Video Q&A: Vaccines During Pregnancy
Jul 18, 2021

Vaccinate Your Family was pleased to host Dr. Laura Riley of NewYork-Presbyterian Hospital and Weill Cornell Medicine, in collaboration with American College of Obstetricians and Gynecologists – ACOG, as she answered questions about COVID-19 and other vaccines during pregnancy and breastfeeding.

Please take a moment to watch the video below, or read the transcript, and share it with any friends who are pregnant, thinking of becoming pregnant, or breastfeeding.

Synovia Moss:

I have the pleasure of introducing Dr. Riley who is with us today. We’re so excited. Dr. Laura Riley is an obstetrician and gynecologist in chief at New York Presbyterian Weill Cornell Medical Center and Chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine, a maternal medicine specialist, and internationally recognized expert on obstetric infectious diseases. Dr. Riley specializes in the treatment of expecting mothers whose pregnancies are high-risk because of chronic illness or infectious diseases. She is the chair of ACOG’s Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group and a member of ACOG’s COVID-19 Work Group, and author of ACOG’s COVID-19 Guidance. She also works with the CDC, the U.S. Department of Health and Human Services, and ACOG to develop practice guidelines for the care of pregnant women with group B Strep, Ebola, Zika, influenza, and COVID-19 as well as maternal immunization. Welcome, welcome, welcome, Dr. Riley, and thank you so much for being here with us today.

Dr. Laura Riley:

It is my pleasure.

Synovia Moss:

So today we are going to have a wonderful conversation with her and again, feel free to put information into the chat so that we can engage you all to be a part of this conversation. Our discussion topics are going to range around three topics: COVID-19 vaccines, Tdap vaccines during pregnancy, and where to find the resources and information or where we go from here. So to begin, Dr. Riley, if you’re pregnant or could be soon or are breastfeeding, what should you be thinking about when considering getting vaccinated against COVID-19?

Dr. Laura Riley:

So, the first thing I would say is let’s sort of separate those things a little bit, because I think that for an individual woman making a decision, someone who is not pregnant or is considering pregnancy, or going through infertility, we would strongly recommend that that woman get vaccinated, right? Protect yourself from COVID-19.

In pregnancy, the recommendation is really quite the same in the sense that we want women to know that COVID-19 infection in pregnancy can be particularly harmful. I think what we’ve learned over the past 15 months of this scary epidemic is that pregnant women are more likely to have an ICU admission, need a ventilator, even the risk of death is higher. We’ve also seen over the course of the last 15 months that there seems to be an increased risk of prematurity for women who get COVID-19, maybe more women get preeclampsia – I think that’s still a question – and then there’s some studies suggesting that more women will get cesarean deliveries. I think at the end of the day, even if we look at any of those individual things, it’s clear that COVID-19 in pregnancy is way worse than in the non-pregnant state.

Because of that, we also know, though, that the COVID vaccines are our best prevention against getting sick with COVID-19. So, I think with pregnancy, the issue is the disease is worse. I think the benefit of the vaccine outweighs the potential risks, but I know that that’s a tough decision for some women to make, yet that’s the recommendation. If it is available, women should strongly consider taking it and go from there.

Then, the third group of women, those who are breastfeeding – I think that’s a slam dunk. Take the vaccine, protect yourself. If you’ve managed to get through pregnancy unscathed, awesome and good for you! But get the vaccine as soon as you possibly can after you deliver. There’s no live virus in this vaccine that you should feel as though you’re potentially giving it to your child through breastfeeding, none of that exists. I would actually remind women that we suggest and give MMR, which is a live vaccine, the minute you’re walking out of the hospital even if you’re breastfeeding. So again, no reason not to get it. It is the best form of protection against the disease and against transmitting it to the rest of your family, so when grandma comes to visit your newborn, you don’t need to be giving her COVID-19.

Synovia Moss:

Oh, thank you so much for that information and for talking about the benefits of the vaccine. Another question is: What can you tell us about how well the vaccines work? What about against the variants?

Dr. Laura Riley:

Yeah, so I think one of the things that happened at the beginning, right when the vaccines were made available, I think a lot of patients were like. “How do you really know this is even going to work?” And honestly, in the clinical trials, we knew that the vaccine would prevent severe illness and hospitalization, but we didn’t know that much about transmission. We were hoping that it would decrease transmission. I think now that the vaccines have been out and available, there’s very good data to suggest that it also prevents transmission. So that’s number one.

