The letter added that pregnant women booked for their first dose at community pharmacy sites would “not have their appointments automatically cancelled”.
“Healthcare professionals should discuss the risks and benefits of vaccination with each pregnant woman presenting for vaccination, as part of the prevaccination clinical assessment and consent process,” the letter continued.
“Patients should be supported to ask questions or seek further information and where necessary, the person should be redirected to an obstetrician, midwife or GP team for further advice and guidance.”
However, for pregnant women who have already received their first dose of the Oxford/AstraZeneca vaccine, “second dose appointments should continue as planned”.
Wei Shen Lim, COVID-19 chair of the JCVI, said: “There have been no specific safety concerns from any brand of COVID-19 vaccines in relation to pregnancy.
“There is more real-world safety data from the US in relation to the Pfizer-BioNTech and Moderna vaccines in women who are pregnant — therefore, we advise a preference for these to be offered to pregnant women.”
Edward Morris, president of the Royal College of Obstetricians and Gynaecologists, said that receiving a vaccination “offers pregnant women the best protection from COVID-19, which can be serious in some women”.
“This move will empower all the pregnant women in the UK to make the decision that is right for them, at the same time that the non-pregnant population in their age group receive protection from COVID-19.”
NHS England had previously advised pharmacy-led vaccination sites on 7 April 2021 that first-dose Oxford/AstraZeneca vaccine appointments would be cancelled automatically for those aged under 30 years with no underlying health conditions, with these patients asked to contact their GP to discuss their vaccination options.
Why is there concern around the Oxford/AstraZeneca vaccine?
Concern around the Oxford/AstraZeneca vaccine stems from the incidence of blood clots with concurrent low platelet counts in patients who have received this vaccine.
As of 5 April 2021, the Medicines and Healthcare products Regulatory Agency (MHRA) reported receiving 100 Yellow Card reports of “major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) in the UK” after having the Oxford/AstraZeneca vaccine.
This means that the overall risk of blood clots is approximately 4.9 in every 1 million people who receive the vaccine.
But Jonathan Van-Tam, the deputy chief medical officer for England, said on 7 April 2021 that, while the risks versus benefits of the Oxford/AstraZeneca vaccine are “finely balanced” in those aged 20–29 years, in older age groups the risk/benefit ratio is “overwhelmingly in favour” of the vaccine.
The MHRA also said that the expected benefits of COVID-19 vaccines “far outweigh any currently known side effects”, and that “as with all vaccines and medicines, the safety of COVID-19 vaccines is continuously monitored and benefits and possible risks remain under review”.
This was supported by research, which found that the risk of patients developing a rare blood clot is 8–10 times higher in COVID-19 infections than after receiving any of the current COVID-19 vaccines.