Pregnant & Breastfeeding Women Who Get the COVID-19 Vaccine Are Protecting Their Infants, Research Suggests
Becky Cummings had multiple reasons to get vaccinated against COVID-19 while tending to her firstborn, Clark, who arrived in September 2020 at 27 weeks.
The 29-year-old intensive care unit nurse in Greensboro, North Carolina, had witnessed the devastation day in and day out as the virus took its toll on the young and old. But when she was offered the vaccine, she hesitated, skeptical of its rapid emergency use authorization.
Exclusion of pregnant and lactating mothers from clinical trials fueled her concerns. Ultimately, though, she concluded the benefits of vaccination outweighed the risks of contracting the potentially deadly virus.
"Long story short," Cummings says, in December "I got vaccinated to protect myself, my family, my patients, and the general public."
At the time, Cummings remained on the fence about breastfeeding, citing a lack of evidence to support its safety after vaccination, so she pumped and stashed breast milk in the freezer. Her son is adjusting to life as a preemie, requiring mother's milk to be thickened with formula, but she's becoming comfortable with the idea of breastfeeding as more research suggests it's safe.
"If I could pop him on the boob," she says, "I would do it in a heartbeat."
Now, a study recently published in the Journal of the American Medical Association found "robust secretion" of specific antibodies in the breast milk of mothers who received a COVID-19 vaccine, indicating a potentially protective effect against infection in their infants.
The presence of antibodies in the breast milk, detectable as early as two weeks after vaccination, lasted for six weeks after the second dose of the Pfizer-BioNTech vaccine.
"We believe antibody secretion into breast milk will persist for much longer than six weeks, but we first wanted to prove any secretion at all after vaccination," says Ilan Youngster, the study's corresponding author and head of pediatric infectious diseases at Shamir Medical Center in Zerifin, Israel.
That's why the research team performed a preliminary analysis at six weeks. "We are still collecting samples from participants and hope to soon be able to comment about the duration of secretion."
As with other respiratory illnesses, such as influenza and pertussis, secretion of antibodies in breast milk confers protection from infection in infants. The researchers expect a similar immune response from the COVID-19 vaccine and are expecting the findings to spur an increase in vaccine acceptance among pregnant and lactating women.
A COVID-19 outbreak struck three families the research team followed in the study, resulting in at least one non-breastfed sibling developing symptomatic infection; however, none of the breastfed babies became ill. "This is obviously not empirical proof," Youngster acknowledges, "but still a nice anecdote."
Leaps.org inquired whether infants who derive antibodies only through breast milk are likely to have a lower immunity than infants whose mothers were vaccinated while they were in utero. In other words, is maternal transmission of antibodies stronger during pregnancy than during breastfeeding, or about the same?
"This is a different kind of transmission," Youngster explains. "When a woman is infected or vaccinated during pregnancy, some antibodies will be transferred through the placenta to the baby's bloodstream and be present for several months." But in the nursing mother, that protection occurs through local action. "We always recommend breastfeeding whenever possible, and, in this case, it might have added benefits."
A study published online in March found COVID-19 vaccination provided pregnant and lactating women with robust immune responses comparable to those experienced by their nonpregnant counterparts. The study, appearing in the American Journal of Obstetrics and Gynecology, documented the presence of vaccine-generated antibodies in umbilical cord blood and breast milk after mothers had been vaccinated.
Natali Aziz, a maternal-fetal medicine specialist at Stanford University School of Medicine, notes that it's too early to draw firm conclusions about the reduction in COVID-19 infection rates among newborns of vaccinated mothers. Citing the two aforementioned research studies, she says it's biologically plausible that antibodies passed through the placenta and breast milk impart protective benefits. While thousands of pregnant and lactating women have been vaccinated against COVID-19, without incurring adverse outcomes, many are still wondering whether it's safe to breastfeed afterward.
It's important to bear in mind that pregnant women may develop more severe COVID-19 complications, which could lead to intubation or admittance to the intensive care unit. "We, in our practice, are supporting pregnant and breastfeeding patients to be vaccinated," says Aziz, who is also director of perinatal infectious diseases at Stanford Children's Health, which has been vaccinating new mothers and other hospitalized patients at discharge since late April.
Earlier in April, Huntington Hospital in Long Island, New York, began offering the COVID-19 vaccine to women after they gave birth. The hospital chose the one-shot Johnson & Johnson vaccine for postpartum patients, so they wouldn't need to return for a second shot while acclimating to life with a newborn, says Mitchell Kramer, chairman of obstetrics and gynecology.