There’s no data that suggests that the efficacy of the vaccine is any different in pregnancy compared to in non-pregnant individuals. So, the same way it protects non-pregnant individuals, it’s protecting pregnant women from getting COVID-19.

And then the variants – the variants are an interesting story. The variant that is now circulating in Brazil is particularly scary because what they’re seeing is that it seems to be more infectious than what we were seeing in the U.S. It also seems to be associated with a greater case fatality rate for pregnant women, which means way more morbidity and deaths associated with COVID with this new variant. The good news is that the vaccines that are available to us in the U.S. are very effective against that new variant. But again, how effective it is will depend a lot on how many people get vaccinated. The closer we get to the ideal state of 70-80% of the population being vaccinated, the better off we’ll be against those variants.

Synovia Moss:

Wow, thank you for that. Another question: do the vaccines pass on protection to the babies in utero or while breastfeeding?

Dr. Laura Riley:

Yeah, that’s a great question. There’s currently data now, including from our institution, which shows that pregnant women who get vaccinated against COVID-19 during pregnancy do pass those antibodies that they make from the vaccine – those antibodies get transmitted to the baby and we can measure it in cord blood, and that’s awesome.

What we don’t know is how much of those antibodies are then protecting the baby after, we don’t know how long those antibodies last. I think if it’s analogous to other vaccines that we use during pregnancy like the flu vaccine or Tdap, if it works like those, you boost mom’s antibody response to whooping cough for example, and then those antibodies cross the placenta and are in the baby’s system for several months after delivery. It’s those antibodies that are absolutely critical to prevent the baby from getting whooping cough in the first few months of life. Babies were dying at a high rate if they in fact got whooping cough and didn’t have that protection from mom. So, assuming that the COVID vaccine works the same way, it should prevent newborns who become exposed to COVID-19 from being infected – that’s our hope.

I think the fact that we found the antibodies in the cord blood is very exciting, but more work is being done on larger populations and to see what kind of protection that women who are breastfeeding can also afford to their babies – do the antibodies appear in the breastmilk in enough of a way to protect babies. So, obviously, breastmilk has lots of benefits, but wouldn’t it be nice if this was another benefit?

Synovia Moss:

Thank you. Well, I’m so excited to have this opportunity to also work with Vaccinate Your Family on a major initiative called Good Health WINs with the National Council of Negro Women and we are building this army of immunization advocates. As we’re preparing our advocates to go out and share the word about the importance of vaccines, we do see the ability and opportunity for us to build vaccine confidence, especially when it comes to maternal health and COVID. One of the questions that we see often is around the safety of the COVID vaccines, especially if you’re pregnant or breastfeeding, and one of the questions we would have is: does the vaccine appear to be safe for babies in utero? What about for newborns and babies who are breastfed?

Dr. Laura Riley:

So, what we know about the safety of the COVID vaccines now is a lot more than we knew at the beginning, right? So, when the vaccines first came out, everyone knows that pregnant women were not part of the original clinical trials. However, the safety data we did have included animal reproductive data which basically showed that there were no adverse effects of the vaccine on developing mice pups. So that’s important information.

The second piece of important information that we had at the time was that biologically, the way the vaccine worked, there was nothing about that mechanism that should cause harm for either a developing fetus or a newborn. So, those are two pieces of information that we went forward with to make the recommendation that yes, pregnant women should strongly consider the vaccine given all the badness associated with COVID infection and pregnancy.

Now, over the last 15 months, over 100,000 pregnant women have been vaccinated against COVID-19 and we have some safety data from those women who then joined a registry, a pregnancy registry, specifically on COVID vaccines, which is wonderful – thank you to all of those women because they have really made a huge difference in everyone’s lives. So, from the preliminary data that has at least been published from that registry, there does not appear to be any safety issues with the vaccine in terms of not an increased risk of miscarriage, which is obviously something that would be of concern to women; not an increased risk of congenital malformations or birth defects; there has not been an increased risk of preterm birth or other pregnancy complications that you might worry about. That’s huge, and as an obstetrician-gynecologist suggesting to my patients to consider this, I am so happy to see that safety data. I wasn’t concerned based on what we knew preliminarily, but it is a lot nicer to now see data in a large number of humans so that we can say we’re not seeing anything different.

