Niharika Sathe, a 34-year-old internal medicine physician in New Jersey, first heard the fertility rumor from another doctor.
In the end, she determined the rumor had no basis in fact, and both she and her friend wound up getting the vaccine. But the experience left her rattled.
“That kind of misinformation is really scary,” Sathe said, adding, “It has enough science to sound potentially plausible.”
As the rollout of the coronavirus vaccine ramps up across the United States, women of childbearing age have emerged as a surprising roadblock to efforts to halt the pandemic by achieving herd immunity. Officials have encountered hesitancy among other groups, including some Black and Hispanic adults and those who believe the pandemic is a hoax. But the reluctance of women in their 20s and 30s — largely around disinformation spread on Facebook, Twitter and other social media — has been more unexpected. With such women making up a large share of the health-care workforce, vaccine uptake at nursing homes and hospitals has been as low as 20 to 50 percent in some places — a far cry from the 70 to 85 percent population target that health officials say may be needed to stop the virus.
“I’m worried, frankly,” said Francis Collins, director of the National Institutes of Health. “There are stories out there on the Internet about how vaccination can lead to infertility. There’s absolutely nothing to that. But when we look at people who are expressing hesitancy, in many instances those are women of childbearing age.”
Women’s concerns come against a backdrop of national surveys showing that a growing share of Americans are open to getting the vaccine. Roughly 40 percent of people said in January that they would get it as soon as they could, up from 34 percent in December, according to a Kaiser Family Foundation report. But many groups that were hesitant late last year remain hesitant.
Women are more likely than men to turn down the shots, and they are especially worried about long-term side effects, with nearly three-quarters saying they were very or somewhat concerned, according to the KFF survey conducted Jan. 11-18. About 12 percent of respondents said they had heard debunked claims that the vaccine causes infertility and either believe it to be true or are unsure if it’s true.
The infertility myth is just one of many reasons women are hesitant, doctors and community organizers say, with others having more general concerns about a vaccine that has only recently been approved and the fact that early trials did not specifically look at pregnant or lactating women, leading to conflicting guidance from health authorities.
The World Health Organization says only those who are at a high risk of contracting the virus or of having a severe case should take the vaccine. The Royal College of Obstetricians and Gynaecologists in the United Kingdom has said that while there’s nothing to indicate any safety concerns for pregnancy, there also isn’t enough evidence to recommend routine use of the vaccine in pregnant women.
In the United States, the Centers for Disease Control and Prevention has been more neutral, saying women should make individual decisions in consultation with their doctors.
“This is an understandable concern,” said Timothy Callaghan, an assistant professor of health policy at Texas A&M University who is researching vaccine hesitancy. “Women who are trying to get clear advice are not getting clear advice about how they should proceed. But to get effective messages, we need to have better data.”
Myth vs. science
The first widely shared false reports about the coronavirus vaccines and fertility began showing up on social media in December, around the time Pfizer-BioNTech and Moderna reported late-stage trial results that their vaccines were safe and highly effective and federal regulators appeared likely to give them a green light.
The disinformation campaign took advantage of the mystique surrounding vaccines built on technology never before used in an approved medical product. Both authorized vaccines rely on repurposed messenger RNA — the genetic material that carries instructions from DNA and delivers them to other parts of the cell — to deliver specially designed spike proteins that trick the body into creating a defense that would protect it from future exposure to SARS-CoV2.
Dora Anne Mills, who has been overseeing the vaccine rollout at MaineHealth, the state’s largest medical provider, said the most frequently asked question from employees has been about the mRNA technology and reproductive issues. She said that when these vaccines were in the pipeline a year ago, she too had questions.
“The idea of an mRNA vaccine sounds so bizarre at first. But this is not gene therapy,” she said.
Mills said she has become “very excited about the vaccines’ safety and efficacy.”
“I have two young adult children and I am fine for them to get it,” she said. “I did not feel that way last summer. I had to educate myself. It was a journey for me.”
Perhaps the biggest concern created by the misinformation about messenger RNA is that the vaccine could cause infertility by priming the immune system to mistakenly attack a protein in the placenta known as syncytin-1, purportedly similar in structure to the coronavirus spike protein.
That false assertion is “creating a storm of confusion and fear among women,” said Yale School of Medicine immunologist Akiko Iwasaki, who became aware of it when strangers tweeted it at her. “I even had people from the medical community reaching out to ask if there’s any validity to this claim.”
Iwasaki and her team set out to test this idea in two different ways.
First, they compared the coronavirus spike protein and syncytin-1 from the placenta, and found “very, very little overlap.” Second, they looked at reactivity of 3,000 or so different proteins in humans to the antibodies formed as a result of a natural infection or vaccination. For syncytin-1, they found none.
