COVID-19 Vaccine policies for pregnant and lactating people worldwide.

About the Covid-19 Maternal Immunization Tracker

Overview

The COVID-19 Maternal Immunization Tracker (COMIT) provides a global snapshot of public health policies that influence access to COVID-19 vaccines for pregnant and lactating people. Through maps, tables, and country profiles, COMIT provides regularly updated information on global and country level policies as they respond to the dynamic state of the pandemic and emerging evidence.

Background

As COVID-19 vaccines are being rolled out across the globe, many have wondered whether pregnant and lactating people can or should be vaccinated as part of broader immunization efforts. Countries have taken a variety of positions - ranging from highly restrictive policies that bar access to vaccines based on pregnancy or lactation status to widely permissive positions in which all pregnant or lactating people can receive vaccine, and in some cases, are recommended and encouraged to do so.

The variability in policy positions is in part a consequence of limited evidence regarding the safety of many COVID-19 vaccine products in pregnancy and lactation. Pregnant and lactating women were excluded from most trials conducted prior to Authorization or Listing, though efforts are underway to improve the evidence base through randomized controlled trials and observational studies. In the meantime, however, public health authorities and recommending bodies are developing guidance on vaccines and pregnancy based upon limited evidence.

Policy positions on vaccination in pregnancy or lactation are important everywhere. There are nearly 2 billion women of reproductive age globally; on any given day, over 150 million people in the world are pregnant and many women spend significant proportions of their adult lives breastfeeding their children – particularly in areas with high fertility rates.

Vaccine policy in pregnancy and lactation is particularly urgent and important in countries with high COVID-19 burden and constrained vaccine supply. Health workers, a top priority group for nearly all contexts, are majority female and many are pregnant or breastfeeding. Other priority groups, such as those with underlying medical conditions or in high exposure occupations or settings, may include countless individuals who are pregnant or lactating. Additionally, pregnancy has been shown to increase the risk of severe COVID-19 disease and contribute to higher rates of preterm birth.

Maps and Features

The COVID-19 Maternal Immunization Tracker (COMIT) maps and tables document where various countries fall on the policy spectrum.

The default display presents the most permissive position across all vaccines in a given country to convey at-a-glance whether pregnant or lactating individuals are allowed or encouraged to receive any vaccine currently authorized for use in that setting. COMIT also allows users to explore the data by vaccine product to see if there are differences in pregnancy policies between products, both within and between countries. Additional details are provided in tables on a country-by-country basis below the maps, including information about which countries require provider consultations or pregnancy tests in order to be vaccinated.

Because this is a dynamic space, with countries and other recommending bodies continuing to update their positions based on the changing epidemiological situation, emerging evidence on vaccine products, and growing understanding of risks of COVID-19 disease in pregnancy, COMIT is updated on a regular basis to reflect changes in policy positions, with country positions reviewed at least every three weeks. See Our Approach to learn more about our methodology and data sources.

Team

The COMIT policy tracker was developed by members of the Johns Hopkins Berman Institute of Bioethics and the Johns Hopkins Center for Immunization Research, with support from the Bill & Melinda Gates Foundation and Wellcome.

The leadership team includes faculty co-leads Ruth Faden, Ruth Karron, Carleigh Krubiner, and Chizoba Wonodi. The website was made possible by support from Andrew Nicklin, Elana Jaffe, Eleonor Zavala, and Rachel Gur-Arie. We also acknowledge the public health students assisting in data collection and technical support: Sheila Roy and Caitlin Salloum.

Disclaimers

This work was produced by employees of the Johns Hopkins University, with support from the Bill & Melinda Gates Foundation and Wellcome. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of JHU, BMGF, or Wellcome.

The policy data presented here are largely sourced from publicly available information on official websites (see Our Approach). While our aim is to provide the most up-to-date and accurate material, we cannot guarantee that all information provided reflects current policy positions. Please note that the tracker documents national or federal level policies. Although we recognize there may be sub-national or regional differences in policy positions, those will not be reflected in the tracker. Should you observe any inaccuracies or if you wish to submit new or missing information, please contact us.

The use of the term “country” on this Tracker does not in all cases refer to a territorial entity that is a state as understood by international law and practice. As used here, the term also covers some territorial entities that are not states. The boundaries, colors, denominations and any other information shown on this map do not imply the expression of any opinion or judgement whatsoever on the part of the JHU concerning the legal status of any country, territory, city or any area or of its authorities, or any endorsement concerning the acceptance of such frontiers or boundaries.

The COMIT team recognizes that not all pregnant or lactating people identify as women. The tracker is intended to assess policy positions that affect vaccination eligibility on the basis of pregnancy or lactation status, regardless of gender identity, although the use of gender-inclusive language in policy documents varies country by country and across recommending bodies.