Like many medical studies, the trials that produced the two COVID-19 vaccines currently available in the U.S. excluded pregnant people. Rather than worry about the possible—if extremely unlikely—risks to the fetus in a clinical trial, it’s easier for pharmaceutical companies to simply leave pregnancy out of the equation. But what are pregnant people who want to get vaccinated supposed to do now that shots are being distributed? While both Pfizer and Moderna are monitoring trial participants who became pregnant after receiving the shots, and public health officials recommend that the vaccine not be withheld from pregnant people, there are no current data to illustrate whether or how the vaccines affect fetal health. As a result, pregnant people who are eligible are currently grappling with the decision of whether to consume a pharmaceutical product that has not explicitly been proved safe for them and their fetuses.
Johanna Barron, 33, is a pregnant medical student who opted to get her first dose of the COVID-19 vaccine last month. We spoke about what informed her decision, how she weighed the benefits and potential risks of getting vaccinated, and why she eventually decided to get the shot. Our conversation has been lightly edited for length and clarity.
Christina Cauterucci: How were you eligible for the vaccine, and when did you get it?
Johanna Barron: I got the first dose of the Pfizer vaccine on Jan. 5. I’ve gotten both doses now. I was eligible because I’m a fourth-year medical student in the D.C. area, seeing patients on a regular basis. So I’m a health care worker with high exposure. Just by nature of the rotations I’ve been on, I’ve mostly been seeing patients in a general health care environment. But I was on an emergency medicine rotation [at the time of my vaccine], and there’s generally less screening in emergency medicine and a lot more possibility that your patients could have COVID.
What has your experience been like, seeing patients during the pandemic?
Initially, they kind of pulled all of us out of the hospitals for the first several months of the pandemic, which was a big adjustment from what we were all expecting for our fourth-year schedules. And then as there were better protocols in place and more protective equipment available, we started being able to go back into the hospital. I haven’t really been on the front lines in the way some people are, in that I’m not in an ICU taking care of people that are really, really ill from COVID. But it’s interesting how much it’s become a new normal to just wear a mask and eye protection every time you see a patient, and your patients are wearing masks, and it does change a lot of dynamics. At this point I don’t think about it as much, but at first it was definitely a pretty scary thing, too.
Were you scared that you would contract it?
I mean, for me, I’m a young, relatively healthy person—which certainly doesn’t mean I couldn’t get a more severe form of the illness. I think I was most concerned about potentially passing it on to other people that I care about. I didn’t want to see my parents or anything like that, just because I didn’t know, with the amount of exposure I had, if I could be asymptomatic and pass it on to my parents, who would have a more severe illness. So that was where my main concern came from. But it’s scary for everyone, I think.
When did you make the decision to get the vaccine?
We were told around early December, mid-to-late November, that they were going to start making the vaccine available to medical students that were working in a clinical context. We didn’t have exact dates at first. Initially I wasn’t really sure whether I wanted to or not, because I am pregnant, and there isn’t a lot of data about that. But by the time it became available to me in early January, I had pretty thoroughly thought about it and made that decision.
And you’d gotten pregnant during the pandemic.
I did, which was a conscious decision as well. My wife and I are a same-sex couple, so it definitely is something that required a lot of planning on our part. It had been something we were planning for a while, and kind of initiated that process before the pandemic. And as it started to ramp up, we talked and said, “Should we continue down this path?” But not having any information about how long the pandemic was going to last—and I think we’re all at a point where life has changed for longer than we might have anticipated—we felt like we had already made that decision. We were in a place in our lives where this is what we wanted to be doing. And it made sense for us in a lot of other contexts, so we weren’t willing to put that on hold.
Did that make you any more scared of potentially contracting the coronavirus at work?
That was definitely a concern. What we do know is that there’s a higher risk of morbidity and mortality in pregnant patients. So pregnant patients, if they become severely ill, are more likely to end up in an ICU, on a ventilator. And there is a higher risk of maternal death from COVID compared to similarly healthy populations that aren’t pregnant. We don’t have a lot of evidence that there’s direct fetal harm from COVID at this point, although any maternal harm could potentially lead to fetal harm. I definitely think it made it scarier, just because it put me in a different category than I was at the beginning, when I wasn’t pregnant and didn’t have any medical condition.
So you found out around early December that the vaccine was going to become available to you. And then by the time it was available, in early January, you had made the decision to get it. Tell me what you went through in that intervening month.
I definitely initially was not sure if I was going to get the vaccine during pregnancy. There is a lack of data about this vaccine specifically, because pregnant people weren’t included in the vaccine trials. And like most people in medicine, I really like data, and I rely on it to make informed decisions. So not having data is kind of uncomfortable. My gut reaction at first was Oh, I don’t know if I want to do that. But the more I thought about it and read about it and talked to people, I decided that a lack of data is just that. Any untested medical intervention has the potential for fetal harm in a pregnant patient. But there’s also no data to suggest that there is a risk with this vaccine. So, this is a little hyperbolic, but the risk of fetal harm from the vaccine is kind of like the risk of fetal harm from eating pancakes or something. We can’t prove there isn’t one, because no one’s studied it, but there’s also not really a plausible mechanism that there is going to be one.
