Australian health authorities say misinformation about COVID-19 vaccine side effects and fertility is remaining stubbornly persistent in the face of mounting evidence about the benefits of the vaccine in mitigating the severe impacts of coronavirus.
The University of Melbourne has in Australia to 20.3 per cent of the population for the fortnight ending on 20 August.
Vaccine hesitancy continues to be lowest in the most COVID-19-affected state of New South Wales, but the overall level has risen in the same fortnight by 0.7 per cent to 18 per cent.
At the weekend, Health Minister Brad Hazzard condemned social media conspiracy theories and misinformation targeting couples wanting to conceive. He said and were fuelling vaccine hesitancy.
"I just want to confirm that the most senior health advisory service in Australia has confirmed, absolutely, that there is no evidence whatsoever that a woman's fertility or a man's fertility would be in any way affected by having the vaccine," Mr Hazzard said.
"Young women and girls who are contemplating having a child should understand that if they don't have the vaccine, and they do get the virus, they may suffer from long COVID or from symptoms that would actually make it more difficult to be able to have children, and to have as many children as they would like."
Some of the misinformation on social media can be traced back to a letter from December 2020 detailing a non-evidenced claim of female infertility risks and the Pfizer vaccine, which has since been discredited.
and speed of misinformation arising from the letter, analysing US-based Google searches for the terms 'infertility and vaccine', and noted the frequency of the search terms increased by 34,900 per cent in the wake of the letter.
What is the advice for pregnant women?
For researcher Dr Anya Arthurs, her personal and professional worlds collided when she became pregnant during lockdown.
Her job with the Flinders University's Pregnancy, Health and Beyond Laboratory saw her studying epigenetics and non-coding RNAs in various aspects of human development and disease, particularly in cancer and reproductive health. Then suddenly she was in the position of deciding whether to have a COVID-19 vaccine in the middle of 2020 when the evidence base did not yet exist on pregnant women and those looking to conceive.
"At the time, neither of the vaccines had been evaluated during pregnancy. So at the time, I chose not to get a vaccine because we didn't have that data," she said.
Dr Anya Arthurs says the benefits of vaccination for new mothers include conferring antibodies and COVID-19 immunity through breast milk. Source: Supplied
Clinical trials of COVID-19 vaccines had not involved pregnant women and it was only once countries had begun their vaccine rollouts in earnest that they were able to collect longitudinal data on how pregnant women were impacted.
"With data we have now, if I could have got the vaccine while I was pregnant, I would have," Dr Arthurs said.
"Especially as there is so much to say that if you do get COVID when you are pregnant or trying to conceive it can be really bad for the mother and also for the baby as well. There are lots of reports of miscarriage and stillbirth."
Now mother to a two-month-old, Dr Arthurs has received her first Pfizer jab and is a fortnight away from the second dose.
the use of Pfizer or AstraZeneca for pregnant women and those looking to conceive, with a preference for Pfizer based on the greater volume of available data on pregnant women.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists has : "Pregnant women are a priority group for COVID-19 vaccination, and should be routinely offered Pfizer mRNA vaccine (Cominarty) or Spikevax (Moderna) at any stage of pregnancy."
What makes the misinformation that is spreading inaccurate?
Professor Kristine Macartney is the director of the National Centre for Immunisation Research & Surveillance (NCIRS). She said unfounded claims that the spike protein within the COVID-19 vaccines harm women's reproductive systems are dangerously inaccurate.
"There are lots of studies done, and there are first principles that tell us the vaccines can't interfere with fertility.
"So for example, with the mRNA vaccines, the mRNA or DNA is not integrated into our genome. It doesn't change our genetic material. There is no programming. There are no microchips. There are no mysterious messages to turn off fertility."
As an mRNA vaccine, the Pfizer vaccine does not alter human cells but uses bits of genetic code to provide instructions to the body to build immunity to COVID-19.
AstraZeneca uses a harmless virus - a de-activated adenovirus - altered to look like the pandemic virus. Once the contents enter the cell, the adenovirus breaks down and can't interact with a person's DNA or cause disease.
Professor Macartney said vaccine hesitancy has always existed, including with the vaccines for polio and for the most common sexually transmitted infection of the human papillomavirus virus (HPV). But it took time for the vaccines to be rolled out in countries for data to come in on pregnant women and those looking to conceive through IVF treatments.
"In the early days [mid-2020], there was a more cautious stance on recommendations in pregnancy. Then in many countries where there have been high rates of COVID-19, tens of millions of people who are pregnant or planning to be pregnant - or breastfeeding - have now been vaccinated.