That same registry data also suggested that the side effects, well-known side effects that one would expect from the vaccine, is not different in pregnancy than what was seen in non-pregnant individuals – the same sore arm, the fatigue, a few women get a fever, more of the side effects seemed to appear after the second shot for women who got an mRNA vaccine. So, I think that that’s all good news to know that essentially the vaccine is working the same way we would have anticipated it, and it’s working the same way it’s working in the general population.

Synovia Moss:

That is really good news. Do you recommend one vaccine over another for pregnant or breastfeeding patients?

Dr. Laura Riley:

So, if they’re breastfeeding, the interesting thing for people who are breastfeeding is the issue that people are worried about the J&J vaccine because there was that short pause and the short pause was because there was seen in a very tiny number of patients a syndrome of blood clotting in the brain or blood clotting in the abdomen in a weird spot that was particularly associated with having low platelets as well. It’s really quite a scary condition, but it has a specific treatment, and I think that when that signal was seen people were like, “Oh, I don’t want to get that vaccine.”  I think because one of the presenting symptoms is headache, I have said to my patients that if you have an alternative, if you can do the mRNA immediately after delivery, then take that. If there’s no alternative, the only thing you can do is J&J, then go get the J&J. It’s better to be vaccinated with something than with nothing.

The only reason I say there might be a little bit of a preference for the mRNA for some women is that if you’re postpartum you already have a headache every day, there’s fatigue, preeclampsia, any number of things. There could be a number of people running to the emergency room thinking it’s something related to their COVID vaccine and it’s not. But I think at the end of the day, the most important thing is to get vaccinated with something, with whatever is available to you. Given the choice, would some women choose mRNA over J&J? Yes, and that’s okay. Lucky for us in the United States that we have a choice, that’s what I would say.

Synovia Moss:

Right, thank you. And that important message you said is just get something which is really important. We have lots of questions coming to us in the chat so again, if you have information or a question, please put it in the chat. We are going to try to get to as many as we can. We’re so excited to have Dr. Riley with us.

Here’s a question from the chat: One of the major concerns I have been hearing from pregnant people who are resistant to get the vaccine is surrounding premature labor and delivery. Could you speak to if there is a chance that receiving the vaccine could cause premature labor and early delivery?

Dr. Laura Riley:

That’s a great question. The data that we have seen so far from pregnant women, so from over 100,000 who have been vaccinated, there doesn’t appear to be an increased risk for pre-term delivery. And when you compare the number they had in that group to the background rate of pre-term birth, absolutely zero difference. The one thing I will say though that we do know is that women who get COVID infection do have an increased risk of pre-term birth. So again, it’s about preventing even worse if you in fact get the infection itself.

Synovia Moss:

Alright, thank you. If a woman is vaccinated early in pregnancy, let’s say in the first trimester, are we still finding protective antibodies for the babies at birth?

Dr. Laura Riley:

That’s such an awesome question, and my patients ask me all the time, “When’s the best time to get the vaccine?” I think that we have to think about the COVID vaccine the same way we think about the flu vaccine. So, we recommend that all women who are pregnant get the flu vaccine during flu season as soon as it’s available – if you’re in the first trimester, you get it in the first trimester; the second trimester, you get it then; the third trimester, you get it then. The issue is that the vaccine is being used to protect you from getting that disease, okay.

An added benefit of the flu vaccine is that those antibodies that you develop against the flu do transmit through the placenta into the baby and protect the baby for some period of time after the baby is born and certainly up until the time the baby can get the vaccine which is 6 months of age. For the COVID vaccine, we’re doing the same thing. We want to protect mom from getting infected, and an added benefit will be when we find those antibodies in maternal blood and we can say later, hopefully, that that’s going to protect your baby from getting sick.

The studies on how much antibody is being transmitted with COVID vaccines, those studies are being done now. Preliminarily, we do have some women who have been vaccinated in the first trimester, but the problem is those people haven’t necessarily delivered yet. So, I would look out for that data – our institution is doing a prospective study on it looking at what the outcome is going to be – and there are many of those studies being done across the country. But the thing that women have to remember is that it’s a little bit different than Tdap because Tdap we give around 26-28 weeks gestation because at that time we know you get the most robust antibody response that then transmits to the baby and protects the baby from whooping cough. The issue is we aren’t worried that something bad is going to happen if mom gets whooping cough, we’re really doing the vaccine to protect the baby so you can choose the ideal time in pregnancy to do that. It’s not the same with COVID. If you are pregnant in my office now, and you come to me at 11 weeks gestation and say, “Dr. Riley, when’s the best time to get the COVID vaccine?” I’ll say, “Today, we want to protect you from getting COVID.” If you decide that you’re going to wait, for example until 28 weeks, you play a little bit of Russian roulette – you’re banking on the fact that you’re not going to get COVID between 11 and 28 weeks. Not such a great thing to bet on in my mind.