I did do a lot of reading. There are guidelines put out by multiple medical societies—like the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and the American Society for Reproductive Medicine—that specialize in fertility. All of them said that the vaccine shouldn’t be withheld from pregnant patients, especially if you have a high risk of exposure, which I do, or if you are high-risk because of another medical condition. And I don’t take that lightly, because they’re the experts in this field, and if they don’t think there’s a theoretical risk that’s high enough that the vaccine should be withheld, then I find that pretty convincing. Those guidelines are informed by people with knowledge of vaccine mechanics, immunology, placental pathology, all of those kinds of things. Basically, they don’t think that there’s any sort of mechanism that would make sense for causing fetal harm.
Did you talk to anyone to help you make the decision?
I talked to my OB-GYN, who kind of had the same sentiments that I had, which is that we don’t have a lot of data right now, but a lack of data is not the same thing as a known risk. Especially based on my potential for exposure, it seemed reasonable for me to receive the vaccine if I wanted to. The guideline is really that people should talk to their medical providers and come to a shared decision-making of whether they think it’s the right choice for them. She didn’t tell me one way or another that I should do it, but certainly helped support me in making that decision.
I talked to other classmates and friends within the medical community, and I talked to my wife, who’s also conveniently in the medical field. I don’t want to pretend it was a super straightforward decision, because we naturally really wanted to feel confident that we were making the best choice for our future child. And as a same-sex couple, our son is the result of a lot of medical intervention and financial expense. The process [of getting pregnant] wasn’t really an easy one for us, emotionally—and, probably in combination with our joint medical knowledge, we’re more anxious than average future parents. But, in the end, we were very much in agreement that the best thing for our kid is to have two healthy, living parents, and potentially get some antibodies from me in utero—which, we’re now starting to see more evidence that those antibodies are getting passed on from pregnant women to their kids. I mean, that’s kind of the best-case scenario, but either way I felt it was the best opportunity to protect all of us.
It really seems like your medical training, or the highly informed medical prism through which you’re approaching this, could be both a blessing and a curse.
Yeah, we always kind of joke that we know just enough to be dangerous to ourselves! We learn a lot about everything, so you have more of a sense of risk—and maybe, when it comes to yourself and your family, kind of an outsized expectation of what those risks might actually be. But it’s more helpful than not in the overall picture of things.
I know the issue of including pregnant people in medical trials is a fraught topic, the subject of a lot of bioethical debate. What do you think of the fact that no pregnant people were included in these vaccine trials?
It means we have no data to guide people, which I think is a shame. We practice informed consent in medicine in general, which is letting people know the known risks and benefits of different things. And I think that should extend to vaccine trials. I don’t think anyone should be forced into a vaccine trial. But I know pregnant women that would have willingly volunteered to be part of a vaccine trial for something like this. I know there are a lot of structural things in place that make it really hard to get that approved at this point, and that’s part of why initial trials just don’t include pregnant women. They don’t include children, often, for similar reasons. But I think we have to trust in people’s autonomy to make that decision for themselves. And if that’s something they’re willing to do, I do think that it would be beneficial to include pregnant women in medical trials.
After you got your first dose, you posted a photo of your vaccination card on Instagram, and in the caption you offered to discuss your decision with anyone who wanted to talk it out. What prompted you to do that?
Honestly, I was really excited! I felt really lucky and grateful that I was able to get the vaccine and that I qualified for it relatively early on. And as a future pediatrician who’s interested in infectious disease, I’m a big proponent of vaccination in general. I think it’s a huge public health accomplishment. And there are a lot of fears and misunderstandings about vaccination in general, so it’s not infrequent that I’ve had conversations with patients and families about them. I think it’s important to continue to have that dialogue open, and I felt a little bit of an obligation to share my decision to receive the vaccine, especially during pregnancy, because I think if I’m going to advocate for something like vaccination, it’s important to demonstrate that I’m not suggesting other people make a choice that I’m not willing to make myself.
I’ve read about health care workers around the country who are refusing the vaccine, in part because they feel like guinea pigs, since they’re among the first to get it. Have you seen any of that reluctance in your cohort?
To be honest, I really haven’t. All of my classmates and I were all really excited to get the vaccine. I don’t doubt that there are people that are concerned about it. I think there is a lack of data, there are a lot of unknowns. And there’s a lot of fears and misunderstandings about vaccination in general, and maybe this vaccine in particular, because of how quickly it was developed. I definitely believe in patient autonomy, so I think, especially at this point, where the vaccine is still, to some extent, under investigation, that it’s reasonable for it to be a personal choice. People should be able to make the decision that works best for them.
How did you feel after getting it?
I feel great. I had a mild headache after first dose, which is very consistent with my immune system doing what it’s supposed to do, and it lasted less than half a day. Other than that, I felt fine. I had a 20-week ultrasound in between my first and second dose, and my kid looked great, was growing appropriately and doing everything he was supposed to be doing. And then I had my second dose just last week, and the only thing I noticed with that was that my arm was a little sore. So I’m very happy with the decision. I have only felt more confident since getting it about the decision to do it.
Is anything about your life going to change now that you’ve gotten vaccinated?
I think my personal sense of safety has changed a little bit. I feel a little more comfortable on a daily basis going and seeing patients and knowing that some of them might have COVID. But in terms of doing social distancing and wearing masks and things like that? Not really. We don’t have enough people vaccinated that I would feel comfortable stopping taking those precautions at this point. And we don’t know how well the vaccine prevents transmission, so I still could potentially be asymptomatic and spread it to someone else, and I certainly don’t want to do that. So definitely still kind of living that pandemic life and being very cautious. But happy to know that I at least have less of a risk of serious illness—and hopefully less of a risk of transmitting COVID to anyone else.