Joint position statement on vaccines from the Society for Birth Defects Research and Prevention and the Organization of Teratology Information Specialists

In this joint position statement, the Society for Birth Defects Research and Prevention (BDRP) and the Organization of Teratology Information Specialists (OTIS) acknowledge the important role that vaccines play in improving public health, including the health of mothers and children. Vaccines have substantially reduced the morbidity, mortality, and healthcare costs associated with vaccine-preventable diseases (Centers for Disease Control and Prevention, 2011a, 2011b). Vaccines are increasingly used during pregnancy to prevent maternal infection and to provide protection for the newborn through passive immunization (Lindley et al., 2019). However, despite strong evidence related to the efficacy and safety of vaccines, vaccine hesitancy (the reluctance or refusal to vaccinate) could reverse some of the progress made. Vaccine hesitancy has led to increased outbreaks of infectious disease in the United States (Patel et al., 2019) and globally (Abad & Safdar, 2015). Pregnant women often cite concern about the effects on their fetus as a common reason for nonvaccination (Lindley et al., 2019). Addressing the drivers of vaccine hesitancy will sustain progress in public health achievements in vaccine-preventable diseases (Lo & Hotez, 2017). In addition, removal of financial barriers will be important given that uninsured children, adolescents, and adults are less likely than those who are insured to receive recommended vaccines (Chan, Chang, Erickson, & Wang, 2019; Hill, Elam-Evans, Yankey, Singleton, & Kang, 2018; Lu et al., 2018). BDRP and OTIS advocate for the continued use of vaccines to improve health, development of new vaccines, removal of barriers to vaccination in developed and developing countries including addressing drivers of vaccine hesitancy and barriers related to costs, and continued support of vaccine safety studies to address concerns raised by the public. The effects of vaccines on public health are well documented. Vaccines are considered by the Centers for Disease Control and Prevention (CDC) to be one of the 10 great public health achievements in the United States and worldwide for 2001–2010 (Centers for Disease & Prevention, 2011a, Centers for Disease & Prevention, 2011b). Vaccination led to the eradication of smallpox, a major cause of global morbidity and mortality. In 1967, the first year of the smallpox eradication program, 43 countries reported cases of smallpox, with at least 10 million cases and 2 million deaths; in 1977, a little over 10 years later, the last known case of smallpox was reported in Somalia (Henderson, 2011). Childhood vaccination has a significant impact on childhood morbidity and mortality; an analysis performed in 2014 showed that 322 million illnesses; 21 million hospitalizations; and 732,000 deaths were estimated to be prevented by vaccines among children born during 1994–2013 over the course of their lifetimes (Whitney et al., 2014). The development of new vaccines has led to continued disease prevention. The human papillomavirus (HPV) vaccination was first recommended for adolescent females in 2006 (recommendations were later extended to males) to prevent cervical and other HPV-associated cancers. Despite the fact that only about half of adolescents in the United States had completed the HPV vaccination series (Walker et al., 2019), substantial decreases in rates of high-grade cervical lesions (cervical cancer precursors) have been observed since the introduction of the vaccine (Benard et al., 2017; Flagg, Torrone, & Weinstock, 2016; Gargano et al., 2019). Rotavirus vaccine is another example: Gastroenteritis due to rotavirus led to up to 70,000 hospitalizations annually before the introduction of the rotavirus vaccine into the infant vaccination schedule in the United States in 2006. Since its introduction, dramatic reductions in the number of hospitalizations, emergency department visits, and physician office visits due to rotavirus have been observed in children <5 years of age (Curns et al., 2010; Shah, Tate, Steiner, & Parashar, 2016; Tate et al., 2010; Wang, Mast, Glass, Loughlin, & Seeger, 2010). Of note, decreases in rotavirus hospitalizations were seen across age groups even among persons who were too old to be vaccinated, demonstrating the indirect effect of vaccinating infants on the health of the entire population, given the importance of young children in disease transmission (Baker et al., 2019; Baker, Dahl, Cubilo, Parashar, & Lopman, 2019). These direct and indirect effects have also been observed globally (Tate et al., 2010). Received: 4 March 2020 Revised: 11 March 2020 Accepted: 11 March 2020