Nataly Saldanha earned the title of “top-notch pregnant woman” at the health clinic where she receives prenatal care in Rio de Janeiro. At 39 weeks pregnant, she is expecting Noely to arrive in the coming days and is proud to have attended all her appointments and undergone all the recommended tests, followed her health care providers’ guidance closely, and kept her vaccinations up to date.
“I’ve always made a point of getting vaccinated, and when I started prenatal care, I made sure my vaccination record was up to date. If there’s any disease going around, I’m immune. I’m also very concerned about my baby. I want to make sure she’s 100 percent healthy,” she explains.
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This is also the view of marketing analyst Raissa Silva de Oliveira, who is 34 weeks pregnant and expecting her baby, Rafael.
“I’ve always gotten every single vaccine because I believe in science. From the start of my prenatal care, my doctor asked about my vaccination status, wanted to see my record, and advised me on the next vaccines I needed to get,” she says.
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Unfortunately, not all pregnant women reach delivery as well-protected as Saldanha and Oliveira. Official figures from Brazil’s Ministry of Health reveal disparities in vaccination coverage, along with some concerning figures.
In 2025, only 55 percent of pregnant women were vaccinated against COVID-19, and 63 percent against the flu, based on data from the Southeast, South, Northeast, and Midwest regions. Preliminary data from this year show a slightly better situation for the flu vaccine, with 76 percent coverage, but COVID-19 vaccination remains at 55 percent. The goal for both vaccines is 90 percent coverage of the target population.
The consequences of vaccine hesitancy have been tragic in many cases. Data compiled by the Ministry of Health at the request of Agência Brasil indicate that, from 2023 through early August 2026, at least 286 pregnant women or women who had recently given birth developed severe acute respiratory syndrome (SARS) after being infected with a subtype of the influenza virus. Of these, 25 died, including seven this year.
Over the same period, COVID-19 caused at least 205 severe cases, resulting in 21 deaths. However, during the three main years of the pandemic - 2020, 2021, and 2022 - there were 3,547 cases of acute respiratory distress syndrome (ARDS) confirmed to have been caused by the virus among pregnant women or women who had recently given birth. Nearly a quarter of these women died, totaling 811 deaths.
For Flávia Bravo, director of the Brazilian Society of Immunizations (SBIm), two factors are key to understanding these figures: complacency in the case of influenza and misinformation when it comes to COVID-19.
“When it comes to the flu, people still wonder, ‘Is this vaccine really that important?’ There’s a tendency to downplay the disease. As for COVID-19, the myth has prevailed that it is an experimental vaccine, rushed into production - which is a lie. It’s an established technology, and we were able to adapt it more quickly for COVID-19 because of global collaboration and significant investment,” she notes.
Vaccination has been instrumental in reducing these rates to their current levels. Brazilian scientists compared records of SARS among pregnant and postpartum women before and after vaccination was introduced for this population and found that the monthly case rate fell to one-third of its previous level. The mortality rate dropped to nearly one-fifth of its previous level.
Even so, COVID-19 and influenza together account for nearly 30 percent of SARS cases among pregnant and postpartum women recorded this year in Brazil. When deaths are analyzed, this proportion rises to more than 50 percent.
Respiratory viruses are the main causes of the syndrome, but it is not always possible to identify which virus caused the condition, meaning these proportions may be even higher. “Pregnant women are among the groups at highest risk for these two diseases, so much so that these two vaccines can be administered at any stage of pregnancy,” Bravo emphasizes.
Vaccination schedule for pregnant women
The Ministry of Health offers four additional vaccines for pregnant women through Brazil’s national public health system, the SUS, in addition to the influenza and COVID-19 vaccines: hepatitis B, dT, dTpa, and VSR. The yellow fever vaccine may also be recommended on an exceptional basis for pregnant women who live in areas with confirmed circulation of the disease during an outbreak, emergency, or high-risk situation, or who are planning to travel to such locations.
Gynecologist Giuliane Lajos advises that all these vaccines should be part of the basic checklist for pregnant women, rather than being viewed as an option or an extra precaution. “I even make a joke: ‘fewer pregnancy tests and more vaccinations.’ Because, whether it’s a girl or a boy, what you really want is a healthy baby and to be healthy enough to care for them.”
The specialist from the National Vaccine Expert Committee of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) explains that pregnant women need to take extra precautions against various infections because pregnancy naturally makes them more vulnerable to infections and severe illness.
“When you become pregnant, half of the baby’s genetic makeup comes from you and the other half from your partner. In order for the uterus to accept this ‘implant,’ several changes occur in a woman’s immune system. In addition, as the pregnancy progresses, lung capacity decreases and some bodily functions decline. That is why it is so important to ensure you have all available vaccinations. If she is vaccinated, a woman may still get an infection sometimes, but it won’t be severe,” Lajos adds.
The gynecologist warns that, without protection, pregnant women are more likely to experience a range of complications and may even die. “Being admitted to the ICU alone significantly increases levels of substances called prostaglandins, which can damage the placenta, affect the baby’s development, and increase the risk of preterm birth.”
An analysis of data from more than 1.2 million pregnant women worldwide showed that women vaccinated against COVID-19, for example, had a lower risk of preterm birth, stillbirth, and fetal congenital anomalies.
Benefits for babies
In addition, by getting vaccinated, a pregnant woman also protects her baby after birth. Vaccination against influenza and COVID-19 does not begin until 6 months of age. Therefore, newborns rely on antibodies passed from their mother through the placenta to help protect them against these diseases.
“Published clinical trials show that the flu vaccine, for example, can reduce the incidence of illness by about 70 percent during a baby’s first few months. It’s the same with COVID-19. There are studies showing that the level of antibodies in the umbilical cord is higher than in the mother’s blood. In other words, in addition to active transfer, the baby is actually born with more antibodies,” Bravo explains.
