I think pregnant women have been badly let down when it comes to the vaccine rollout in the UK. I am a HCW and actively sought out getting the vaccine during my pregnancy and was thankfully successful (Pfizer, though I personally would have accepted AZ and still would if that was all I could get). Colleagues I know have been refused the vaccine according to some kind of trust policy lottery even though it has been allowed for pregnant HCW since January. These are professional women from healthcare backgrounds able to make an informed decision, treated as passive vessels for fetuses. Ugh. Several pregnant HCW have been reported in national media who have died from covid infection acquired in the third trimester (since start of pandemic). Some of these deaths which followed the vaccine rollout were potentially preventable. But those women had that choice taken from them due solely to their pregnancy, though it actually put them at greater risk of death from covid. How many pregnant women have died from covid vaccination? (None that I am aware of).
The first failure was to exclude pregnant women from clinical trials of the vaccine when there is no theoretical basis for risk to pregnancy. By that I mean, there is no logical reason to think the vaccine would be harmful to pregnancy (AZ is not live and works in the same way as other vaccines which can be given to pregnant women, Pfizer is literally a tiny piece of mRNA etc), it's just a case of not having the evidence to demonstrate safety from trials etc. However, if a lack of evidence is used as the basis for not including pregnant women in trials and not vaccinating pregnant women (eg not collecting evidence) then pregnant women are just left out without a way forward and the default of not being vaccinated. It's circular: "there is not enough evidence for us to proceed with gathering evidence". For a long time now there has been evidence that pregnant women in the third trimester are significantly more likely to need ITU, to die from covid and suffer other adverse outcomes such as emergency CS, their baby being delivered prematurely or needing admission to NICU etc. Why then for so long was the safest course of action assumed to be to leave pregnant women unvaccinated with no way forward? It's only looking at 1 risk (possible, but theoretically implausible risk from vaccination) that is unknown, and totally ignoring another risk (death, ITU etc) which is known, for which evidence does exist. Lazy.
Then, to just communicate "it isn't safe" without offering pregnant women the opportunity to weigh up the uncertainty for themselves, as competent adults is just patriarchal and discriminatory. And now that we are in the position where there is good evidence the Pfizer vaccine is perfectly safe (>90,000 doses given to pregnant women in the US with no significant adverse effects), a complete and sudden U-turn on the messaging that the vaccine is "unsafe" (as opposed to, "very likely to be safe but we haven't proven it") to "you should have it" is understandably causing pregnant women to feel confused, afraid and hesitant.
Given what we know about the additional risk to pregnant women, it also doesn't make sense with the evidence of vaccine safety in pregnancy, that they aren't being prioritised. Many pregnant women are still unable to access the vaccine because they are young (as you would expect!). But to benefit from the greatest reduction is risk is time-critical for pregnant women. Ugh ugh ugh.
Imagine if we had decided not to offer the vaccine in clinical trials to people from minority ethnic backgrounds and then excluded them from the vaccine rollout due to a lack of vaccine safety evidence, despite evidence of higher risks from covid? How is it acceptable to treat pregnant women this way? A pregnant woman can choose an abortion (I am wholly in favour of the right to make this choice) but not to have a potentially life saving vaccine (until fairly recently) in case it somehow harms her fetus (though at no stage has anyone been able explain how this might happen because there is no obvious mechanism from the working of the vaccines). Ugh!