The hospital suspended the program when the Food and Drug Administration and the Centers for Disease Control and Prevention paused use of the J&J vaccine starting April 13, while investigating several reports of dangerous blood clots and low platelet counts among more than 7 million people in the United States who had received that vaccine.
In lifting the pause April 23, the agencies announced the vaccine's fact sheets will bear a warning of the heightened risk for a rare but serious blood clot disorder among women under age 50. As a result, Kramer says, "we will likely not be using the J&J vaccine for our postpartum population."
So, would it make sense to vaccinate infants when one for them eventually becomes available, not just their mothers? "In general, most of the time, infants do not have as good of an immune response to vaccines," says Jonathan Temte, associate dean for public health and community engagement at the University of Wisconsin School of Medicine and Public Health in Madison.
"Many of our vaccines are held until children are six months of age. For example, the influenza vaccine starts at age six months, the measles vaccine typically starts one year of age, as do rubella and mumps. Immune response is typically not very good for viral illnesses in young infants under the age of six months."
So far, the FDA has granted emergency use authorization of the Pfizer-BioNTech vaccine for children as young as 16 years old. The agency is considering data from Pfizer to lower that age limit to 12. Studies are also underway in children under age 12. Meanwhile, data from Moderna on 12-to 17-year-olds and from Pfizer on 12- to 15-year-olds have not been made public. (Pfizer announced at the end of March that its vaccine is 100 percent effective in preventing COVID-19 in the latter age group, and FDA authorization for this population is expected soon.)
"There will be step-wise progression to younger children, with infants and toddlers being the last ones tested," says James Campbell, a pediatric infectious diseases physician and head of maternal and child clinical studies at the University of Maryland School of Medicine Center for Vaccine Development.
"Once the data are analyzed for safety, tolerability, optimal dose and regimen, and immune responses," he adds, "they could be authorized and recommended and made available to American children." The data on younger children are not expected until the end of this year, with regulatory authorization possible in early 2022.
For now, Vonnie Cesar, a family nurse practitioner in Smyrna, Georgia, is aiming to persuade expectant and new mothers to get vaccinated. She has observed that patients in metro Atlanta seem more inclined than their rural counterparts.
To quell some of their skepticism and fears, Cesar, who also teaches nursing students, conceived a visual way to demonstrate the novel mechanism behind the COVID-19 vaccine technology. Holding a palm-size physical therapy ball outfitted with clear-colored push pins, she simulates the spiked protein of the coronavirus. Slime slathered at the gaps permeates areas around the spikes—a process similar to how our antibodies build immunity to the virus.
These conversations often lead hesitant patients to discuss vaccination with their husbands or partners. "The majority of people I'm speaking with," she says, "are coming to the conclusion that this is the right thing for me, this is the common good, and they want to make sure that they're here for their children."
CORRECTION: An earlier version of this article mistakenly stated that the COVID-19 vaccines were granted emergency "approval." They have been granted emergency use authorization, not full FDA approval. We regret the error.
Surfing for Science: A Fin Sensor Is Making Waves
For David Walden, a Southern Californian, surfing is a lifestyle, not a hobby. The 38-year-old works nights at a seafood restaurant to leave his mornings free for surfing.
While the surfers are doing what they love, they are also collecting information that is helping scientists better understand the ocean.
"Once you fall in love with the ocean, you need it like a daily cleanse or refresher," he says. "The positive mental and physical effects of the ocean, the endorphins and dopamine, keep you addicted in a good way."
Given his dedication to surfing, Walden was delighted when he became one of more than 200 surfers last year to test Smartfin, a 5-1/2-inch surfboard fin that contains a circuit board, a rechargeable battery, a GPS device, a sensor that captures temperature to one-hundredth of a degree, and a motion sensor that tracks the movement of the waves. While Walden and his fellow surfers are doing what they love, they are also collecting information that is helping scientists better understand the health of the near-shore ocean and how its chemistry is shifting due to climate change.
"I'm excited to be a part of it," Walden says. "I like to tell people I surf for science."
Back on shore, the surfers download the Smartfin data via a smartphone app so they can be accessed by scientists and other interested parties. (You can see where Smartfin surfers go at this interactive map.)
