What those Fauci texts actually show

Yesterday several text messages from Fauci’s government phone were released, and headlines immediately suggested they revealed a cover up.

The texts in question came from Anthony Fauci, Rochelle Walensky (CDC director at the time), and Vivek Murthy (Surgeon General at the time) discussing potential risks of COVID vaccination in pregnant women.

One particular comment from Dr. Fauci is catching attention. He said that “since many people have significant cytokines storm and fever after the 2nd dose, this theoretically could be associated with miscarriage in the 1st trimester.”

Because Dr. Fauci didn’t broadcast these thoughts to the masses, this is being interpreted as a cover up.

Was this a cover up?

Was Fauci really saying one thing in private and another thing in public?

To answer that, let’s look back at January 2021 when these texts were sent. This was a month after the COVID vaccines first became available in late December 2020. At the time, the CDC was not recommending COVID vaccines for pregnant women. Because pregnant women were not included in the initial clinical trials, there was not enough data to make a clear recommendation.

What was known at the time:

• pregnant women were at higher risk for severe outcomes from COVID
• COVID vaccines reduced the risk of severe outcomes generally

What wasn’t known at the time:

• if COVID vaccines had increased risk of side effects in pregnant women (more data was needed!)

What were pregnant women told in January 2021?

Due to this lack of data in pregnant women, there was no official recommendation that they receive the COVID vaccine when these texts were sent. Pregnant women who were part of other eligible groups (pregnant health care workers) could get the vaccine if they wanted to — but due to the uncertainty about the risks, it wasn’t yet recommended. Here’s what CDC’s Advisory Committee on Immunization Practices said in December 2020:

“No data are currently available on the safety of COVID-19 vaccines in pregnant persons. If pregnant persons are part of a group that is recommended to receive a COVID-19 vaccine (e.g., health care personnel or essential worker), they may choose to be vaccinated. A conversation between the patient and the patient’s clinical team might assist with decisions regarding the use of vaccines approved under EUA for the prevention of COVID-19. Guidance for pregnant persons will be updated as new data becomes available”

Is this different from what Fauci said?

Not really. When scientists say “we lack safety data,” it means there could be harms, and Dr. Fauci was speculating about one theoretical harm.

These texts show that leaders were considering potential side effects and taking them seriously. And while it’s perfectly fine to speculate in a group chat, it would have been inappropriate (and really confusing!) if national leaders speculated about theoretical risks on the national stage without the data to back it.

More data was needed to understand the risks, and that data eventually came.

What does the data show now?

There have now been numerous studies looking into this question involving tens of thousands of pregnancies. And thankfully, they found no increased risk of miscarriage with COVID vaccination during pregnancy. Here are just a few:

• Study of 18,780 women shows no increased risk of miscarriage with COVID vaccination
• Study of 18,477 women found no increased risk of first trimester miscarriage with COVID vaccination
• A systematic review of 21 studies including 149,685 women found no increased risk of miscarriage with COVID vaccination

And many studies revealed benefit: a systematic review of 177 studies involving 638,791 participants found COVID vaccination was associated with fewer C sections, fewer still births, and fewer severe COVID infections in mom and baby.

The verdict

Dr. Fauci’s texts were consistent with public messaging about COVID vaccines for pregnant women at the time: the risks weren’t fully known, and more data was needed. The data is now here and tells a clear story — there is no association between COVID vaccination and miscarriage. That’s a good thing.

Thanks to The Evidence Collective for pulling together some of this data.

Kristen Panthagani, MD, PhD, is completing a combined emergency medicine residency and research fellowship focusing on health literacy and communication. In her free time, she is the creator of the newsletters You Can Know Things and The Public Health Roundup. You can also find her on Instagram, Threads, and LinkedIn. Views expressed belong to KP, not her employer.