The lack of immunization among infants is also a concern. The Ministry of Health’s Influenza Epidemiological Surveillance Information System recorded nearly 4,000 cases of SARS caused by influenza among children under 2 years of age through September 19 this year, including 55 deaths.
Meanwhile, there have been 808 severe cases of COVID-19 in this age group, with 18 deaths. Since 2023 - the year the World Health Organization (WHO) declared the end of the pandemic - at least 9,725 children under 2 years of age have become severely ill with COVID-19, 223 of whom have died.
The mRNA vaccines currently administered to pregnant women and children in Brazil have already demonstrated nearly 100 percent efficacy in preventing deaths from COVID-19. Flu vaccination can reduce the risk of death by up to 75 percent.
According to Giuliane Lajos and Flávia Bravo, vaccinating pregnant women, combined with vaccinating children themselves starting at 6 months of age, is essential to reducing these numbers. The trend in respiratory syncytial virus cases provides an example of the potential impact of high vaccination coverage.
Launched last year, the vaccination program has already reached 1.7 million pregnant women, representing an estimated 86 percent coverage of the target population. Combined with the administration of monoclonal antibodies to premature infants and those with comorbidities, the program is already yielding results.
In the first half of 2026, 6,674 severe cases were reported among infants up to 6 months of age - less than half the 14,061 infections reported during the same period last year.
Pertussis
Brazil’s vaccination history offers other examples of the power of this indirect protection. The administration of the dT vaccine to women, including pregnant women, since the 1960s helped Brazil eliminate neonatal tetanus, a condition in which the infection is acquired by the infant during childbirth and can lead to severe, potentially fatal illness. Diphtheria has also been virtually eliminated in the country, with fewer than 40 confirmed cases reported over the past 10 years.
However, in response to outbreaks of whooping cough among newborns, the SUS began offering the dTpa vaccine to pregnant women in 2014, providing protection against the bacterium Bordetella pertussis, which causes coughing and fever and can lead to breathing difficulties.
The infant vaccination schedule includes vaccination against whooping cough, but the first dose is administered at 2 months of age, and the primary series is not completed until 6 months of age. This means newborns rely on maternal antibodies for protection against the disease and to reduce the risk of severe illness if they become infected.
According to the Ministry of Health, dTpa vaccination coverage among pregnant women rose from 34 percent in 2016 to 94 percent in 2025. Preliminary data for this year indicate a coverage rate of 88 percent. In addition, vaccination rates among infants have remained close to 90 percent since 2023.
As a result, the number of pertussis cases in Brazil has been declining, but cases remain significant, underscoring the importance of protecting infants in particular. In 2024, there were 7,747 confirmed cases, falling to 2,744 in 2025 and 401 as of September 10 this year.
About 20 percent of those infected during this period were under 1 year old, but this proportion rises to more than 90 percent when deaths from the disease are considered. Of the 11 deaths recorded in 2026, nine were infants under 1 year old, eight of whom were under 6 months of age.
Health care professionals
The two experts interviewed by Agência Brasil also emphasize that all vaccines administered during pregnancy have been properly tested and pose no risk to pregnant women or their babies. “The COVID-19 vaccine, which faces the most resistance, has become the most studied vaccine in the world. And there is no proven risk of fetal malformations, autism, or death - nothing,” emphasizes gynecologist Giuliane Lajos.
Flávia Bravo, director of SBIm, urges health care professionals to be more emphatic in debunking these falsehoods and providing patients with accurate guidance.
“Vaccination, in fact, isn’t a topic most doctors are very familiar with. Many of them end up relying on the same sources as the general public and don’t do what they Should - which is to seek out reliable sources of information, review clinical trials, and examine surveillance data,” she adds.
Family physician Catarina Jatobá de Souza, who treats Nataly Saldanha at the Ricardo Lucarelli Family Clinic in Rio de Janeiro, explains that the vaccination card is checked during the very first appointment and that, whenever a dose is needed, the pregnant woman is immediately directed to the vaccination room next door.
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“This is very convenient because the pregnant woman can take advantage of her appointment to do both things, and we know that if the vaccination is scheduled for another day, it might fall through. That’s why we also try to schedule appointments for the day the pregnant woman is due to get vaccinated,” she explains.
Other professionals are also involved in ensuring that pregnant women keep their vaccination cards up to date. “Community health workers make monthly home visits during pregnancy, and they also remind patients to bring their vaccination cards to their appointments and let us know if any pregnant woman is not up to date on her vaccinations,” the doctor explains.
Raissa Silva de Oliveira, who also receives prenatal care through the public health system but at a different facility, almost got a scolding from her health worker. “They called me from the clinic to remind me about the RSV vaccination because I hadn’t gone there to get it, but I had gotten it at the vaccination center in the mall. The woman didn’t just take my word for it; she asked me to send a photo of my vaccination card so she could verify it.”
Even social gatherings, such as meetings for expectant mothers and parents, and recreational activities such as belly-painting events have become opportunities to raise awareness. “We take the opportunity to talk about the importance of vaccines with the whole family,” Catarina Jatobá adds.
The doctor argues that these spaces are also important for pregnant women to talk to other women who have already received the vaccines and are doing well. “I always say that I’ve never seen a single serious case caused by a vaccine, unlike the diseases themselves. But this way, they can see for themselves that there’s no risk,” she emphasizes.
Nataly Saldanha, a model pregnant patient, is an example of how this approach can make a difference. “When I had my first daughter, I didn’t have access to any of this. It’s great to be able to talk to other mothers. There are so many new things today, including new vaccines, such as those for COVID-19 and bronchiolitis. I’m rediscovering it all over again.”
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