1. Rohan, Annie J. PhD, RN, FAANP, FAAN

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Pregnant women who contract COVID-19 are broadly recognized to be at increased risk for severe disease and even death, compared with nonpregnant women. They are at higher risk for preterm birth and other adverse pregnancy outcomes. In August 2021, with mounting evidence supporting safety and efficacy, the Centers for Disease Control and Prevention (CDC, 2021, August 11) formally recommended COVID-19 vaccination for people aged 12 years and older who are pregnant, lactating, trying to get pregnant, or who might become pregnant in the future. In July 2021, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine unequivocally endorsed COVID-19 vaccination in pregnant women (ACOG, 2021). Yet at the time of this writing, just 26% of pregnant Americans have been vaccinated, placing this population among the nation's most hesitant to vaccinate (CDC, 2021, October 9).


This is hardly the first time that we have encountered a gap between a widely endorsed professional standard and its uptake in the pregnant patient population. Patient access has almost always presented as our primary challenge. Despite endorsement, many professional standards have been difficult to implement because of cost, complexity, patient transportation issues, limited number of providers offering the service, lack of institutional resources, among other challenges. But not this time. COVID-19 vaccination is free and available to all. It is offered in clinics, mobile vaccination units, and neighborhood convenience stores in every U.S. community. Providers and patients are aware of the standard through public service announcements streaming on our airways. So WHY such a gap? What is our path for getting this vulnerable patient population vaccinated when all the usual barriers appear to have been addressed?


U.S. Congressional hearings are currently underway to address regulation of social media. There is growing concern that social media is undermining the shared sense of reality that underpins society, such that we cannot agree on FACTS. Sophisticated algorithms are used by social media platforms to manicure user newsfeeds by capitalizing on human "confirmation bias." We like information we agree with, or that is "sensational." Manicured newsfeeds that stimulate engagement with a platform are exponentially able to influence people toward having a particular opinion. More engagement = more influence = more engagement. In many cases, social networks have also evolved into platforms for propaganda and empowering disruptive voices, anger, ideologies, and messages. The breakdown of truth, dismissal of science, and growing inability to differentiate facts from opinion make it progressively more difficult for people with different access to evidence, such as patients and providers, to consider the facts, have productive discussion, and draw evidence-based conclusions.


The degree to which our society engages with social media was perhaps unimagined by its proponents. It is now difficult to overstate the amount of misinformation that our patients encounter on these platforms. As a profession that values science and promotes evidence-based care for our patients, how can we overcome this new barrier? Congress is trying to develop consensus on "the problem," but there is little guidance on solutions. We know that role modeling is another powerful human influence. Nurses have been rated the most ethical and honest profession for an impressive 19 years in a row (Gallup, 2020). We can certainly begin to balance the influence of social media with the influence of our powerful profession.


An overwhelming majority of nurses can answer "yes" when their patients ask if they are vaccinated. There remains, however, opportunity to improve rates of patient vaccination through role modeling uptake of evidence-based vaccination guidelines. Where vaccine hesitancy exists, please consider your sources, and pay attention to the algorithms that may be luring your bias.




Centers for Disease Control and Prevention. (2021, August 11). COVID-19 vaccines while pregnant or breastfeeding.[Context Link]


Centers for Disease Control and Prevention. (2021, October 9). COVID-19 vaccination among pregnant people aged 18-49 years overall, by race/ethnicity, and date reported to CDC - Vaccine Safety Datalink, United States.[Context Link]


Gallup. (2020, December 22). U.S. ethics ratings rise for medical workers and teachers.[Context Link]


The American College of Obstetricians and Gynecologists. (2021, July 30). ACOG and SMFM recommend COVID-19 vaccination for pregnant individuals.[Context Link]