CDC COVID-19 vaccine policy reversal raises alarms for pregnant women

CDC COVID-19 vaccine policy reversal raises alarms for pregnant women | Image Credit: © myskin - © myskin - stock.adobe.com.

The policy reversal on May 27, 2025, to remove the COVID-19 vaccine from the CDC’s recommended immunization schedule risks severe adverse maternal and neonatal health outcomes, according to a recent publication in JAMA.¹

Widespread medical endorsement for COVID-19 vaccination

COVID-19 vaccination has received renewed endorsement from 32 organizations, including the American College of Obstetricians and Gynecologists and the American Medical Association. By removing it from the CDC guidelines, authors fear public trust in evidence-based care may be reduced, alongside vaccine uptake.

“A further compounding concern is the bypassing of established, transparent processes such as review by the Vaccines and Related Biological Products Advisory Committee and the Advisory Committee on Immunization Practices, which traditionally inform CDC recommendations,” wrote the authors.

Research has highlighted the efficacy of the COVID-19 vaccine toward protecting mothers and infants, including a 10-fold increase in cord anti-Spike antibodies from 3 or more doses vs 2 doses found in a 2024 study.² The results highlighted a geometric mean concentration for anti-Spike antibodies of 674 after 2 doses and 8159 after 3 doses among mothers. Cord anti-Spike antibodies displayed similar outcomes.

Misuse of shared decision-making

A merging of evidence-based medicine and preference-sensitive care was highlighted by the CDC’s policy shifts.¹ According to the authors, professional responsibility is abandoned when shared decision-making principles are applied to a situation best managed through vaccination.

According to the authors, shared decision-making should be utilized when 2 or more options with similar risk-benefit profiles are available. In cases such as COVID-19 vaccination, a single course of action is highly supported by high-quality evidence. Vaccination has been proven effective, with the benefits significantly outweighing the risks.

The role of clinicians in upholding professional responsibility

Authors highlighted the professional responsibility model as a tool for completing essential obligations in COVID-19 vaccination counseling. The model highlights the importance of a clinician’s recommendation in maternal decision-making. Therefore, it is essential for clinicians to explain the risks of COVID-19 infection and the high safety of vaccination.

The professional responsibility model also emphasizes the need to empower patients to make informed decisions. This included addressing vaccine hesitancy and providing information about the risks of nonvaccination while respecting patient autonomy.

Additionally, respecting the right to refuse vaccination ensures accurate information drives all decisions. To provide optimal counseling, the authors recommended building trust through understanding patients’ concerns and utilizing clear communication. According to the authors, it is an abandonment of professional responsibility not to provide clear recommendations and evidence.

Societal and clinical risks of misapplied ethics

Authors also discussed the clinical, professional, and societal consequences of the CDC misapplying shared decision-making or its equivalence. This included decreased vaccine uptake, which may lead to higher rates of morbidity and mortality. Populations already facing health disparities are especially at risk.

An additional side effect is legitimizing vaccine hesitation. False neutrality indicates medical reasons for decreasing vaccination uptake, increasing hesitation among physicians, which will lead to higher rates of maternal morbidity.

A real-world impact has already been observed. Certain pharmacies are not giving pregnant women the COVID-19 vaccine, and significant confusion about clinical guidance has been noted by some health care workers.

Ethical responsibility to guide

Authors wrote that abandoning the responsibility to synthesize complex evidence for patients who need guidance is disrespectful toward patients at a time when they need this support the most. This also creates a dangerous precedent that making recommendations may be ethically inappropriate.

The concerns that arise from the societal impact of false neutrality are shown by the advice of Department of Health and Human Services Secretary Robert F. Kennedy Jr for patients to do their research. Authors also expressed worry about ripple effects toward the uptake of other vaccines that protect pregnant women and their infants.

“The stakes are too high for pregnant women, their infants, and the integrity of medical practice to allow conceptual confusion to masquerade as ethical sophistication,” wrote investigators.

References:

1. Grünebaum A, Chervenak FA. Professional responsibility for COVID-19 vaccination in pregnancy. JAMA. 2025. doi:10.1001/jama.2025.11328
2. Krewson C. COVID-19 vaccine dosing impact on maternal and infant antibodies. Contemporary OB/GYN. January 24, 2024. Accessed June 30, 2025. https://www.contemporaryobgyn.net/view/covid-19-vaccine-dosing-impact-on-maternal-and-infant-antibodies.