Prioritizing pregnant women for COVID-19 vaccination.

Despite emerging evidence on safety and efficacy, most countries do not offer COVID-19 vaccines to pregnant women even though they are at higher risk of complications from COVID-19. We performed a web search of COVID-19 vaccination policies for pregnant women under two categories: countries bearing a high burden of COVID-19 cases and countries with a high burden of maternal and under-five mortality. Of the top 20 countries affected by COVID-19, 11 allow vaccination of pregnant women, of which two have deemed it safe to vaccinate pregnant women as a high-risk group. In contrast, only five of the 20 countries with high under-five mortality and maternal mortality allow vaccination of pregnant women and none of these countries has included them as part of a high-risk group that should be vaccinated. India and Indonesia, with one-fifth of the world's population, fall under both categories but do not include pregnant women as a priority group for COVID-19 vaccination. To prevent COVID-19 from further aggravating the already heavy burden of maternal and under-five mortality, there is a strong case for including pregnant women as a high-priority group for COVID-19 vaccination. We recommend including COVID-19 vaccination in routine antenatal care in all countries, particularly India and Indonesia in view of their high dual burden.