Synovia Moss:

Alright, thank you. So, how confident can we be that the vaccine doesn’t cause long-term side effects?

Dr. Laura Riley:

So, I think really what we can fall back on is how the vaccine works. There’s nothing about the vaccine that makes us think it has long-term implications for both the person who got it initially and the person who transmits those antibodies to the baby. We just don’t see, biologically, how that would happen, but we don’t have that data. I think people have to recognize that we just haven’t seen that data and it’s going to be a while. Someone said to me yesterday, “Well how do I know that everything’s going to be fine when my kid is 2 years old?” and I can’t tell you that because there aren’t any 2-year-olds yet that we could study. I think it makes a great case that we should definitely follow these children for a long period of time, but again there is nothing biologically that seems that we should be concerned about it. The flipside is if you have a preterm baby because you got COVID, you are signing up, definitely, for a lifetime of various issues that are going to be long term. So we have to think about that.

Synovia Moss:

Thank you. Here’s another question from the chat: Is there a safer or more ideal time during pregnancy to get the vaccination? I’m concerned about fever as a side effect from the second shot especially in the first trimester because isn’t fever linked to possible birth defects?

Dr. Laura Riley:

Such a great question. Yeah, everyone was like freaking out about the fever situation. So first of all I would say the good news is that pregnant women don’t seem to get a huge amount of fever, some women will get a fever just like in the general population as I said. And the fever, I would just put out there, is short-lived – 24-48 hours, take Tylenol, the fever goes away. Not worried about that kind of short-term fever, even in the first trimester. I always say to my patients, if you get a fever, take Tylenol. The fever will go away, I wouldn’t be worried about it.

And I think that the data about fever and birth defects aren’t actually that good. To be honest with you, it’s really old data and some of those studies actually mixed up the fever with having other infections, so how do you know it wasn’t the infection as opposed to the fever itself being the real culprit? Again though, I think the fact that the fever is so short-lived makes me say just get it, because the other thing is having had COVID myself, the fever with COVID was not fast and it didn’t get better with Tylenol. So, it’s a totally different scenario.

Synovia Moss:

So, some of the work we’re doing with Vaccinate Your Family and the National Council of Negro Women is we are really targeting the reproductive age women and the basic question that they ask is: is it safe to get vaccinated if you’re hoping to get pregnant in the future?

Dr. Laura Riley:

Yeah, so there’s a lot of concern about fertility and I think that all I can tell you is there’s nothing biologically about this vaccine that should mess with your fertility. That’s certainly not what I’ve seen, I’ve seen a whole lot of people who are getting pregnant, and I am busier than I have been in a really long time. Yeah, so there’s no data, absolutely, to suggest that this impacts fertility, and I will tell you that the experts in fertility have put out statement after statement after statement just to reassure people that they are on board with vaccination because they don’t want pregnant women to get COVID-19. That’s going to make life really bad for some of them.

Synovia Moss:

Yes. So, I really wanted to say this is excellent about the COVID-19 vaccines and pregnancy. We’re very excited that we’re going to be able to shift a little bit more to talk as we’re getting ready to enter flu season. So let’s talk a little bit about flu and TDAP vaccines during pregnancy, what other vaccines are recommended during pregnancy, and why.

Dr. Laura Riley:

Yeah, so as we talked about flu vaccine when flu season comes in October, November, and December, we’re going to be all about vaccinating women against flu. The reason is that we’ve seen during multiple pandemics, epidemics, and every year, actually, that there are flu deaths and that the likelihood of dying from flu is higher if you’re pregnant.

If you think about it, there are the physiological changes of pregnancy that just make it harder to clear flu and people do very poorly. We will recommend for all of our patients, the minute that flu vaccine is available, that they go ahead and get vaccinated. There’s tons of safety data on the flu vaccine in pregnancy, it’s not associated with miscarriage, birth defects, you name it. So that would be number one.

