Covid 19 has been with us for more than 3 years. Now we know a lot about this infection, and we are a little relaxed that its vaccine is available. There are a lot of myths and misconceptions about it in public, some are specially obstetrics and gynecology related. We can divide three years of Covid 19 into three phases based on our knowledge about it. The first phase was the initial phase which was managed based on our background concepts of viral infections and pandemics. Second phase was when we had some experience and hope of vaccine coming. Third and the current phase is when we have the vaccine and are using it. Misconceptions appeared in all these stages. They spread in public faster than the facts because of social media. Now we are dealing with the myths of Covid 19 vaccination. I will talk about misconceptions about the Covid vaccination that we face in obstetrics and Gynecology clinics routinely.

A very common question in the women of reproductive age is that vaccine will cause Infertility. This concept started from the false report that spike proteins of vaccine Biotech (Pfizer) and Moderna are like spike proteins of Synticin1 that is involved in growth and attachment of placenta.^1,2 Hence it causes infertility and in general public this effect was considered for all the vaccines. Fact is that both Pfizer and Moderna vaccines are messenger RNA vaccines. They make the cells in the body to produce proteins similar to spike proteins of corona virus and body produces antibodies against it to fight Covid infection. Spike proteins of vaccine and Synticin1 are two different proteins. Studies about these vaccines have

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shown that these two vaccines have not increased infertility in women trying for pregnancy, even by IVF.³ Sinopharm is the commonest vaccine used in Pakistan for initial vaccination. This is classic inactivated virus vaccine. It has no similarity to Synticin1. None of the studies has shown its effect on fertility.

Second common misconception is that vaccine came quickly so its safety and efficacy is not trusted, it was available free of cost to public and they were encouraged to get it. Facts are majority of vaccines are 88 to 95% affective. Sinopharm is 79% affective. No severe or life- threatening affects are seen with any of these vaccines. China shared the genetic information of Corona Virus quickly and development of vaccine started early. Most of the vaccines are made by the methods which were already there for other vaccines. Vaccine producing companies have large resources and some of the countries paid in advance to develop the vaccine. Companies started producing vaccine even before FDA approval and were ready to roll it out as soon as approval came. Many countries rushed to get the vaccine and provided it free of cost to their population. The reason was it was a pandemic and cost, and implication of infection was much more then providing free vaccine.

Another misconception was getting Covid 19 infection due to vaccine. Especially pregnant women were worried. Fact is none of the Covid

19 vaccine contains live virus. Pfizer and Moderna contain messenger RNA which instructs the body to produce proteins like spike proteins of virus not live virus. Sinopharm

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contains inactivated virus. It only produces immune response not the disease.

Some worries were about dangerous side effects of Covid vaccines. Fact is Covid vaccine can have side effects, but most are not dangerous, are self-limiting and only lasts for a couple of days. They are pain at injection site, body aches, sometimes fever. Pregnant women may get some nausea. There was once reporting of possibility of thrombosis after Johnson and Johnson vaccine. This is not used in our country. Vaccine adverse event reporting system (VAERS) of US says even minor side effects were not all due to vaccine.

Another confusion was that vaccine will change human's genetic system. Probably it was because some vaccines are messenger RNA. It is very clear they are messenger RNA not DNA. They enter the cell but not the nucleus. Sinopharm is not RNA, it is an inactive virus and can't change DNA.

There are some concerns that vaccine contains some controversial substances like microchips, tracking devices, fetal tissue, implants, antibiotics, magnets. Fact is that vaccines only contain fats salt and sugar. Currently no available microchips and magnets are small enough to be injected by a needle. Sinopharm contains inactive viruses which are inactivated by a chemical beta propiolactone so virus can't replicate.

