Study Shows Gap Between Respiratory Vaccine Recommendations and Uptake For Pregnant Women

A recent population-based registry study, published in Eurosurveillance, shows a significant gap between public health recommendations and actual vaccine uptake among pregnant women, signaling a critical need for proactive intervention from community health providers like pharmacists.¹

“This study aims to calculate the overall influenza and COVID-19 vaccination coverage among pregnant women, assess the timing of vaccinations during pregnancy, as well as regional and age-related differences,” the study authors said.¹ “The findings can inform strategies to enhance maternal vaccination and strengthen surveillance across EU/EEA countries facing similar challenges.”

During the 2023-2024 respiratory season, investigators found that only 29.9% of pregnant women received the influenza vaccine, and a mere 12.1% were vaccinated against COVID-19. These figures fall drastically short of the 75% coverage target recommended by the World Health Organization for at-risk groups. Even more concerning for the pharmacy profession, a key site for vaccine administration and counseling, is that only 11.4% of the more than 53,000 women studied received both vaccines during their pregnancy.^1,2

The study, conducted in Norway, highlights a pattern of missed opportunities that pharmacists are uniquely positioned to address. Although vaccination rates for both influenza and COVID-19 peaked in November 2023, they plateaued shortly thereafter, meaning many women who were in their first trimester during the autumn did not receive protection as their pregnancies progressed into the peak of the respiratory season.¹

For pharmacists, this suggests that the window for maternal immunization should extend well beyond the initial autumn rush. The researchers noted that women attending antenatal care later in the season were rarely vaccinated, despite the continued presence of circulating viruses.¹

The clinical stakes of these low numbers are high, as pregnancy represents a uniquely vulnerable physiological state. Medical experts note that the immune system naturally down-regulates during pregnancy to prevent the body from rejecting the developing fetus, which simultaneously makes the mother more susceptible to severe viral infections. Furthermore, heart and lung changes—such as the diaphragm shifting upward—can cause pregnant individuals to breathe faster and experience greater respiratory distress when ill.^3,4

The risks of remaining unvaccinated include a higher likelihood of maternal complications like preeclampsia, gestational diabetes, and blood clotting disorders. For the infant, maternal infection is associated with increased risks of preterm birth, low birth weight, and stillbirth.^3,4

Pharmacists can play a pivotal role in reversing these trends by addressing the specific barriers identified in the Norwegian cohort. The study found the lowest vaccine uptake among women aged 25 years or younger, a demographic that research suggests may rely heavily on social media for health information, leading to increased vaccine hesitancy.¹

“Despite the Norwegian population's generally high level of trust in health authorities and recommendations, our results show considerable regional differences in vaccination coverage, with lower rates in the northern health region and among women aged 25 years or younger,” the study authors said.¹ “Similar geographic disparities have been reported for other vaccines, where coverage in northern Norway is often below the national average.”

By providing evidence-based counseling, pharmacists can clarify that the benefits of vaccination extend to the newborn through the placental transfer of antibodies, which provides critical protection in the first months of life when the infant is too young to be vaccinated themselves. Specifically for influenza, pharmacists should ensure patients receive the inactivated virus shot rather than the live nasal spray vaccine, which is contraindicated during pregnancy.^1,3

Financial and structural barriers also contribute to the current coverage gap. In Norway, although COVID-19 vaccinations are free, influenza shots often require a copayment, a factor that may hinder uptake compared to the recently introduced pertussis vaccine, which reached 73% coverage after being integrated as a free service.^1,2

As accessible health care providers, pharmacists can advocate for the safety and efficacy of these immunizations, noting that flu vaccination alone has been shown to reduce maternal hospitalizations by up to 40%. Strengthening maternal immunization efforts requires a shift from passive availability to active integration within every health care encounter, ensuring that every visit to the pharmacy becomes an opportunity to protect both the patient and infant.^1,3,4

READ MORE: Immunization Resource Center

Are you ready to elevate your pharmacy practice? Sign up today for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips straight to your inbox.

REFERENCES

1. Stecher M, Greve-Isdahl M, Dahl J, et al. Missed opportunities for maternal immunisation against influenza and COVID-19, Norway, October 2023 to May 2024: a population-based registry study. Euro Surveill. 2026;31(7):2500504. doi:10.2807/1560-7917.ES.2026.31.7.2500504

2. Missed opportunity to protect pregnant women and newborns: study shows low vaccination rates among expectant mothers in Norway against COVID-19 and influenza. News release. European Centre for Disease Prevention and Control. February 19, 2026. Accessed February 26, 2026. https://www.eurekalert.org/news-releases/1117008

3. Mayo Clinic Health System. Pregnancy and respiratory illnesses: tips to reduce your flu risks. September 30, 2022. Accessed February 26, 2026. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/pregnancy-and-respiratory-illnesses

4. Cleveland Clinic. COVID while pregnant. Updated December 20, 2024. Accessed February 26, 2026. https://my.clevelandclinic.org/health/diseases/covid-while-pregnant