The second one that we suggest for all women is the Tdap, which is tetanus-pertussis, but really we recommend it because we want to protect your baby against whooping cough and there are random outbreaks of whooping cough. We know that children who are at less than the age of one are at an increased risk for dying from whooping cough and so it’s super important for women to get vaccinated.

We’ve had the experience back in the early 2000s of trying to vaccinate mom, sister, grandma, partner, trying to do this cocooning of the baby and protect everybody, but that honestly didn’t work that well unless mom was vaccinated and actually transmitting those antibodies directly to the baby. So, again, super important for newborns.

The other thing I would say about the flu vaccine that I said earlier is that an added benefit of the flu vaccine is we know that those antibodies are transmitted to the babies and will protect the babies for the first six months of life while they’re exposed to everybody and can’t get vaccinated themselves yet.

So, those are the two most common things that we recommend. There are other vaccines that we recommend, but they are usually for women who are at higher risk for some particular reason, some particular health issue or finishing vaccine series. So if for some reason you are in the midst of getting your hepatitis vaccines, you need to just finish that up and get fully protected against hepatitis. That’s one that I can think of off the top of my head, but there are others, like the pneumococcal vaccine if you’re a smoker or have asthma; you should finish whatever it is you have started or what is recommended. Pregnancy is not a reason to not do it.

Synovia Moss:

Absolutely. So what’s the cadence, do I get the vaccine for the first dose and then do flu and then do my second dose, or what would you recommend that cadence look like?

Dr. Laura Riley:

Yeah, so my hope is that all women out there are getting vaccinated so then you don’t have to add COVID as one of your pregnancy vaccines. But, for whatever reason if that does not work out, the CDC has put out guidance that you can get multiple vaccines on the same day, so you probably don’t have to think about it too much. I think certainly with COVID numbers being as high as they are in some areas, I would prioritize that. Prioritize the thing that is most likely to get you sick. And we know that flu will hit pockets of the U.S. differently, so it’s ideal to get your vaccine before it gets to your state or county, but I would probably prioritize that way.

Synovia Moss:

Okay, so still talking about the vaccine: if a person receives the first dose prior to becoming pregnant and they haven’t gotten their second, how well protected are they with that one dose?

Dr. Laura Riley:

That first dose doesn’t seem to be so protective, based on the data that exists in non-pregnant individuals, so I personally would not operate just based on that. I would get the second dose so that you know you’re protected, especially because what’s circulating now are these variants, so you want as much protection from these variants as you can possibly get. We know that the one-time dose is just not enough if you get the mRNA vaccines.

Synovia Moss:

Okay. Alright, well another question that we have is: what is known about the safety and the benefits of those vaccines for both pregnant people and their babies? For COVID, Tdap, flu, all of them.

Dr. Laura Riley:

So COVID, I think we’ve pretty much knocked out of the park here with all the data that is available. And let me just say one other thing that I think is important for people to know, and my patients certainly ask me about this, is if something develops are you going to let me know? Absolutely. There is a safety technical group which is like another little subgroup from the COVID vaccine workgroup at the CDC that is looking at data every single week from multiple safety systems that exist in the U.S. So, their system is a passive surveillance system which anybody, a doctor, a nurse, a patient, can write in and say, I took the vaccine and my arm got sore, or I got a high fever, or my baby was pre-term. Anyone can do that, and we look at that data every single week to make sure that we’re not seeing things that make us think that could be related to the vaccine or not – most of the time it’s not, but it’s still information that needs to be had. And so that subgroup is available now and looking at safety data on a weekly basis with the COVID vaccines.

I can tell you that when the flu pandemic hit in 2009, when there was the H1N1 epidemic and pregnant women were dying from the flu, there was this same vaccine safety technical group and I was a member of the group then and basically what we did was we looked at safety data that came in from all the different safety systems because people were concerned about the increased risk of miscarriage, pre-term birth, and things like that. So we have that same system set up now. I would say now, for flu, we have years and years of safety data so we’re not concerned about the safety of the flu vaccine. We’ve got lots of safety data on pertussis as well, nothing has ever come about. And so far, everything we’ve seen about COVID has been good as well but know that we’re watching and I think that’s really important.

And if there is something, there is no time wasted once people recognize there is something different, even though it could or could not be related to the vaccine because it is important for the public to know about it so they can best take care of themselves. It’s also important for doctors to know because the way we take care of some syndromes may be different from other similar conditions. So, that I think is also really important for people to know.