By putting sensors directly onto surfboards, oceanographers can collect data to help them better understand the global-warming related changes occurring in coastal oceans in temperature, salinity, and pH, all properties that have huge implications for the species that live in near-shore ecosystems.
There is much unknown about coastal waters because it's so difficult to obtain meaningful measurements. Traditional methods to monitor the close shore, such as bottle samples and buoys, are time consuming and expensive and tend to get damaged by the surf.
The Smartfin is the brainchild of Dr. Andy Stern, a retired neurologist. He and his brother-in-law, sculptor and filmmaker Todd McGrain, run The Lost Bird Project, a nonprofit devoted to raising awareness about climate change and other environmental issues. Stern brought his super fin idea to engineer Benjamin Thompson, who spent several years creating a prototype in his garage workshop. Smartfin was further developed by scientists at the Scripps Institution of Oceanography at the University of California at San Diego.
"The big challenge was to make a sensor small enough to fit in the fin but still produce good measurements," says Andreas Andersson, an associate professor of geoscience research at Scripps.
The Surfrider Foundation, a surfer-led nonprofit environmental organization, came aboard two years ago to distribute the Smartfin to its San Diego members.
Smartfin has also made a splash with scientists at the University of the Sunshine Coast in Queensland on the eastern coast of Australia. They are using the fin's temperature sensor to better understand how climate change is affecting the movement and distribution of marine life. And at the Plymouth Marine Laboratory in Plymouth, United Kingdom, the Smartfin's precise temperature readings of the near-shore ocean's surface are being used to improve the accuracy of satellites that monitor the ocean from hundreds of miles away.
"It's hard to talk about climate change in a way that's not boring or gloomy, but there's nothing gloomy or depressing about surfers and Smartfin."
"The hope is that Smartfin will improve the satellite measurements, which could improve the retrieval of temperature data around the world," says Dr. Phil Bresnahan, Smartfin's lead engineer at Scripps. In the future, the fin will include sensors to measure pH, chlorophyll (algae), dissolved oxygen, and turbidity (water clarity).
Stern envisions a time when thousands of surfers, paddle boarders, and other water enthusiasts worldwide will have Smartfins and be downloading data for scientists and environmentalists. Right now, there are approximately 70 surfers in the San Diego area using Smartfin and an additional 30 globally.
Scientists have plenty of evidence that global warming is largely caused by humans. Now they are trying to figure out what the long-term effects of climate change may be. For example, scientists are trying to predict which sections of coral reef, which house 25 percent of marine species, are most vulnerable so interventions can be developed to save them. Because of its small size, Smartfin is ideal to measure temperature changes in coral reefs.
Smartfin was also intended to be an educational tool. "It's a great way to start a different conversation about climate change," says Stern. "It's hard to talk about climate change in a way that's not boring or gloomy, but there's nothing gloomy or depressing about surfers and Smartfin. People want to hear more."
Turning surfers into citizen scientists makes perfect sense, says David Pasquini, 35, a longtime surfer who works for the British Consulate General's office in Oceanside, Calif. "Anyone who spends a lot of time in the ocean is aware of the changes happening in the ecosystem, the climate," says Pasquini. "Everyone asks, 'What can I do?'" Surfing with Smartfin, Pasquini feels like he is giving back.
"I know the data will be analyzed and eventually used to make a policy that helps with climate change. That's a great feeling--just by surfing, doing something you love, you're contributing."
Would you leave your small child in the care of a robot for several hours a day? It may sound laughable at first, but think carefully.
"Given the huge amounts of money we pay for childcare, a [robot caregiver] is a very attractive proposition."
Robots that can care for children would be a godsend to many parents, especially the financially strapped. In the U.S., 62 percent of women who gave birth in 2016 worked outside the home, and day care costs are often exorbitant. In California, for instance, the annual cost for day care for a single child averages over $22,000. The price is lower in some states, but it still accounts for a hefty chunk of the typical family's budget.
"We're talking about the Holy Grail of parenting," says Zoltan Istvan, a technology consultant and futurist. "Imagine a robot that could assume 70 percent to 80 percent of the caregiver's role for your child. Given the huge amounts of money we pay for childcare, that's a very attractive proposition."
