Acceptability of COVID-19 Vaccines in an International Sample of Pregnant Women

Background: There has been an unprecedented global effort to produce safe and effective vaccines for COVID-19. In less than a year, several pharmaceutical companies and research organizations have developed vaccines that effectively bring about an immune response. However, COVID-19 vaccines have not been accepted by a large percentage of the general population, especially among those excluded from the clinical trials of potential vaccines, such as pregnant women. The current study was aimed to identify predictors of vaccine acceptance in an international sample of pregnant women. Methods: In 2020, data were collected from pregnant women via an anonymous, online, cross-sectional survey. The survey was hosted on the Pregistry platform for COVID-19 studies and was advertised through a variety of social media platforms and parenting forums in 16 countries. Data related to demographics and likelihood of accepting a COVID-19 vaccine were collected. Results: In total, 5,356 women were included in the study. Vaccine acceptance increased as perceived vaccine efficacy increased. If the vaccine was found to be 90% effective, 30% of our sample indicated that they would be ‘very likely’ to get vaccinated, 11% ‘fairly likely’ and 12% ‘somewhat likely’. Ten percent of respondents felt that they were ‘very well informed’ about COVID-19 vaccines, while 8% were ‘very confident’ that these vaccines are safe and/or effective. Over 50% held the opinion that vaccination was ‘very important’ for their country and that the majority of the population should be vaccinated. In a multivariate model, being a college graduate (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.07-1.35), >30 years of age (OR: 1.11, CI: 1.00-1.23), and residing in Africa (OR: 2.37, CI: 1.52-3.73), Asia (OR: 3.63, CI: 2.96-4.48), Europe (OR: 1.17, CI: 1.03-1.33), and South America (OR: 2.22, CI: 1.92-2.58) were associated with increased vaccine acceptance. White Hispanic, Asian, Black/ Black Hispanic, and Hispanic participants had increased odds of accepting the vaccine compared with those who self-identified as White; however, when stratified by region, this increase only held in North America for Hispanic participants. Conclusion: Only half of our international sample of pregnant women indicated that they would be ‘somewhat likely’, ‘fairly likely’, or ‘very likely’ to get vaccinated against COVID-19. Acceptance differed by region, race and ethnicity, age, and education. This fairly low acceptance suggests a need for public health campaigns that can increase confidence among pregnant women.