We thank Drs Sookaromdee and Wiwanitkit for their interest in our paper describing COVID-19 vaccine knowledge, attitude and practices among pregnant women in the eight sites of the Global Network for Women’s and Children’s Health, and especially for their focus on discrepancies in vaccination rates and vaccine hesitancy among pregnant women.^{1, 2} Several health data systems track population vaccination rates by country.³ The discrepancy in vaccination rates between sub-Saharan Africa and the rest of the world is stark. In all the populated continents but Africa, more than half of the population has received at least one COVID-19 vaccine dose. In the countries of the Global Network sites in Asia, the reported rates of receiving at least one dose is 74% in India, 62% in Pakistan and 79% in Bangladesh. Guatemala’s reported rate was 50%. Most countries in sub-Saharan Africa have vaccination rates at 20% or less. In the DRC, only 2.2% of the population has been vaccinated to date.

In our paper, across eight Global Network sites including those from sub-Saharan Africa, overall, about one-third of the pregnant women said they would refuse COVID-19 vaccination, mostly due to concerns related to safety and effectiveness.² However, the majority said they would accept COVID-19 vaccination if available. Thus, we agree that it is important to distinguish concerns regarding vaccine hesitancy where vaccine is available, often in the more developed countries, compared with the lack of vaccine, such as seen in many areas of sub-Saharan Africa. Acquiring a sufficient amount of vaccines and developing a system to administer them to all those eligible, including pregnant women as well as children, should be the first priority.

Sookaromdee and Wiwanitkit note that some vaccines may be more effective than others.¹ While that may be so, the World Health Organization has stated that all approved COVID-19 vaccines offer substantial levels of protection against serious COVID-19 infections and deaths.⁴ They recommend that one should take whatever vaccine is first available and state that the current vaccines provide strong protection against serious illness and death. We hope that the possible variation in vaccine effectiveness will not be a factor that either delays vaccination or contributes to the number of those who decide not to vaccinate at all.

Sookaromdee and Wiwanitkit emphasize the importance of appropriate COVID-19 education as a method to increase vaccination rates. Our study found that in a number of countries, many pregnant women claimed to have little information related to vaccine effectiveness and safety.² We should reiterate that the US CDC has concluded that for pregnant women, the vaccine is safe and effective and that, with few exceptions, all women should be vaccinated. Sookaromdee and Wiwanitkit also note that the COVID-19 vaccination story is still evolving. For that reason, ongoing collection and reporting of vaccination data by each country is crucial. An ongoing registry that collects vaccination rates and asks questions related to vaccine hesitancy, such as that maintained by the Global Network for Women’s and Children’s Health Research can provide this information for an important segment of the population.⁵

In summary, the most important intervention to reduce serious morbidity and death related to COVID-19 infection is vaccination. Widespread education emphasizing the safety and effectiveness of COVID-19 vaccination is crucial. Women planning to become pregnant and those already pregnant should be vaccinated without delay. In-country government officials and those in national and international health organizations should do all in their power to ensure COVID-19 vaccines are available for all.

我们感谢 Sookaromdee 博士和 Wiwanitkit 博士对我们的论文感兴趣，该论文描述了全球妇女和儿童健康网络八个地点孕妇的 COVID-19 疫苗知识、态度和做法，尤其是他们关注疫苗接种率和疫苗接种率的差异孕妇对疫苗犹豫不决。^{1, 2}多个健康数据系统按国家/地区跟踪人口疫苗接种率。^3个撒哈拉以南非洲地区与世界其他地区的疫苗接种率差异十分明显。在除非洲以外的所有人口稠密的大陆，超过一半的人口至少接种了一剂 COVID-19 疫苗。在亚洲全球网络站点的国家中，报告的至少接种一剂疫苗的比例在印度为 74%，在巴基斯坦为 62%，在孟加拉国为 79%。危地马拉报告的比率为 50%。大多数撒哈拉以南非洲国家的疫苗接种率在 20% 或更低。在刚果民主共和国，迄今为止只有 2.2% 的人口接种了疫苗。

在我们的论文中，在包括撒哈拉以南非洲地区在内的八个全球网络站点中，总体而言，大约三分之一的孕妇表示她们会拒绝接种 COVID-19，这主要是出于对安全性和有效性的担忧。²但是，大多数人表示，如果可以的话，他们会接受 COVID-19 疫苗接种。因此，我们同意，重要的是要区分对有疫苗可用的疫苗犹豫的担忧（通常在较发达国家）与缺乏疫苗的担忧（如在撒哈拉以南非洲的许多地区所见）。获得足够数量的疫苗并开发一个系统来为所有符合条件的人（包括孕妇和儿童）接种疫苗，应该是首要任务。

Sookaromdee 和 Wiwanitkit 指出，某些疫苗可能比其他疫苗更有效。¹虽然情况可能如此，但世界卫生组织表示，所有批准的 COVID-19 疫苗都提供了相当程度的保护，可预防严重的 COVID-19 感染和死亡。⁴他们建议人们应首先接种任何可用的疫苗，并指出当前的疫苗可提供强有力的保护以预防严重疾病和死亡。我们希望疫苗效力的可能变化不会成为延迟接种疫苗或增加决定不接种疫苗的人数的因素。

Sookaromdee 和 Wiwanitkit 强调了适当的 COVID-19 教育作为提高疫苗接种率的方法的重要性。我们的研究发现，在一些国家，许多孕妇声称对疫苗有效性和安全性知之甚少。^2个我们应该重申，美国疾病预防控制中心已经得出结论，对于孕妇来说，该疫苗是安全有效的，除了少数例外，所有女性都应该接种疫苗。Sookaromdee 和 Wiwanitkit 还指出，COVID-19 疫苗接种的故事仍在发展中。因此，每个国家持续收集和报告疫苗接种数据至关重要。收集疫苗接种率并询问与疫苗犹豫有关的问题的持续登记（例如全球妇女和儿童健康研究网络维护的登记）可以为重要的人群提供此信息。^5个

总之，减少与 COVID-19 感染相关的严重发病率和死亡的最重要干预措施是疫苗接种。强调 COVID-19 疫苗接种安全性和有效性的广泛教育至关重要。计划怀孕和已经怀孕的妇女应立即接种疫苗。国内政府官员以及国家和国际卫生组织的官员应尽其所能确保所有人都能获得 COVID-19 疫苗。