“There is no scientific ground” for the infertility idea, Iwasaki said. “It is nonsense.”
Experts also point out that 12 women in the Pfizer-BioNTech clinical trials and six in the Moderna trials became pregnant after taking the vaccine, although they note that is only anecdotal evidence.
There is less known about pregnancy and the vaccine. On Thursday, Pfizer-BioNTech announced an international study to evaluate its coronavirus vaccine in pregnant women. This month, White House adviser Anthony S. Fauci, an infectious-disease expert, said that among 10,000 pregnant women who have received the shots, there were “no red flags.”
The recommendation to get the vaccine is unqualified for some women.
Richard Beigi, a professor of obstetrics, gynecology and reproductive sciences and president of the Magee-Womens Hospital at the University of Pittsburgh Medical Center, urged pregnant women to “consider the benefit of getting, but also the risk of not getting the vaccine.”
“We are increasingly becoming aware as the pandemic has gone across the world that when pregnant women develop symptoms and get sick, they appear more likely to get more critically ill,” said Beigi, who is part of the coronavirus task force of the American College of Obstetricians and Gynecologists.
Iwasaki said getting the vaccine might be optional for a pregnant woman who is able to isolate herself so she is not exposed to others.
“But if you are an essential worker,” she said, “then the risk-benefit ratio may be considered in favor of the vaccine. Every woman should make their own decision, but having the facts around it is important.”
As for women who have already given birth and are breastfeeding, Iwasaki said, “We feel more confident the vaccine would be beneficial.”
“Not only does it allow the mother to get protected,” she said, “we think the mother can transfer the good antibodies to the babies through the milk that would allow the baby to be protected.”
Each day, Lori Porter, chief executive of the National Association of Health Care Assistants, fields back-to-back phone calls from young women trying to decide whether to get the vaccine. Porter said the uptake among her members, who mostly work in nursing homes, is so low that the few who get the shots have to defend their decisions to their colleagues.
“I can’t answer all their questions, and neither can anyone else,” Porter said. “That’s the problem.”
Porter has sought funding from federal officials to launch targeted education campaigns to set the record straight. But so far, she said, that money has not materialized, and no cohesive federal response to the fertility disinformation has been presented — leaving health-care providers to come up with their own strategies.
Carrie Saia is chief executive of Holton Community Hospital in Kansas, where just over half of hospital employees eligible for the vaccine chose to get it. Hospital officials have pushed out myth-versus-fact emails twice a week and put out a survey about the issue. But she said she still expects only about 60 percent to get the shots.
“In our nursing unit, the majority of staff are childbearing age and some have just come back from maternity,” she said.
LaTanja Silvester, Louisiana director of the nonprofit Resilience Force, which has been working on community outreach efforts for the New Orleans public health department, said the key to persuasion is getting the correct information to trusted leaders. But even that has been an uphill battle — one of her colleagues, a young woman, acknowledged that she, too, is hesitant to get the shots due to fertility concerns.
“We need to dispel the myths, especially in the minority community,” Silvester said. “We’ve heard, ‘It’s going to prevent you from having kids.’ Well, no, that’s not true, but we need to make them feel comfortable with who they are hearing that message from.”
Monique Luisi, a Missouri School of Journalism assistant professor, advocates aggressive countermessaging. Luisi, who is 32 and does not yet have children, tells women she sees the vaccine as a way to protect her own fertility: “The first step is protecting my life.”
She and others hold out hope that as more research comes out on the coronavirus vaccines and fertility, pregnancy and lactation, more women will become comfortable with receiving the shots. Just in the past month, two studies appeared to suggest that pregnant women may be able to pass antibodies against SARS-CoV-2 to their fetuses.
One paper, published online before peer review, detailed the case of a front-line health-care worker in Florida who was vaccinated while 36 weeks pregnant. After the baby was born three weeks later, researchers detected antibodies in the cord blood. And a study in JAMA Pediatrics led by a researcher at the Children’s Hospital of Philadelphia found antibodies in placentas from 72 out of 83 pregnant women who had previously been infected.
Amanda Sacco, 30, a nurse in Texas who’s trying to start a family, consulted with her fertility doctor before deciding to get the vaccine. She said the majority of her colleagues have said they are not getting the shots, and even her own parents are hesitant. But she came away from her own research convinced the vaccine is safe and was also pleased with the indication that if she got the vaccine, she might be able to pass on some immunity to her child.
She said she believes changing women’s views about the vaccine begins with those in the medical field.
“If you were to convince more health-care workers to accept the vaccine,” she said, “they can better explain it to their patients and help get the word out.”