Both China and Japan are on the leading edge of employing specially designed social robots for the care of children. Due to long work schedules, shifting demographics and China's long-term (but now defunct) one-child policy, both countries have a severe shortage of family caregivers. Enter the iPal, a child-sized humanoid robot with a round head, expressive face and articulated fingers, which can keep children engaged and entertained for hours on end. According to its manufacturer, AvatarMind Robot Technology, iPal is already selling like hotcakes in Asia and is expected to be available in the U.S. within the next year. The standard version of iPal sells for $2,499, and it's not the only robot claimed to be suitable for childcare. Other robots being fine-tuned are Softbank's humanoid models Pepper and NAO, which are also considered to be child-friendly social robots.
iPal talks, dances, plays games, reads stories and plugs into social media and the internet. According to AvatarMind, over time iPal learns your child's likes and dislikes, and can independently learn more about subjects your child is interested in to boost learning. In addition, it will wake your child up in the morning and tell him when it's time to get dressed, brush his teeth or wash his hands. If your child is a diabetic, it will remind her when it's time to check her blood sugar. But iPal isn't just a fancy appliance that mechanically performs these functions; it does so with "personality."
iPal robot interacting with a boy.
The robot has an "emotion management system" that detects your child's emotions and mirrors them (unless your child is sad, and then it tries to cheer him up). But it's not exactly like iPal has the kind of emotion chip long sought by Star Trek's android Data. What it does is emotional simulation--what some would call emotional dishonesty--considering that it doesn't actually feel anything. But research has shown that the lack of authenticity doesn't really matter when it comes to the human response to feigned emotion.
Children, and even adults, tend to respond to "emotional" robots as though they're alive and sentient even when we've seen all the wires and circuit boards that underlie their wizardry. In fact, we're hardwired to respond to them as though they are human beings in a real relationship with us.
The question is whether the relationships we develop with robots causes social maladaptation, especially among the most vulnerable among us—young children just learning how to connect and interact with others. Could a robot in fact come close to providing the authentic back-and-forth that helps children develop empathy, reciprocity, and self-esteem? Also, could steady engagement with a robot nanny diminish precious time needed for real family bonding?
It depends on whom you ask.
Because iPal is voice-activated, it frees children to learn by interacting in a way that's more natural than interacting with traditional toys, says Dr. Daniel Xiong, Co-founder and Chief Technology Officer at AvatarMind. "iPal is like a "real" family member with you whenever you need it," he says.
Xiong doesn't put a time limit on how long a child should interact with iPal on a daily basis. He sees the relationship between the child and the robot as healthy, though he admits that the technology needs to advance substantially before iPal could take the place of a human babysitter.
It's no coincidence that many toymakers and manufacturers are designing cute robots that look and behave like real children or animals, says Sherry Turkle, a Professor of Social Studies and Science at MIT. "When they make eye contact and gesture toward us, they predispose us to view them as thinking and caring," she has written in The Washington Post. "They are designed to be cute, to provide a nurturing response" from the child. "And when it comes to sociable AI, nurturance is the killer app: We nurture what we love, and we love what we nurture."
What are we saying to children about their importance to us when we're willing to outsource their care to a robot?
The problem is that we get lulled into thinking that we're in an actual relationship, when a robot can't possibly love us back. If adults have these vulnerabilities, what might such lopsided relationships do to the emotional development of a small child? Turkle notes that while we tend to ascribe a mind and emotions to a socially interactive robot, "Simulated thinking may be thinking, but simulated feeling is never feeling, and simulated love is never love."
Still, is active, playful engagement with a robot for a few hours a day any more harmful than several hours in front of a TV or with an iPad? Some, like Xiong, regard interacting with a robot as better than mere passive entertainment. iPal's manufacturers say that their robot can't replace parents or teachers and is best used by three- to eight-year-olds after school, while they wait for their parents to get off of work. But as robots become ever more sophisticated, they're expected to become more and more captivating, and to perform more of the tasks of day-to-day care.
Some studies, performed by Turkle and fellow MIT colleague Cynthia Breazeal, have revealed a darker side to child-robot interaction. Turkle has reported extensively on these studies in The Washington Post and in her 2011 book, Alone Together: Why We Expect More from Technology and Less from Each Other. Most children love robots, but some act out their inner bully on the hapless machines, hitting and kicking them and otherwise trying to hurt them. The trouble is that the robot can't fight back, teaching children that they can bully and abuse without consequences. Such harmful behavior could carry over into the child's human relationships.
And it turns out that communicative machines don't actually teach kids good communication skills. It's well known that parent-child communication in the first three years of life sets the stage for a child's intellectual and academic success. Verbal back-and-forth with parents and caregivers is like food for a child's growing brain. One article published in JAMA Pediatrics showed that babies who played with electronic toys—like the popular robot dog AIBO—show a decrease in both the quantity and quality of their language skills.
