ACOG Releases Guidance on Ethical Issues Associated With Vaccination

Washington, DC – With the world witnessing a vaccine rollout of unprecedented scale, the American College of Obstetricians and Gynecologists (ACOG) has released a new Committee Opinion, Ethical Issues With Vaccination in Obstetrics and Gynecology. Although this new guidance document does not specifically address distribution of COVID-19 vaccines, the conclusions are applicable to the ongoing pandemic response.

The Committee Opinion concludes, for example:

• As health care professionals, obstetrician–gynecologists have an ethical obligation to promote protection from infectious disease among their patients and society in general
• Obstetrician–gynecologists should counsel their patients about vaccination in an evidence-based manner that allows patients to make an informed decision. This includes counseling pregnant and lactating patients about the safety and efficacy of routine vaccination, recognizing that most vaccines are appropriate for use in pregnancy and lactation
• Concerns about the effect of vaccination on the fetus should be discussed in light of relevant medical evidence and understood within the context of each patient’s social network, cultural beliefs, and values

“The goals of vaccination are twofold: to preserve the health of individual patients as well as the health of the general public,” said Jami Star, MD, a member of ACOG’s Committee on Ethics and a primary author of the document. “The COVID-19 pandemic has emphasized that the protective measures we can take do not just protect each of us as individuals, but also benefit our communities. Vaccination is just such a measure.”

The newly released Committee Opinion acknowledges challenges to vaccine uptake and acceptance, including widespread misinformation and disinformation on social media regarding safety; limited knowledge and awareness about recommended vaccinations; lack of trust in the medical system, especially in communities of color because of historic and ongoing injustices and systemic racism; prioritization of personal freedoms over collective health; and vaccination delay and refusal through nonmedical exemptions from state-mandated vaccination requirements.

In cases of vaccine hesitancy, counseling from an obstetrician–gynecologist can play an essential role in helping patients make informed decisions, as there is evidence that recommendations from health care professionals strongly influence patient decisions to accept vaccination. Concerns about vaccination should be discussed and understood within the context of patients’ lived experience and social determinants of health as well as their cultural and religious beliefs and values.

“It is natural and appropriate that patients, including pregnant individuals, have questions about vaccination, especially in a public health emergency, when those questions may be exacerbated by the timeline of vaccine development,” said Kavita Shah Arora, MD, MBE, MS, Vice Chair of ACOG’s Committee on Ethics and co-author of the Committee Opinion. “Open, transparent conversations about the maternal and fetal risks and benefits of both vaccination and nonvaccination are key to helping patients make informed, evidence-based decisions.”

Access ACOG’s Conversation Guide for Clinicians on COVID-19 Vaccines and Pregnancy.