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As a health care worker, Jordan McCutcheon could get the COVID-19 vaccine anytime she wants. But the 28-year-old dental assistant turned that decision over to someone else: the parents of the baby she’s been carrying for almost five months.
McCutcheon, who lives in Marietta, Ohio, jokingly calls herself a “rent-a-womb.” As a surrogate, she says her connection to the baby currently growing inside her is nothing like the motherly love she felt when she carried her own 3-year-old twins. This is a job, and as part of that job, she signed a contract to let the baby’s parents make medical choices for her, including whether to get the COVID-19 vaccine.
They preferred that McCutcheon stay unvaccinated.
“This is their baby, so if that’s how they want to protect their baby, then as a parent they should be able to make that decision,” she said.
As the availability of the coronavirus vaccines expands across the U.S., demand is booming among would-be parents for surrogates who have not yet gotten the COVID-19 vaccine and are willing to stay unvaccinated for nine months. Surrogacy agencies have been fielding so many requests for unvaccinated women that several have started specifically matching vaccine-averse prospective parents with surrogates who are willing to stay unvaccinated.
But for those with pregnancies already underway, the decision about whether to vaccinate is forcing surrogates and would-be parents into tough conversations. Pregnant people face higher risks of severe illness if they catch COVID-19—which could lead them to give birth too early.
About half of the parents working with Massachusetts-based Circle Surrogacy now want a surrogate who’s not planning to get vaccinated during her pregnancy. Emily Sonier, the director of clinical and program support at the agency, even had a surrogate and set of intended parents dissolve their partnership because they couldn’t agree on whether the surrogate should get vaccinated.
“It’s actually been surprising to me that there are a lot of intended parents that don’t want to do the vaccine,” Sonier said. “We’ve had situations where whether or not a surrogate would get the flu shot, but nothing to this degree.”
Four other surrogacy agencies told VICE News that they’re also hearing from would-be parents determined to have surrogates who’ll stay unvaccinated throughout their pregnancies.
“I think it’s too new of a vaccine. Even if studies are coming out right now, it would be physically impossible for them to have any long-term data that could be valid, in my opinion.”
An agency based in California, Surrogate First, has had about a quarter of intended parents say they want an unvaccinated surrogate, according to Program Director Ashley Mareko. And sometimes, they’re willing to go to extreme lengths to make that happen.
“We had intended parents who did not want her [the surrogate] to have the vaccination, were worried about COVID, and they actually paid for her lost wages to not work the last three months” of her pregnancy, Mareko said. “It gave peace of mind to them and it allowed the surrogate not to have any type of financial hardship.”
At Surrogate Solutions, headquartered in Texas, 10 percent of intended parents will only work with an unvaccinated surrogate. The agency added questions about vaccination to its applications for parents and surrogates in mid-January, said Gayle Garrett, Surrogate Solutions’ founder.
“People have very strong feelings one way or the other, and we want to make sure that they’re compatible in their views before we start down this path to surrogacy,” she said.
Intended parents and surrogates have struggled to stay on the same page about safety since the beginning of the coronavirus outbreak; the vaccine is no different. “Intended parents already feel a lack of control over this pregnancy since they’re not physically carrying themselves,” Garrett said. “They’re trusting another person to carry this pregnancy, and at the same time, they’re trusting someone else that she will adhere to the [COVID-19] guidelines.”
Victoria Ferrara, founder of Worldwide Surrogacy, which has offices in Connecticut and New York, told VICE News that a pregnant surrogate working with her agency had the chance to get vaccinated because she works in health care. But she turned it down, because the baby’s mother didn’t want her to get the shot.
“The intended mother was going so far as to ask me if the surrogate actually got the vaccine, could she then turn around and request a termination of the pregnancy,” Ferrara said. “It just really exemplified, for me, that severe level of anxiety that some people have.”
Amy Stewart Kaplan, the president of the California-based West Coast Surrogacy, said some of her parent clients have said they may be comfortable with a surrogate who’s vaccinated ahead of her pregnancy—but once she’s pregnant, they no longer want her to get the shot.