" followed up by SMS surveys, followed to the end of their pregnancy to see the outcomes of that pregnancy. Was there pre-term delivery? Did the baby do okay compared to women who weren't vaccinated during pregnancy? And even women who got COVID themselves.
"And all of these studies have now been able to read out and give us so much more confidence to advise women who are pregnant that is okay to be vaccinated in your pregnancy."
Today, the data collected by national governments and health authorities from 4.5 billion COVID-19 vaccines administered has built a very solid evidence base.
"In many different ways, all the evidence stacks up really strongly to say that: there is no issue with vaccines and fertility. The issue with fertility, and your health more broadly, is it is not a good idea to get COVID, and it is a much better idea to be vaccinated," Professor Macartney said.
What about the risks to men or young people?
Professor Macartney said the volume of longitudinal data and the reporting mechanisms of adverse COVID-19 vaccines has not detected negative impacts on men's sperm count, or on the long-term fertility of young people.
"There have been concerns that the antibodies that the vaccine might generate do something to the sperm count. But there are now studies that tell us the complete opposite."
She said while there is more information being gathered in this field, health experts also draw from first principles and the debilitating, sometimes fatal, effects of contracting COVID-19.
"If you are a young person, no matter what your gender is, if you have COVID, if you have long COVID, you're health is not good. If you have been intensive care, if you have been on a heart, lung bypass machine on a ventilator, there is a significant chance that your health and wellbeing - and maybe your ability to have a family - may be impacted over time.
"If you die from COVID, you can't go on to be a parent. These are reasons why we want people to be vaccinated against COVID. To keep them healthy and well.
"On the flip side, there is an increasing number of studies that tell us about the safety of COVID-19 vaccines in young people and in pregnant women."
She said scientists and health authorities are continuing to sift through data to uncover any adverse side effects, including longer-term.
"It is an ongoing project. You can be assured we are being thorough and leaving no stone unturned."
Australia's medicines regulator, the Therapeutic Goods Administration, has been conducting regular Vaccine safety is also being , led by the NCIRS, involving at least 2.5 million instances of vaccinations including Australians of different ethnic backgrounds.
How should people weigh up the risks from vaccines?
Professor Macartney said when weighing up risks, it is important to consider the bigger picture.
"If you are a pregnant woman with underlying health conditions that will increase your risk of severe outcomes from COVID, that is even more reason to be vaccinated now. Or if you're an older pregnant woman, with each decade of age, the risk of severe outcomes [from COVID-19] goes up.
"So if you're in your 40s and pregnant, please don't worry about the vaccine [side-effects]. Think about what COVID looks like and know the benefits of being vaccinated, particularly if you're in an area where COVID is about."
As for the path out of lockdown and reducing COVID-19 transmission, that depends on getting high levels of vaccine coverage. Professor Macartney said she would like that level to be between 95 and 98 per cent of the community.
"We need everyone who can possibly be vaccinated to be vaccinated because every time someone isn't vaccinated, they're taking a risk. They're throwing the dice with meeting the virus some way or another, passing it around, being admitted to our healthcare system, the virus spreading to our vulnerable who will be less protected by vaccination because they have got a transplant or they have an immune system problem.
"We really owe it to our community to get on board with the vaccine."
For Dr Arthurs, the experience of having a baby during the pandemic informed her research project to review the evolving literature on COVID-19 vaccine impacts on pregnant women. What she uncovered confirmed that the negative side effects are far greater for unvaccinated pregnant women who contract COVID-19 than from the vaccines.
"The most important thing that we see is that if you are to get COVID-19 when you are pregnant, we see some really devastating effects in the baby. Sometimes stillbirth or miscarriage - or even pre-term birth which is when the baby is born too early, which can be quite detrimental in the long-term.
"It can be really devastating in early pregnancy and that is because the mother has respiratory distress where she is not able to breathe properly, affecting the oxygen that goes to her cells in her placenta, which is supplying the baby with oxygen as well.
"What we do see is there is the ability to confer antibodies in breast milk, in some papers. This is preliminary data but is comforting to know that this is the case. And there are a lot of other cases where antibodies are conferred through breast milk, so it does make a lot of sense that this could be the case.
"All in all, the paper shows it is quite scary [to get COVID-19 as an unvaccinated pregnant woman]. We don't want to get COVID-19 when we're pregnant or conceiving. If we can get a vaccine that could protect us and also give immunity to our little ones then that would be the way to go."
The paper is due to be published for the Biochimica et Biophysica Acta - Molecular Basis of Disease journal at the end of this week.
Those with concerns about the vaccine are advised to speak to their GP or a doctor.
