LETTERS: Today, we will no longer be able to hear the soothing voice of Siti Sarah Raisuddin who succumbed to Covid-19 and left an orphan born at 28 weeks of pregnancy who will never get to hear her lullaby.
This is a tragic incident that follows many other pregnant mothers before her. She was unvaccinated against the virus as were many maternal deaths from Covid-19.
This leads us to seriously question the Covid-19 vaccination policy for pregnant mothers in Malaysia.
Specifically, we call for the current guideline of "first dose to be administered between Week 14-33 of the pregnancy" to be expanded to "first dose to be administered at any stage of pregnancy". Our intention is to prevent any more unnecessary maternal deaths due to Covid-19.
In the second Edition of the Clinical Guideline for Covid-19 in Malaysia (published on 13th April 2021), it was mentioned on page 69 that:
1. When can a pregnant mother be vaccinated? Between 14-33 weeks of gestation.
2. Should the second dose be administered to a woman who finds out she is pregnant after getting the first dose? Yes. However, the second dose should be deferred until 14 weeks of gestation.
It took 2 months for the relevant committee to improve and come up with the third edition (published on July 12, 2021). However the deadly sentence remains: "The first dose of the vaccine is to be administered between 14-33 weeks of pregnancy", despite the risk of increasing deaths among pregnant mothers with Covid-19.
The committee continues to ignore the guidelines used in other countries, despite the increasing risk of Malaysian maternal deaths. We share three examples of guidelines that state that Covid-19 vaccines should be offered at any stage of pregnancy.
One, the Royal College of Obstetricians and Gynecologists (RCOG) in the United Kingdom states that "the vaccine is considered to be safe and effective at any stage of pregnancy".
Two, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australian Technical Advisory Group on Immunisation (ATAGI) have explicitly mentioned that pregnant women should be routinely offered the vaccine at any stage of pregnancy.
And three, the American College of Obstetricians and Gynecologists (ACOG) recommends that "all pregnant women be vaccinated against Covid-19". Finally, data from 36,000 vaccinated pregnant mothers in the United States show no obvious safety signals.
We are unable to find the evidence basis for the "Week 14-33" recommendation in Malaysia, and we welcome clarifications from relevant committees and decision-makers. Without a strong evidence basis, we urgently call upon the committee to change the guideline to allow vaccination of pregnant women at all stages of pregnancy.
The "Week 14-33" recommendation has created confusion across Malaysia. We have anecdotal stories of mothers in their 30th week of pregnancy who were keen to be vaccinated, but who were turned down by Klinik Kesihatan and advised to wait for the notification in MySejahtera. These notifications may may only appear at 33 weeks, which means they miss the window for vaccination.
One of us saw two mothers rejected by vaccination centres for first dose vaccination at 35 weeks and 38 weeks respectively. This occurred despite the mothers declaring their expected date of delivery in MySejahtera and given vaccination appointments. One of them even brought a supporting letter from their doctor. Imagine the risk they took with such exposure to the crowd at the PPV.
A clear, simple and straightforward guideline that includes pregnant mothers at any stage of pregnancy will help the vaccination administration process in Malaysia. These guidelines are being used religiously throughout the nation by our Klinik Kesihatan, staff nurses and vaccination providers and even by obstetricians and gynecologists.
We urge the government to facilitate Covid-19 vaccinations for this group of vulnerable mothers. One important way to facilitate vaccinations is to utilise the existing network of nearly 2000 Klinik Kesihatan across Malaysia. Mothers should vaccinated during their antenatal check-ups and reduce their Covid-19 exposure by going to PPV. We must make things easy for our pregnant mothers.
We have delayed the vaccination of pregnant mothers in Malaysia two times already. Firstly, because our vaccination program only started in Feb 2021 (when the world started in Dec 2020). And secondly because under-40 vaccination only started in June 2021.
We cannot delay this any further. We must protect our pregnant mothers immediately. Therefore, we call on the relevant committees to urgently modify the third edition of the guideline now, and deploy Klinik Kesihatan to vaccinate mothers.
DR IMAN JEFFREY, DR SAADIAH SULAIMAN
Kuala Lumpur