“It’s typically not black and white,” she said. “For some people, it may be. But for most parents, we’re finding it’s just a preference and a conversation.”
Typically, parents want surrogates who are willing to undergo more medical treatment to protect the baby, like getting extra genetic testing or ultrasounds—not less. But many would-be parents told surrogacy agencies that the coronavirus vaccines are just too new, too unstudied, for them to feel comfortable with a pregnant woman getting one.
Troy, an intended parent from California who asked VICE News to withhold his last name, said he hadn’t even thought about whether he’d feel comfortable with vaccinating a pregnant surrogate until the agency he’s working with brought it up. But he knew his answer immediately: no, thank you.
“I’m not an anti-vaxxer or a pro,” Troy said. He’s been inoculated against other illnesses before, and he’d take the COVID-19 vaccine if it were easy to get. But he’s not rushing to roll up his sleeves. “I think it’s too new of a vaccine. Even if studies are coming out right now, it would be physically impossible for them to have any long-term data that could be valid, in my opinion.”
Troy and his wife have spent a decade trying to have a baby; their last surrogacy ended in a miscarriage. Luckily, they ended up matching with a surrogate who shared their views and agreed not to be vaccinated while pregnant.
Although a patchwork of laws govern surrogacy in the U.S., a surrogate’s constitutional right to control her own body ultimately overrules any contract she may sign with intended parents. These surrogacy contracts, which are only legally recognized in certain states, are pregnancy roadmaps, often outlining expectations like compensation as well as how the surrogate will stay healthy and keep the intended parents up to date as the pregnancy progresses. A surrogate who got vaccinated against the parents’ wishes could still be taken to court—but the parents wouldn’t likely win, according to Ferrara, who’s also an attorney.
“If she was following the recommendations of her doctor and the research was providing that it was better for a pregnant woman to get the vaccine than not, and she got it and the parents didn’t want her to, I would say that would be less likely to be deemed a breach of the contract,” Ferrara said.
There’s very little data available about who becomes a gestational surrogate. (Gestational surrogates, who carry a fertilized embryo containing someone else’s egg, make up 95 percent of all surrogacy in the U.S., according to a 2016 study by researchers from the Centers for Disease Control.) But a 2009 review of several studies on surrogacy concluded that “most women who agree to become either gratuitous or commercial surrogates”—that is, unpaid or paid—“are Caucasian, Christian, and in their late 20s to early 30s,” with varying amounts of education. Surrogacy agencies frequently require that candidates have children of their own.
Intended parents tend to be older, richer, and more educated, the review found, compared to surrogates and their partners. Many have poured tens of thousands of dollars and years of struggle into trying to have a baby. Gestational surrogacy can easily cost upwards of $100,000, according to Robert Klitzman, a psychiatry professor and the co-founder of the Center for Bioethics at Columbia University.
“They would face a lot of pressure to acquiesce, and they would, I think, face a lot of obstacles in going to court, given the power differential,” said Klitzman, who wrote a book studying surrogacy, “Designing Babies: How Technology is Changing the Ways We Create Children.” “What are the relative rights of gestational surrogates, intended parents? What are the rights of the unborn child?”
Marina, who also asked VICE News to withhold her last name, has been vaccinated against the coronavirus. But when she started looking for a surrogate to carry her second child, she knew that she wanted the contract to specify that the surrogate wouldn’t get the vaccine. The lack of data on its impact on pregnant women, Marina thought, made it too big a risk.
“I’d rather have everything in writing, make sure we’re all on the same page before we go—not halfway through, ‘Oops, we’re not on the same page here,” said Marina, who lives in New York state. “If everything else was perfect and she said, ‘No, I’m gonna get it,’ then I would’ve had to look for somebody else.”
