Content

• Actions now required

Classification: Official

Publication approval reference: C1259

To:
ICS Leads
CCG Accountable Officers
NHS Foundation Trust and Trust Chief Executives
Local Authority Chief Executives
PCNs and GP practices
Community Pharmacies

Copy to:
NHS Medical directors
Chief Nurses
Chairs of ICSs
CCG Chairs
Chairs of NHS trusts and foundation trusts
NHS Regional Directors
NHS Regional Directors of Commissioning

17 April 2021

Dear colleague

We are writing to you following the update from the Joint Committee on Vaccination and Immunisation (JCVI) in relation to COVID-19 vaccination during pregnancy and actions to take. The update has been published and can be found here: https://www.gov.uk/government/news/jcvi-issues-new-advice-on-covid-19-vaccination-for-pregnant-women.

The statement from JCVI states:

“There have been no specific safety concerns identified with any brand of coronavirus (COVID-19) vaccines in relation to pregnancy.

Real-world data from the United States shows that around 90,000 pregnant women have been vaccinated, mainly with mRNA vaccines including Pfizer-BioNTech and Moderna, without any safety concerns being raised.

Based on this data, the Joint Committee on Vaccination and Immunisation (JCVI) advises that it’s preferable for pregnant women in the UK to be offered the Pfizer-BioNTech or Moderna vaccines where available. There is no evidence to suggest that other vaccines are unsafe for pregnant women, but more research is needed.

The advice, published in Public Health England’s Green Book, a clinical professional guide for vaccinators in the UK, still advises that pregnant women should discuss the risks and benefits of vaccination with their clinician, including the latest evidence on safety and which vaccines they should receive.”

Public Health England’s Green Book has been updated to reflect this latest advice from the JCVI advice and can be found here.

Actions now required

First doses

• Pregnant woman in eligible cohorts who have yet to receive a COVID-19 vaccination, should be offered the Pfizer-BioNtech vaccine or Moderna vaccine. This currently includes women who are pregnant in cohorts 1, 2, 4, 6 and the 45-49 year old age group. This means that all vaccination sites who are offering the Moderna or Pfizer BioNtech vaccine are required to ensure that from 19 April 2021, pregnant women are able to book appointments for their vaccination at the same time as non-pregnant women, based on age and clinical group.
• The National Booking System (NBS) has been updated to recommend that those who are pregnant speak to a healthcare professional such as an obstetrician, midwife or GP team before booking their first dose appointment. Further updates are planned to the NBS over the coming days to support eligible pregnant women to book an appropriate appointment. We will share further details on this in due course. Those using local booking systems will need to update their systems and processes to reflect the JCVI revised advice.
• All vaccination sites should implement screening procedures to ensure pregnant women are identified and offered the Pfizer BioNtech or Moderna vaccine.
• For sites that do not currently offer an alternative vaccine to the AstraZeneca vaccine, they should cancel first dose appointments if they know the patient is pregnant and direct patients to a PCN site or a vaccination centre that is administering the Pfizer-BioNTech or Moderna vaccine. Pregnant women already booked for a first dose at a community pharmacy-led site or a vaccination centre will not have their appointments automatically cancelled.
• Healthcare professionals should discuss the risks and benefits of vaccination with each pregnant woman presenting for vaccination, as part of the pre-vaccination clinical assessment and consent process. Guidance is contained within Chapter 14a of the Green Book. Patients should be supported to ask questions or seek further information and where necessary, the person should be redirected to an obstetrician, midwife or GP team for further advice and guidance.
• JCVI have also stated that “Woman who are planning pregnancy, are in the immediate postpartum, or are breastfeeding can be vaccinated with any vaccine, depending on their age and clinical risk group.” PHE’s Green Book advises that “There is no known risk associated with being given a non-live vaccine whilst breastfeeding. JCVI advises that breastfeeding women may be offered any suitable COVID-19 vaccine. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for immunisation against COVID-19; at the same time, women should be informed about the absence of full safety data for the vaccine in breastfeeding.”

Second doses

• PHE’s Green Book advises that ‘Pfizer and Moderna vaccines are the preferred vaccines for pregnant women of any age, because of more extensive experience of their use in pregnancy. Pregnant women who commenced vaccination with AstraZeneca, however, are advised to complete with the same vaccine’.
  ‘If a woman finds out she is pregnant after she has started a course of vaccine, she may complete vaccination during pregnancy using the same vaccine product (unless contra-indicated). Alternatively, vaccination should be offered as soon as possible after pregnancy.
  Therefore, for pregnant women who have received a first dose of AstraZeneca and are due to receive their second dose, no further action is required and second dose appointments should continue as planned.

Vaccine supply

• PCN-led and Hospital Hub sites should first look to vaccinate eligible pregnant women with Pfizer-BioNtech through excess supply for second dose clinics.
• PCNs should escalate via their Regional Vaccination Operations Centre (RVOC) if they have insufficient Pfizer vaccine to vaccinate their eligible patients who are pregnant, as per the guidance shared with PCN sites last week. Local systems will have a key role to play in managing demand and ensuring patients have access to the appropriate vaccines.
• If Hospital Hubs have insufficient Pfizer-BioNTech supply to vaccinate an eligible pregnant woman, they should direct the patient to a PCN-led site or a Vaccination Centre offering the Moderna vaccine.

Thank you for your continued efforts and, as ever, we are hugely grateful for everything that you are doing to make the NHS-delivery of this programme the success that it is.

Yours sincerely,

Dr Nikki Kanani | Medical Director for Primary Care

Dr Jonathan Leach OBE | NHS England Medical Director for COVID-19 Immunisation