# Pregnant women’s attitudes and intentions toward tuberculosis, malaria, group B streptococcus, and respiratory syncytial virus vaccines in pregnant: Findings from a cross-sectional study of pregnant women living in Brazil, Ghana, Kenya, and Pakistan

## TL;DR

This study explores pregnant women's attitudes toward vaccines for TB, malaria, GBS, and RSV in four countries, finding that safety and protecting the baby are key factors in vaccine acceptance.

## Contribution

The study provides novel insights into vaccine attitudes among pregnant women in low- and middle-income countries for four specific maternal vaccines.

## Key findings

- Vaccine safety for the baby was the most important factor in vaccine acceptance for participants.
- Approximately 30% of participants would definitely intend to receive a GBS vaccine, the highest among the four vaccines.
- About 40% of participants believed vaccines are unnatural, indicating significant vaccine hesitancy.

## Abstract

There are numerous infections that can adversely impact a developing fetus, neonates, and pregnant women, and there is limited research related to how specific infections experienced during pregnancy can affect these populations. Tuberculosis (TB), malaria, Group B streptococcus (GBS) and respiratory syncytial virus (RSV) can cause negative outcomes to maternal and neonatal health. For TB and GBS, there are vaccines in various stages of clinical trial development, and malaria and RSV vaccines are available. This study aimed to examine pregnant women’s attitudes toward TB, malaria, GBS, and RSV vaccines in Brazil, Ghana, Kenya, and Pakistan. We administered a cross-sectional survey to pregnant women, recruiting women seeking care in primarily urban health facilities. We surveyed 1,603 pregnant women. Participants indicated that vaccine safety for the baby was the most important factor in their decision-making related to vaccine acceptance, followed by vaccine efficacy for the baby, and then vaccine safety for the mother. When asked why they would receive any of the four vaccines, participants indicated that protecting the baby was most important, followed by protecting self, and then stopping the spread of disease. Almost one-third of participants (30%) indicated that they would definitely intend to receive a GBS vaccine, followed by malaria (26%), RSV (25%), and TB (19%). Related to vaccine hesitancy, approximately 40% of our participants agreed that vaccines are unnatural, 38% agreed that the body should develop natural immunity, and 19% had delayed a recommended vaccine. Pregnant women are interested in receiving various vaccines while pregnant. As several new adult vaccines are on the horizon, understanding the attitudes of potential vaccine beneficiaries at higher risk for diseases is critical for informing clinical trial design and, in the long term, vaccine acceptance.