Questions about—and doubts over—whether pregnant women should take the coronavirus vaccines started to swirl as soon as the FDA approved the Moderna and Pfizer-BioNTech vaccines for emergency use, in mid-December. Initially, the World Health Organization said that pregnant people should get vaccinated, while the CDC said they “may choose to be vaccinated.”
That disagreement stemmed from the fact that neither Moderna nor Pfizer knowingly included pregnant women in their initial vaccine trials, as is common in biomedical research. A handful of women in the trials later became pregnant or found out they’d been pregnant at the time of the trial; as of December, they hadn’t reported any serious complications.
The WHO ultimately reversed its position and agreed with the CDC, but countless pregnant women have still agonized over whether to get vaccinated.
More than 10,000 pregnant women have now been vaccinated in the U.S., and in early February, Dr. Anthony Fauci, the nation’s top infectious disease expert, said there have been no “red flags” so far. Animal testing of mRNA vaccines—like the Moderna and Pfizer vaccines—have also found that they didn’t impact fertility or hurt a pregnancy. Now, Pfizer is launching another round of trials involving 4,000 pregnant women. Johnson & Johnson, whose vaccine was approved in February, plans to test its vaccine on pregnant women after it launches trials that will include children and newborns.
“They don’t want to be a ‘guinea pig’—their word.”
Until recently, whether a surrogate should be vaccinated was largely a hypothetical issue, given that it was only available to a fraction of the U.S. population. But states are now loosening their guidelines for vaccine eligibility; 15 states and Washington, D.C., have now decreed that pregnancy itself makes someone eligible for a vaccine.
The surrogates are also deeply split over whether they want a coronavirus vaccine. Several surrogates who spoke to VICE News said they’d feel comfortable letting the parents make the decision. Others are insisting they won’t get inoculated against the coronavirus at all, according to agencies.
McCutcheon, who works four days a week in a dentist’s office, caught COVID-19 after matching with the parents of the baby she’s now carrying. She came down with a mild case after traveling to Seattle in November to have an embryo implanted in her uterus. Now, months later, she’s tired of letting the threat of the virus loom over her. Instead, McCutcheon and the intended parents are more concerned about her exposure to X-rays at work than they are about whether she could catch COVID-19 again.
“I’ve had it and I’m fine,” said McCutcheon, though she still can’t smell or taste. “I just want to live normal, and I don’t feel like being vaccinated is gonna do anything for me necessarily.”
At Surrogate Solutions, the Texas agency, about half of surrogates are opposed to being vaccinated. At Surrogate First, in California, around 35 percent of surrogates say they’re not willing to get vaccinated at all. Another 10 to 15 percent say they’d get vaccinated before they get pregnant, but not during the pregnancy itself.
“They don’t want to be a ‘guinea pig’—their word,” said Mareko, Surrogate First’s surrogate program director. Her agency has tried to figure out what, exactly, is driving surrogates to refuse the vaccine. They’ve looked for commonalities among the surrogates’ locations, nationalities, ages. “But it really is across the board, in every category.”
Sarah Burtis, a surrogate in Spokane, Washington, who’s pregnant and due in April, didn’t talk to the intended parents she’s working with about whether she’d get vaccinated against the coronavirus. When the pregnancy started, a coronavirus vaccine seemed like a possibility on the far-off horizon.
“I told them I’d pretty much do whatever they wanted me to—I mean, no, like, voodoo, witch doctor-type stuff, but anything medical that would make them feel comfortable,” Burtis said. “At the end of the day, they’re the ones who have forked out so much time and money to have a child.”
If she hadn’t been working as a surrogate, Burtis said she would’ve preferred to wait and let other, more at-risk people get the vaccine first. But when Burtis learned she was eligible, thanks to her job at a psychiatric hospital, she texted the baby’s intended mother to ask what to do.
The mother said she’d prefer if Burtis got vaccinated. So she did.
“I wanted her to completely trust that I’m making the best decisions for her and for her baby as well, and to feel comfortable, because they hired a complete stranger to carry their child,” Burtis said. “I am glad I did it at the end of the day.”