key: cord-0806376-wgnmh98j authors: Chervenak, Frank A.; McCullough, Laurence B.; Grünebaum, Amos title: Reversing Physician Hesitancy to Recommend COVID-19 Vaccination for Pregnant Patients date: 2021-11-08 journal: Am J Obstet Gynecol DOI: 10.1016/j.ajog.2021.11.017 sha: b6c47a159eff33ff1ab24a978b71922bb1fe1c83 doc_id: 806376 cord_uid: wgnmh98j nan COVID-19 vaccine acceptance and equity will require multifaceted policies and programming 105 that respect diverse communities and is essential not only to increase vaccinations overall, but also to 106 reduce disparities overall in ethnic and racial communities. 21 Consequently, Carson et al. concluded that 107 among important considerations for vaccine acceptance is the desire for practitioner recommendation: 108 "Culturally centered care and practitioner recommendations may help promote vaccine acceptability, The first root cause of physician hesitancy is the misapplication of therapeutic nihilism in the 142 clinical management of pregnancy. Therapeutic nihilism is defined as "skepticism regarding the worth of 143 therapeutic agents especially in a particular disease." 73 Therapeutic nihilism is a powerful antidote to 144 enthusiasm, the belief in clinical benefit in the absence of evidence. Therapeutic nihilism was reinforced when a small number of catastrophes, including 146 thalidomide and diethylstilbestrol, made practitioners and the public realize that the placenta did not 147 always prevent medications from reaching or harming the fetus. Thus, the new philosophy in obstetrics 148 became "…akin to therapeutic nihilism," in which obstetricians were taught to believe that "…we live in 149 a sea of teratogens." 74 Therapeutic nihilism as it relates to COVID-19 vaccines is partially exemplified in a 150 letter to the authors in response to our COVID-19 vaccination counseling publication. 75 151 Therapeutic nihilism was one reason why pregnant women were excluded from COVID-19 152 vaccine trials. This exclusion, even though there were no theoretical concerns and there was no 153 evidence of adverse outcomes after thousands of pregnant women had already been vaccinated, 154 reinforced therapeutic nihilism in clinical practice and helped to explain the hesitancy of professional liability. The logic here is that if a physician recommends a form of clinical management in the absence 160 of a statement from professional associations that such a recommendation should be made, and the 161 patient experiences an adverse outcome, the physician may increase exposure to professional liability. Understandable prudence creates strong physician hesitancy to recommend COVID-19 vaccination. The terminology of "shared decision making" has been used increasingly in the medical the informed consent process that involves discussion of the benefits and risks of available treatment Estimates of vaccine hesitancy for COVID-19 Parental 534 acceptance and uptake of the HPV vaccine among African-Americans and Latinos in the United 535 States: A literature review Prevention and control of seasonal influenza with 541 vaccines: recommendations of the Advisory Committee on Immunization influenza season Professionally responsible coronavirus disease 544 2019 vaccination counseling of obstetrical and gynecologic patients Academic physicians as factory workers: identifying and 598 preventing alienation of labor SARS-CoV-2 Antibodies Detected in Mother's 33798480 Coronavirus disease 2019 vaccine response in pregnant and 608 lactating women: a cohort study High antibody levels in cord blood from 610 pregnant women vaccinated against COVID-19 Informed consent Informed consent The professional responsibility model of