“There is no bad time to get vaccinated,” Dr. Walensky said.
“Get vaccinated while you’re thinking about having a baby, while you’re pregnant with your baby, or after you’ve delivered your baby,” she added.
“The environment changed during 2021 and by September 2021, COVID-19 vaccines were recommended by applicable recommending bodies (e.g., ACIP in the U.S.) for pregnant women in all participating/planned countries, and as a result the enrollment rate declined significantly.”
The data do not appear in a peer-reviewed journal or a pre-print, nor have they been submitted to the FDA for evaluation.
Trial Design
Pfizer originally planned to recruit 4,000 healthy women aged 18 or older who were 24 to 34 weeks pregnant. Half would be randomized to the vaccine and the other half to a saline placebo.The efficacy and safety of the vaccine would be determined by assessing COVID-19 cases, antibody responses, and adverse events.
Peculiarly, Pfizer planned to vaccinate all the mothers in the placebo group, one month after giving birth to their babies.
Retsef Levi, a professor at the Massachusetts Institute of Technology Sloan School of Management, said that vaccinating mothers in the placebo group during the assessment period would introduce a new variable into the experiment and “corrupt” the data.
Sample Size Too Small
Less than 10 percent of the originally planned 4,000 study participants ended up in the trial.“Only 348 women were recruited—174 in each arm—meaning that the trial was never going to have the statistical power, particularly when analyzing potential harms,” Mr. Levi said.
“To me, the wording in the protocol suggests that the FDA or another regulator basically gave Pfizer permission to do less,” Mr. Levi said.
“It’s not surprising though. The vaccine had already been recommended for pregnant women and many have taken it, so there is no upside to completing a trial that may detect signals of potential harms. It can only create problems for them, right?” he added.
Given that pregnant women were being vaccinated with a product that had not undergone rigorous safety testing in pregnancy, the FDA was asked whether and why it allowed Pfizer to scale back the trial.
The FDA replied, “As a general matter, FDA does not comment on interactions it may or may not be having with sponsors about their clinical trials.”
“There are just not enough babies in this trial to detect rare or very rare adverse events. We learned from studies in animals that lipid nanoparticles in the vaccine can deposit in many organs including the ovaries, so we must be extremely cautious about the potential negative impacts of the vaccine on reproductive health,” Dr. Spelsberg said.
Exclusion Criteria
The small sample size may have been the result of the strict selection process.Pfizer recruited participants with an impeccable pregnancy history, and most were in their third trimester (27–34 weeks gestation), a stage when the baby’s major development has already occurred.
“It appears that they cherry-picked the mothers to get the best results,” Mr. Levi said. “We have no idea what impact this vaccine has on the early stages of development of an embryo or fetus, because all the women had advanced pregnancies when they were recruited.”
Dr. Spelsberg agreed.
“The first trimester is particularly vulnerable to adverse reproductive health outcomes,” she said.
Missing Data
Mr. Levi also noticed that “only partial data” were published.“It doesn’t include any important metrics such as COVID infections or antibody levels and its says we must wait until July 2024 for those results. It’s disturbing to say the least,” Mr. Levi said.
Also missing from the dataset was a full account of birth outcomes. Of the 348 women in the trial, Pfizer only reported on the birth of 335 live babies.
Of the 13 pregnancies unaccounted for, Pfizer reported one fetal death (stillbirth) in the vaccine group, and the outcome of the other 12 pregnancies remains unknown.
Trial Dropouts
Finally, data on quite a few babies were lost to follow-up in the trial.“Twenty-nine babies in the placebo arm didn’t get to the end of the 6-month surveillance period, versus 15 babies in the vaccine arm. That’s almost double. Again, this is concerning and requires a detailed and transparent explanation,” Mr. Levi said.
Overall, Mr. Levi and Dr. Spelsberg say the delays and failure to disclose vital data are unacceptable.
“Pfizer took a year to publish the data. When they finally did, it is incomplete. And we are expected to wait until July 2024 for the next batch of results, while authorities continue to recommend the vaccine in pregnant women,” Mr. Levi said.
“We still don’t have solid scientific evidence whether this vaccine is safe for pregnant women and their babies,” Dr. Spelsberg said. “It’s a tragedy and a scandal that vaccine use has been recommended, even mandated to women before, during, and after pregnancy.”
Questions were put to Pfizer, but the company didn’t respond by deadline.
Moderna is also conducting a clinical trial of its mRNA vaccine in pregnancy, but no data are available.