Pregnant women’s attitudes and intentions toward tuberculosis, malaria, group B streptococcus, and respiratory syncytial virus vaccines in pregnant: Findings from pregnant women living in Brazil, Ghana, Kenya, and Pakistan

Introduction There are numerous infections that can adversely impact a developing fetus, neonates, and pregnant women, and there is limited research related to how specific infections experienced during pregnancy can affect these populations. Tuberculosis (TB), malaria, Group B streptococcus (GBS) and respiratory syncytial virus (RSV) can cause negative outcomes to maternal and neonatal health. For TB and GBS, there are vaccines in various stages of clinical trial development, and malaria and RSV vaccines are available. This study aimed to examine pregnant women’s attitudes toward TB, malaria, GBS, and RSV vaccines in Brazil, Ghana, Kenya, and Pakistan.

We administered a cross-sectional survey to pregnant women, recruiting women seeking care in primarily urban health facilities.

We surveyed 1,603 pregnant women. Participants indicated that vaccine safety for the baby was the most important factor in their decision-making related to vaccine acceptance, followed by vaccine efficacy for the baby, and then vaccine safety for the baby. When asked why they would receive any of the four vaccines, participants indicated that protecting the baby was most important, followed by protecting self, and then stopping the spread of disease. Almost one-third of participants (30%) indicated that they would definitely intend to receive a GBS vaccine, followed by malaria (26%), RSV (25%), and TB (19%). Related to vaccine hesitancy, approximately 40% of our participants agreed that vaccines are unnatural, 38% agreed that the body should develop natural immunity, and 19% had delayed a recommended vaccine.

Pregnant women are interested in receiving various vaccines while pregnant. As several new adult vaccines are on the horizon, understanding the attitudes of potential vaccine beneficiaries at higher risk for diseases is critical for informing clinical trial design and, in the long term, vaccine acceptance. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was funded by the Gates Foundation (grant INV-016977) to R.J.L/R.A.K. at the Johns Hopkins Bloomberg School of Public Health. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Johns Hopkins Bloomberg School of Public Health Institutional Review Boa rd (00020864), University of Campinas/Unicamp Brazil (63968222.1.1001.5404), Jundiai University Institutional Review Board Brazil (63968222.1.1001.5404), Ghana Health Service Ethics Review Committee (028/03/23), Aga Khan University Kenya (2023/ISERC −17(v2), Pumwani Maternity Hospital (PMH/CEO/76/0785/2023), Aga Khan University Pakistan (2024-8633- 30122), National Bioethics Committee for Research Pakistan (4-87/NBCR-1029/23/1087), and Ethics Research Committee World Health Organization (CERC.0193A, CERC.01 93B, CERC.0193C), Ethics Review Committee Pan American Health Organization (PAHOERC.0633.01). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data Availability Data will be made available upon reasonable request.