Vaccines and Nonmedical Exemptions

Vaccines are a proven, safe, public health tool with the potential to prevent and eradicate many infectious diseases affecting children, adolescents, and adults, including diseases that cause serious adverse outcomes in pregnancy. Immunizations are a hallmark of public health. According to Centers for Disease Control and Prevention (CDC), “Over the years, these vaccines have prevented countless cases of disease and saved millions of lives” (1).

The American College of Obstetricians and Gynecologists (ACOG) determined that immunization is an essential component of health care for adults, including pregnant people (2). In addition, there is no evidence of adverse fetal effects resulting from vaccination during pregnancy with inactivated virus, bacterial vaccines, or toxoids, and there is a growing body of evidence demonstrating the safety of vaccination  (2,3,4, 6, 7).

Vaccination rates are currently declining due, largely, to nonmedical exemptions, which threaten to reverse decades of progress in reducing and possibly eradicating vaccine-preventable diseases. In fact, the World Health Organization (WHO) listed vaccine hesitancy as one of 10 threats to global health in 2019 (5). When population immunity drops below the threshold levels needed to prevent transmission, vulnerable patients including pregnant people, infants too young to be vaccinated, children, adults with incomplete vaccinations, and immunocompromised individuals, are placed at increased risk. 

It is clear that nonmedical exemptions from immunizations—personal, philosophical or religious—endanger the health of the exempted and other individuals, communities, and our nation. ACOG opposes nonmedical exemptions from state immunization requirements and urges obstetrician–gynecologists to educate and encourage patients to get immunized. It is also important to recognize that some medical exemptions may be for temporary reasons; it is important to periodically reassess the need for medical exemptions.

Studies consistently demonstrate that rates of vaccine acceptance and receipt are substantially higher when the recommendation and administration comes directly from a person’s obstetrician or other obstetric care provider (2). It is critical that obstetric and gynecologic health care professionals talk directly with each patient about the importance of indicated immunizations during pregnancy, annual examinations, prepregnancy counseling, and postpartum visits (8). Vaccine exemptions should be granted only when medical contraindications exist that would compromise a patient’s health.

References

1. Centers for Disease Control and Prevention. Vaccines and the diseases they prevent: recommended vaccines by disease. CDC; 2024. Accessed July 22, 2025. https://www.cdc.gov/vaccines/by-disease/.
2. Maternal immunization. ACOG Committee Opinion No. 741. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e214–7. doi: 10.1097/AOG.0000000000002662.
3. Update on immunization and pregnancy: tetanus, diphtheria, and pertussis vaccination. Committee Opinion No. 718. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e153–7. doi: 10.1097/AOG.0000000000002301.
4. Polyzos KA, Konstantelias AA, Pitsa CE, Falagas ME. Maternal influenza vaccination and risk for congenital malformations: a systematic review and meta-analysis. Obstet Gynecol 2015;126:1075–84. doi: 10.1097/AOG.0000000000001068.
5. World Health Organization. Ten threats to global health in 2019. WHO; 2019. Accessed July 22, 2025. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019.
6. Palmsten K, Suhl J, Conway KM, Kharbanda EO, Ailes EC, Cragan JD, et al. Influenza vaccination during pregnancy and risk of selected major structural noncardiac birth defects, National Birth Defects Prevention Study 2006-2011. Pharmacoepidemiol Drug Saf 2022;31:851–62. doi: 10.1002/pds.5435.
7. de Bruin O, Phijffer E, Ahmadizar F, van der Maas N, Wildenbeest J, Sturkenboom M, et al. Are maternal vaccines effective and safe for mothers and infants? A systematic review and meta-analysis of randomised controlled trials. BMJ Glob Health 2023;8:e012376. doi: 10.1136/bmjgh–012376.
8. Maternal Immunization Task Force. Comments to CDC Advisory Committee on Immunization Practices: importance of maternal immunization. Accessed July 22, 2025. https://www.acog.org/programs/immunization-for-women/activities-initiatives/importance-of-maternal-immunization

Approved by the Board of Directors June 2019
Amended June 2019
Amended and Reaffirmed July 2022
Amended and Reaffirmed July 2025