Synovia Moss:

And we have one more question in the chat as we begin to wrap this up: is there any way to check our cord blood for COVID antibodies when the baby is born for those of us who are vaccinated early in pregnancy?

Dr. Laura Riley:

So, I don’t know that you can do it as a routine. If you’re in a study, that’s exactly what’s being studied. So, we may not be able to get your cord blood, but we are getting a group of women’s cord blood so that we can see exactly how much antibody is in the cord blood whether you were vaccinated in the first, second, or third trimester or breastfeeding. So, we will have that data. The breastfeeding stuff is a little harder though because you’re able to test things in breastmilk but nobody really wants to stick their baby to see what kind of antibodies are in the baby. So, we do have a small number of babies who are okay with it, but that’s a harder study to do.

Synovia Moss:

Okay, well you have been a wealth of information, and one of the things that we really value is to give people the opportunity to find information for themselves. So, where would you suggest people who are pregnant or breastfeeding go to find trusted science-based information about vaccines?

Dr. Laura Riley:

Well, they can go to you guys, you guys have done a great job of putting out really important information. ACOG has some great information, ACOG is the American College of Obstetricians and Gynecologists. And then also the CDC, the page on pregnancy and COVID vaccines is really well done, very straightforward, here’s what we know, here’s what we don’t know, and here’s how you can weigh the risks and benefits.

ACOG also has a nice risk-benefit calculus that people can utilize, and I think just talking that through with someone else, hopefully, you can get to your provider— if you can’t, talking to nurses and other healthcare providers is also helpful. The Society for Maternal and Fetal Medicine also has one of these things where you can think about the risks and these are the benefits. And again, really reminding people that you’re thinking about things like what’s the risk of the disease itself? What happens if I get COVID? That’s really what the question is. How do I prevent myself from getting COVID? Well, it is important to mask, social distance, do all of those things, but still remember that people are getting infected despite that and so, the best prevention at the end of the day is going to be a COVID vaccine.

Synovia Moss:

Thank you. And again, just to reiterate, if you’d like to get trusted information, science-based information, you can go to www.vaccinateyourfamily.org or www.acog.org if you want some additional information, and of course, you can always go to the CDC. So what resources, Dr. Riley, do you think are available for those who are pregnant or breastfeeding in the U.S. who are uninsured or cannot afford vaccinations?

Dr. Laura Riley:

Vaccinations are free. This is not an afford, not-afford thing. You should be able to walk in and get a COVID vaccine wherever it’s available. I think the issue is the availability; we know that the access is not as good as it should be, although I think that every state is making an effort to make sure that it’s available. It may take a phone call or two, but I would start with the health department because they have to know where the vaccine is available. And, certainly, for pregnant women, your provider should know where it’s available – a lot of us don’t have it in our offices, but we know in the very close vicinity of our offices where it is. In fact, some obstetrical units are actually giving, which we do, we offer the vaccine on your way out the door so if you haven’t gotten your vaccine during pregnancy you can get it postpartum. So, I think that there’s more and more vaccines available and people just need to ask, just pick up the phone and ask.

Synovia Moss:

Alright, and I did want to share with our listeners today that if you’d like more information about resources you can always go to Vaccinate Your Family, they have a tremendous website and they actually have a tool on their website regarding paying for vaccines, so use that as a resource too.

Well, we are going to wrap this session up, thank you so much for tuning in. Please share this video with your communities and like Vaccinate Your Family and ACOG if you haven’t already. Vaccinate Your Family will be hosting more live Q&As as well as science-based information about vaccines during pregnancy and all stages of life.

And before we leave, I would like to ask and thank Dr. Laura Riley, are there any closing comments, words of wisdom, anything you’d like to share with the world regarding the work that you do as you continue to make a difference and improve the lives of not only your patients but the global community as well. So, we thank you for that. Any closing comments or remarks?

Dr. Laura Riley:

I don’t think so, I just hope that everyone will go ahead and get vaccinated because we really need to move on from COVID-19. It has affected us in so many different ways, that the protection it can give us is tremendous and I think we just need to take advantage of it.

Synovia Moss:

Well thank you so much for that. Again, what a joy and honor it is to be able to connect with you and to share this forum with you. And to those of you were listening and watching, we would love to hear your feedback. Please take a minute to fill out a very brief survey about this video and we’ll post a link in the comments. Thank you everybody for participating and I ask that you stay safe and be well!


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