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Manca TA, Top KA, Graham JE. COVID-19 vaccination in pregnancy: How discrepant public health discourses shape responsibility for fetal health. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100265. [PMID: 37069999 PMCID: PMC10084631 DOI: 10.1016/j.ssmqr.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/16/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023]
Abstract
Early in COVID-19 vaccine rollout, expert recommendations about vaccination while pregnant and breastfeeding changed rapidly. This paper addresses the (re)production of gendered power relations in these expert discourses and recommendations in Canada. We collected texts about COVID-19 vaccine use in pregnancy (N = 52) that Canadian health organizations (e.g., professional societies, advisory groups, health authorities) and vaccine manufacturers made publicly available online. A discourse analysis was undertaken to investigate intertextuality (relations between texts), social construction (incorporation of assumptions about gender), and contradictions between and within texts. National expert recommendations varied in stating COVID-19 vaccines are recommended, should be offered, or may be offered, while manufacturer texts consistently stated there was no evidence. Provincial and territorial texts reproduced discrepancies between the Society of Obstetricians and Gynaecologists of Canada and National Advisory Committee on Immunization recommendations, including that COVID-19 vaccines should be versus may be offered in pregnancy. Our findings suggest gaps in data and discrepant COVID-19 vaccine recommendations, eligibility, and messaging limit guidance regarding vaccination in pregnancy. We argue that these discrepancies magnified the already common practice of deferring responsibility for the uncertainties of vaccination in pregnancy onto parents and healthcare providers. The deferral of responsibility could be reduced by harmonizing recommendations, regularly updating texts that describe evidence and recommendations, and prioritizing research into disease burden, vaccine safety, and efficacy before vaccine rollout.
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Affiliation(s)
- T A Manca
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, Alberta, T9S 3A3, Canada
- Department of Sociology and Social Anthropology, Dalhousie University, Room 1128, Marion McCain Arts and Social Sciences Building, Halifax, Nova Scotia, B3H 4R2, Canada
| | - K A Top
- Department of Pediatrics (Infectious Diseases), Dalhousie University, 5850 University Avenue, P. O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada
- Canadian Center for Vaccinology, IWK Health Centre, 5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada
| | - J E Graham
- Department of Pediatrics (Infectious Diseases), Dalhousie University, 5850 University Avenue, P. O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada
- Canadian Center for Vaccinology, IWK Health Centre, 5980 University Ave, Halifax, Nova Scotia, B3K 6R8, Canada
- Technoscience & Regulation Research Unit, Faculty of Medicine, 5849 University Avenue, C-301, Halifax, NS, B3H 4H7, Canada
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Manca T, Humble RM, Aylsworth L, Cha E, Wilson SE, Meyer SB, Greyson D, Sadarangani M, Parsons Leigh J, MacDonald SE. "We need to protect each other": COVID-19 vaccination intentions and concerns among Racialized minority and Indigenous Peoples in Canada. Soc Sci Med 2022; 313:115400. [PMID: 36206660 PMCID: PMC9519366 DOI: 10.1016/j.socscimed.2022.115400] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 01/26/2023]
Abstract
People may choose to receive vaccines in response to pressures that outweigh any concerns that they have. We explored Racialized minority and Indigenous Peoples' motivations for, perceptions of choice in, and concerns about, COVID-19 vaccination. We used a sequential explanatory mixed methods approach, including a national survey administered around the time vaccines were first authorized (Dec 2020) followed by qualitative interviews when vaccines were becoming more readily available to adults (May-June 2021). We analyzed survey data using descriptive statistics and interviews using critical feminist methodologies. Survey respondents self-identified as a Racialized minority (n = 1488) or Indigenous (n = 342), of which 71.4% and 64.6%, respectively, intended to receive a COVID-19 vaccine. Quantitative results indicated perceptions of COVID-19 disease were associated with vaccination intention. For instance, intention was associated with agreement that COVID-19 disease is severe, risk of becoming sick is great, COVID-19 vaccination is necessary, and vaccines available in Canada will be safe (p < 0.001). COVID-19 vaccines were in short supply in Canada when we subsequently completed qualitative interviews with a subset of Racialized minority (n = 17) and Indigenous (n = 10) survey respondents. We coded interview transcripts around three emergent themes relating to governmentality and cultural approaches to intersectional risk theories: feelings of collective responsibility, choice as privilege, and remaining uncertainties about COVID-19 vaccines. For example, some mentioned the responsibility and privilege to receive a vaccine earlier than those living outside of Canada. Some felt constraints on their freedom to choose to receive or refuse a vaccine from intersecting oppressions or their health status. Although all participants intended to get vaccinated, many mentioned uncertainties about the safety and effectiveness of COVID-19 vaccination. Survey respondents and interview participants demonstrated nuanced associations of vaccine acceptance and hesitancy shaped by perspectives of vaccine-related risks, symbolic associations of vaccines with hope, and intersecting social privileges and inequities (including racialization).
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Affiliation(s)
- Terra Manca
- Faculty of Nursing, University of Alberta, Canada,Corresponding author
| | | | | | - Eunah Cha
- Faculty of Nursing, University of Alberta, Canada
| | - Sarah E. Wilson
- Public Health Ontario, ICES, Canada,Dalla School of Public Health, University of Toronto, Canada
| | - Samantha B. Meyer
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Canada
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Canada,Vaccine Evaluation Center, BC Children's Hospital Research Institute, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Canada,Department of Pediatrics, University of British Columbia, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Canada
| | - Shannon E. MacDonald
- Faculty of Nursing, University of Alberta, Canada,School of Public Health, University of Alberta, Canada
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