Anna V. Sosa of the Child Speech and Language Lab at Northern Arizona University studied 26 ten- to 16-month-old infants to compare the growth of their language skills after they played with three types of toys: Electronic toys like a baby laptop and talking farm; traditional toys like wooden puzzles and building blocks; and books read aloud by their parents.
The play that produced the most growth in verbal ability was having books read to them, followed by play with traditional toys. Language gains after playing with electronic toys came dead last. This form of play involved the least use of adult words, the least conversational turn-taking with parents, and the least verbalizations from the children. While the study sample was small, it's not hard to extrapolate that no electronic toy or even more abled robot could supply the intimate responsiveness of a parent reading stories to a child, explaining new words, answering the child's questions, and modeling the kind of back-and-forth interaction that promotes empathy and reciprocity in human relationships.
Most experts acknowledge that robots can be valuable educational tools, but they can't make a child feel truly loved, validated, and valued.
Research suggests that the main problem of leaving children in the care of robots on a regular basis is the risk of their stunted, unhealthy emotional development. In Alone Together, Turkle asks: What are we saying to children about their importance to us when we're willing to outsource their care to a robot? A child might be superficially entertained by the robot while her self-esteem is systematically undermined.
Two of the most vocal critics of robot nannies are researchers at the University of Sheffield in the U.K., Noel and Amanda Sharkey. In an article published in the journal Interaction Studies, they claim that the overuse of childcare robots could have serious consequences for the psychological and emotional wellbeing of children.
They acknowledge that limited use of robots can have positive effects like keeping a child safe from physical harm, allowing remote monitoring and supervision by parents, keeping a child entertained, and stimulating an interest in science and engineering. But the Sharkeys see the overuse of robots as a source of emotional alienation between parents and children. Just regularly plopping a child down with a robot for hours of interaction could be a form of neglect that panders to busy parents at the cost of a child's emotional development.
Robots, the Sharkeys argue, prey upon a child's natural tendency to anthropomorphize, which sucks them into a pseudo-relationship with a machine that can never return their affection. This can be seen as a form of emotional exploitation—a machine that promises connection but can never truly deliver. Furthermore, as robots develop more intimate skills such as bathing, feeding and changing diapers, children will lose out on some of the most fundamental and precious bonding activities with their parents.
Critics say that children's natural ability to bond is prime territory for exploitation by toy and robot manufacturers, who ultimately have a commercial agenda. The Sharkeys noted one study in which a state-of-the-art robot was employed in a daycare center. The ten- to 20-month-old children bonded more deeply with the robot than with a teddy bear. It's not hard to see that starting the robot-bonding process early in life is good for robot business, as babies and toddlers graduate to increasingly sophisticated machines.
"It is possible that exclusive or near exclusive care of a child by a robot could result in cognitive and linguistic impairments," say the Sharkeys. They cite the danger of a child developing what is called in psychology a pathological attachment disorder. Attachment disorders occur when parents are unpredictable or neglectful in their emotional responsiveness. The resulting shaky bond interferes with a child's ability to feel trust, pleasure, safety, and comfort in the presence of the parent. Unhealthy patterns of attachment include "insecure attachment," a form of anxiety that arises when a child cannot trust his caregiver with meeting his emotional needs. Children with attachment disorders may anxiously avoid attachments and may not be able to experience empathy, the cornerstone of relationships. Such patterns can follow a child throughout life and infect every other relationship they have.
An example of the inadequacy of robot nannies rests on the pre-programmed emotional responses they have in their repertoires. They're designed to detect and mirror a child's emotions and do things like play a child's favorite song when he's crying or in distress. But such a response could be the height of insensitivity. It discounts and belittles what may be a child's authentic response to an upsetting turn of events, like a scraped knee from a fall. A robot playing a catchy jingle is a far cry from having Mom clean and dress the wound, and perhaps more importantly, kiss it and make it better.
Most experts acknowledge that robots can be valuable educational tools. But they can't make a child feel truly loved, validated, and valued. That's the job of parents, and when parents abdicate this responsibility, it's not only the child that misses out on one of life's most profound experiences.
So consider buying a robot to entertain and educate your little one—just make sure you're close by for the true bonding opportunities that arrive so fast and last so fleetingly in the life of a child.