Protecting pregnant people & infants against influenza: A landscape review of influenza vaccine hesitancy during pregnancy and strategies for vaccine promotion

ABSTRACT

Before COVID-19, influenza vaccines were the most widely recommended vaccine during pregnancy worldwide. In response to immunization during pregnancy, maternal antibodies offer protection against potentially life-threatening disease in both pregnant people and their infants up to six months of age. Despite this, influenza vaccine hesitancy is common, with few countries reporting immunization rates in pregnant people above 50%. In this review, we highlight individual, institutional, and social factors associated with influenza vaccine hesitancy during pregnancy. In addition, we present an overview of the evidence evaluating interventions to address influenza vaccine hesitancy during pregnancy. While some studies have indicated promising results, no single intervention has consistently effectively increased influenza vaccine uptake during pregnancy. Using a social-ecological model of health framework, future strategies addressing multiple levels of vaccine hesitancy will be needed to realize the potential health benefits of prenatal immunization programs.

Plain Language Summary

Pregnant people are a high priority group for influenza vaccination annually. Although vaccination can protect both mother and infant, vaccination rates are suboptimal during pregnancy. Previous research has suggested reasons for suboptimal vaccination rates, including concerns about the safety of vaccination during pregnancy and limited access to, and awareness of, influenza vaccines during pregnancy. Studies that have attempted to increase influenza vaccination rates during pregnancy have mostly shown no effect – with some exceptions. Public health professionals need to reevaluate strategies for improving vaccination rates during pregnancy.

KEYWORDS:

• Influenza vaccine
• maternal immunization
• pregnancy
• vaccine hesitancy
• immunization barriers
• prenatal vaccination
• vaccine promotion

Disclosure statement

No potential conflict of interest was reported by the authors.

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Funding

The author(s) reported that there is no funding associated with the work featured in this article.