LAUSR

Overview The public health response to the Zika crisis has evoked debate and critique, although there has been at least 1 clear success: rapid progress toward a vaccine, with phase 2 testing starting in early 2017, just a year after the Public Health Emergency of International Concern was declared. Among the challenges of developing a vaccine to prevent Zika infection during pregnancy are ethically complex questions about the appropriate role of pregnant women in the vaccine development agenda. Though ideally women will be vaccinated before conceiving, inadvertent vaccination during pregnancy is unavoidable when women of childbearing age are targeted. Vaccination during pregnancy may also be beneficial because the risks of Zika infection persist through gestation.1 Both underscore the importance of developing an approach that meets the needs of those most at risk: pregnant women and their offspring. To some extent, the timing is auspicious. Vaccination during pregnancy is increasingly accepted and endorsed—the Advisory Committee for Immunization Practices recommends pertussis and inactivated influenza vaccines for all pregnant women. However, certain vaccines are contraindicated—notably, live attenuated vaccines such as measles, mumps, and rubella and varicella.2 Further, research with pregnant women is now widely recognized as ethically permissible, considerable challenges notwithstanding. To better understand Zika’s challenges, some have looked to rubella, an illness associated with a severe congenital syndrome. While its eradication in the Americas is often lauded as a success story, for pregnancy and vaccination, rubella provides a cautionary tale.