BRIDGING KNOWLEDGE GAPS Educating frontline providers on maternal pertussis immunization

Newborns do not receive their first vaccine against pertussis until six weeks of age. In the first weeks of life, newborns remain highly vulnerable to pertussis, with protection relying entirely from maternal antibodies transferred transplacentally acquired maternal antibodies following Tdap vaccination.¹ Yet despite a WHO recommendation in place since 2014,² Tdap remains unavailable in most community health centers in the Philippines.

This article presents findings and recommendations from the workshop “Enhancing Confidence in Administering Maternal Tdap,” organized by the Philippine Infectious Diseases Society for Obstetrics and Gynecology (PIDSOG) on August 14, 2025. The workshop brought together healthcare professionals from multiple local government units (LGUs) to identify gaps in maternal Tdap immunization at the community level and advise actionable recommendations.

The burden of preventable disease
Neonatal tetanus and pertussis are different diseases, but both are largely preventable through maternal Tdap. In the past year, both continue to cause neonatal morbidity and mortality in the Philippines based on the data from the DOH Epidemiology Bureau (Morbidity Week 29, July 19, 2025).³

• 53 neonatal tetanus cases were recorded, a 23% reduction from 2024, yet with a case fatality rate (CFR) of 43.4%
• 91% of neonatal tetanus cases involved home deliveries with 85% of the cases having unknown maternal vaccination status
• 259 cumulative pertussis cases were reported; 51% occurred in unvaccinated individuals.

While tetanus prevention has long relied on tetanus toxoid (TT) and tetanus-diphtheria (Td), only Tdap provides the additional critical protection against pertussis—highlighting a missed opportunity in the current maternal immunization strategies. The opportunity to reduce the burden lies in the timely administration of the Tdap vaccine to pregnant women.

What the workshop revealed: Critical barriers at the LGU level

The workshop conducted by PIDSOG revealed a consistent pattern across participating LGUs, participants demonstrated genuine commitment to maternal health—yet structural and systemic barriers prevent Tdap from reaching pregnant women at the community level. These barriers reflect not isolated issues, but interconnected system failures spanning supply, policy clarity and service delivery. 

Tdap unavailability: Tetanus toxoid (TT) is widely available, and tetanus-diphtheria (Td) is accessible in select facilities. But Tdap, the only vaccine that confers neonatal protection against pertussis transplacentally, is not stocked in any of the participating health centers.
Confusion on vaccine timing and selection: Providers remain uncertain about which tetanus-containing vaccine is appropriate during pregnancy, particularly for women with incomplete or unknown vaccination histories who require catch-up schedules. 
Vaccine hesitancy persists but openness exists: Hesitancy persists, yet many pregnant women actively ask about "mga bakunang pambuntis." This signals genuine receptivity and an opportunity that only a confident, informed provider can convert into successful vaccinations.
Persistent vaccine stock-outs: Weak forecasting, procurement gaps, and limited LGU resources repeatedly interrupt supply chains. Stock-outs don't just delay doses, they erode public trust in the health system, a harm that is difficult to undo.
Limited weekend clinic hours: Restricted operating hours systematically exclude working pregnant women from prenatal visits, compounding missed vaccination opportunities for those already underserved.

Expert interpretation: What the numbers and workshop results reflect

A neonatal tetanus case fatality rate of 43.4%3 signals not only incomplete coverage but systemic failure in ensuring maternal protection before delivery. It reflects a failure to adequately provide maternal immunization at the local level. Unlike tetanus, pertussis has no currently functional substitute for Tdap—making its absence in LGUs a critical and addressable gap. The lack of maternal Tdap in LGU health centers means neonates enter their most vulnerable period entirely unprotected against a preventable disease.^2,4 

Together, the surveillance data and workshop findings point to the same conclusion: The system has the willing providers, but not the tools, supply, or institutional support to deliver the protection that mothers and newborns need. At present, the absence of a clear national directive on maternal Tdap integration into routine immunization contributes to inconsistent implementation across LGUs. 

Expert recommendations: What must change and why

Healthcare worker confidence shapes vaccine uptake, and that confidence must be built deliberately and sustained institutionally. The following recommendations are grounded in national surveillance data, WHO guidance, and frontline testimony from the workshop and represent the minimum steps needed to close the gaps identified above. 

Secure Tdap at every LGU health center: Tdap must be explicitly included in the LGU Annual Investment Plans for Health (AIPH) and aligned with UHC financing mechanism to ensure sustainable procurement. Its continued absence is not a supply coincidence but a policy gap that demands deliberate correction.
Integrate maternal Tdap into routine prenatal care: Maternal Tdap should be institutionalized as a standard antenatal intervention, with inclusion in prenatal checklists and performance indicators for primary care facilities.
Build provider capacity through regular training: Capacity-building sessions supported by visual aids and infographics on vaccine timing are essential, with a focus on catch-up schedules. A confident, knowledgeable provider is the most effective tool against vaccine hesitancy.
Launch a sustained maternal immunization campaign: Evidence-based messaging must be consistently embedded in mothers’ classes. Women who ask about vaccines must receive well informed responses and individualized counselling must be available for those who remain hesitant.
Reform supply chain governance: National and local stakeholders must strengthen forecasting and distribution mechanisms. Every stock-out is an interruption in neonatal protection and a preventable one.

Conclusion

Maternal Tdap is a single vaccine given once during pregnancy that protects against three serious disease.¹ Its limited reach is driven not by lack of evidence or provider willingness, but by gaps in vaccine supply, funding, and coordinated follow-through.

As the Philippines moves forward under Universal Health Care, maternal Tdap immunization must be a standard obligation in LGU planning and routine prenatal services. Every pregnant woman who walks into a health center deserves access to it, and every newborn deserves the protection it provides. Closing this gap is not a matter of innovation, but of implementation—ensuring that existing evidence is translated into equitable access for every Filipino mother and child.