It was because of all the above myths on social media and spread by the word of mouth many people especially pregnant and breast-feeding mothers avoid getting the vaccine. In fact, they are among the groups who are more vulnerable to infection, and it prevents slowing down and transmission of infection if they are not vaccinated. Remember the facts, if a pregnant woman gets covid infection She has double chances of admission in hospital and be on ventilator as compared to non-pregnant women and 70% increased risk of death. She is at higher risk of getting pregnancy complications, like

preterm birth, caesarean section, increased blood pressure and risk of still birth. Vaccine does not cross placenta but antibodies can cross the placenta and are secreted in breast milk so they will protect the newborn from the infection. In pregnancy and breast-feeding benefits of vaccine outweighs the risks. Now in CDC's Covid vaccine in pregnancy register 185000 women responded in vaccine safety tracking system.

CDC recommends Covid vaccination to the ladies who are planning pregnancy, who are pregnant or breast feeding. It recommends booster dose to these ladies as well.^4,5 ACOG (American college of Obstetricians and Gynecologists) and society of maternal fetal medicine in USA recommend vaccination in pregnant and breast-feeding mothers. According to RCOG (Royal college of Obstetricians and Gynecologists) all pregnant women will be offered Covid vaccination when their age group is called (RCOG vaccination guideline). In UK pregnant women are considered priority group for vaccination.^6,7 Recommended vaccines in UK are Pfizer, Moderna, Astrazeneca, Jannsen and Novavex.

In Pakistan Pfizer, Moderna and Sinopharm is used. UK Teratology information service (UKTIS) monograph says non-live vaccines are Hepatitis A, B, seasonal flu, Rabies, tetanus, polio HPV, meningococcal and Covid 19. No previous data about them shows that they are harmful during pregnancy while data about some is limited. UKTIS recommends exposure to non-live vaccine at any stage of pregnancy is not an indication for termination of pregnancy or extra monitoring during pregnancy. Remember Sinopharm is the first Chinese vaccine which was authorized by WHO for emergency.

Conclusion from all the above discussion is that covid vaccine is safe for the women during reproductive age. It does not cause infertility, can be given during pregnancy and breastfeeding.

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References:

• Kelen G, Maragakis L. COVID-19 vaccines: Myth versus fact. John Hopkins Medicine. 2021.

• Shimabukuro TT, Kim SY, Myers TR, et al. Preliminary findings of mrna covid-19 vaccine safety in pregnant persons. N Engl J Med. 2021; 384: 2273-2282.

• Bentov Y, Beharier O, Moav-Zafrir A, Kabessa M, Godin M, Greenfield CS, et al. Ovarian follicular function is not altered by SARS-CoV-2 infection or BNT162b2 mRNA COVID-19 vaccination. Hum Reprod. 2021; 36(9): 2506-2513. doi: 10.1093/humrep/deab182.

• Food and Drug Administration. Fact sheet for healthcare providers administering vaccine (vaccination providers): emergency use authorization (EUA) of the Pfizer-BioNTech COVID- 19 vaccine to prevent coronavirus disease 2019. Available at

  https://www.fda.gov/media/144413/down load. Accessed on Jun, 2022

• Food and Drug Administration. Fact sheet for healthcare providers administering vaccine (vaccination providers): emergency use authorization (EUA) of the Moderna COVID-19 vaccine to prevent coronavirus disease 2019. Available at: https://www.fda.gov/media/144637/downloa. Accessed on Jun, 2022

• Oliver SE, Gargano JW, Marin M, Wallace M, Curran KG, Chamberland M, et al. The Advisory Committee on Immunization Practices' interim recommendation for use of Pfizer-BioNTech COVID-19 vaccine - United States. MMWR Morb Mortal Wkly Rep. 2020; 69: 1922-1924.

• Bentov Y, Beharier O, Moav-Zafrir A, Kabessa M, Godin M, Greenfield CS, et al. Ovarian follicular function is not altered by SARS–CoV-2 infection or BNT162b2 mRNA COVID-19 vaccination. Human Reproduction. 2021; 36(9): 2506-2513.