Release Date : February 07 2022
ACOG Committee Opinion on Ethical Issues with Vaccination in Obstetrics and Gynecology (2021)
About the Guideline
- This opinion was created by the American College of Obstetricians and Gynecologists (ACOG) Committee on Ethics, in collaboration with committee members Jami Star, MD, and Kavita Shah Aror, MD, MBE, MS.
- Vaccination goals are to promote both individual and public health in the community.
- Barriers to vaccination are often the result of misinformation, which creates distrust in the general public and discourages vaccination.
- This guideline will discuss how obstetrician-gynecologists can educate their patients on the need for vaccination, administer vaccines, and be positive public health role models.
Key Clinical Considerations
Become familiar with the recommendations and best-practice statements provided in this recommendation, especially if you work in an OB/GYN setting
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Recommendations and Conclusions
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- Obstetrician-gynecologists have an ethical obligation to become knowledgeable about current recommendations and guidelines regarding vaccines and to encourage their patients to be vaccinated, but also to help their patients understand the risks, indications, and benefits of vaccination.
- Informed decision making for patients will require obstetrician-gynecologists to have evidence- based discussions with them about vaccination, in accordance with the Centers for Disease Control and Prevention’s (CDC) guidelines.
- For those patients who are uncertain about or refuse vaccination, time should be set aside to have an open dialog to address concerns. Should the patient continue to refuse, document their refusal in the patient record. The vaccine should be offered again at return visits in case the patient has changed their mind.
- State laws that permit nonmedical exemptions for personal, philosophical, or religious reasons can impede the ability to vaccinate many patients and thereby protect vulnerable individuals.
- Vaccination and reproductive health care services of adolescents can create ethical challenges regarding confidentiality and informed consent, as access to reproductive health care services can require parental consent or notification.
- Pregnant and lactating patients should be offered vaccinations based on evidence-based (ACOG or CDC) information regarding informed decisions.
- Obstetrician-gynecologists also should be vaccinated unless they have a medical contraindication.
Ethical Issues and Considerations
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- Dealing with misinformation and distrust is a major challenge that causes patients to refuse vaccinations offered or recommended. Social media has played a significant role in disseminating false and damaging information that increases the level of fear regarding vaccination in some patients and results in distrust in the vaccine.
- Ethical issues and considerations require obstetrician-gynecologists to educate and encourage patients to be vaccinated, if medically possible, to preserve the health of individuals as well as the general public.
- Help patients make informed decisions by giving them evidence-based guidelines from the CDC, ACOG, and other reputable sources. Review the indications for and the risks and benefits of the vaccine and its alternatives with patients prior to their decision to be vaccinated. Discuss the risks to oneself and close contacts regarding the disease to be prevented. Withholding a vaccine without patient refusal is an ethical violation.
- The Vaccine Information Statements (VISs) on the CDC website are available in multiple languages and contain information about the vaccine being given to the patient. They should be offered to both patients who receive the vaccine and patients who refuse it.
- Vaccination hesitancy and refusal has been named by the World Health Organization (WHO) as a threat to global health. WHO notes that the identified causes of vaccination hesitancy are complacency, low confidence in and mistrust of the medical field, and a lack of convenience.
Nonmedical Exemptions
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- State laws require certain vaccinations for school enrollment but have allowed medical exemptions when necessary. There are also some provisions for religious and philosophical exemptions.
- Nonmedical exemptions are a threat to the individual and to the general public, as the rate of vaccination is reduced, which allows the disease to spread more readily.
- Obstetrician-gynecologists are encouraged to support the repeal of nonmedical vaccination laws in the states they practice in.
Public Health Emergencies
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- When vaccines are developed quickly to address an emergent disease or pandemic, patients may have concerns about the safety and effectiveness of these vaccines.
- Obstetrician-gynecologists must remain up to date on the progress of these emergent vaccines and be prepared to share evidence-based, updated knowledge with their patients to address fears and support informed decision making around taking the vaccine.
Adolescents
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- State laws vary as to which medical treatments may be given without parental support, so obstetrician-gynecologists need to understand the current laws in their states and jurisdictions.
- Parental consent will often depend on parents’ trust in the obstetrician-gynecologist‘s recommendations and an informed choice of recommended vaccinations, such as HPV, for their child.
- Shared decision making between the adolescent, parent or guardian, and obstetrician- gynecologist is the best way to manage the health care needs of adolescent patients.
Pregnancy and Lactation
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- Safety and efficiency are important in the management of pregnant or lactating patients; however, vaccination rates in these patients are low compared with nonpregnant or nonlactating patients.
- Counseling of these patients must be done using the most current evidence and information to promote trust in vaccine safety and the prevention of disease. Passive immunity in the newborn should also be discussed as a side benefit of vaccinations.
- Providing the time for open dialog to address concerns the patient may have is important to help them feel comfortable with vaccination recommendations. Refusal should be respected and documented in the patient record and other means to reduce transmission and exposure should be given to patients, as appropriate.
Vaccination of Health Care Professionals
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- Obstetrician-gynecologists have an ethical obligation to be vaccinated to prevent disease spread and transmission.
- Health care vaccination supports the following goals:
- Reduction of disease spread among both inpatients and outpatients in the community
- Prevention of illness among medical staff
- Less absenteeism among medical staff
- Following vaccination guidelines to support the professional obligation to protect patients
- Sending a message to patients and the community, via vaccination, that there is benefit to and safety in receiving vaccinations
Reference
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American College of Obstetricians and Gynecologists’ Committee on Ethics, et al. (2021). ACOG Committee Opinion No. 829: Ethical issues with vaccination in obstetrics and gynecology.
Obstetrics and Gynecology, 138(1), e16–e23. Retrieved December 2021 from
https://doi.org/10.1097/aog.0000000000004390