Prioritizing People with Serious Mental Illness for COVID-19 Vaccination

December 15, 2020
Jonathan Alicea

There are numerous individual and systemic barriers that preclude this vulnerable population from taking preventative measures.

As discussions surrounding prioritization of the coronavirus disease 2019 (COVID-19) vaccine continue to be pertinent, there is a particular focus among the healthcare community in ensuring at-risk populations, such as people with serious mental illness (SMI), have access to preventative COVID-19 care.

In an article co-written written by Nicola Warren, MBBS, School of Medicine, University of Queensland, Australia, and colleagues, it was noted that medical experts have opined that there is an ethical duty to prioritize patients with SMI, a population with increased odds of becoming infected by COVID-19 and having subsequent rates of hospitalization, morbidity and mortality.

Nonetheless, there are structual barriers that remain which may preclude access to a vaccine at the individual and public health level.

“People with SMI are less likely to receive preventive or guideline-appropriate health care for concerns such as cardiovascular disease and cancer,” Warren and colleagues wrote. “This reduced access to preventive care is reflected in the low uptake of immunizations recommended for adults among people with SMI.”

As an example, they indicated that influenza vaccination rates among this population are as low as 25%.

In their article, Warren and colleagues lay out various strategies and solutions for overcoming these barriers.

Overcoming Individual Barriers to Vaccination

People with SMI may be willing to take preventative measures—such as receiving a vaccine—if they perceive themselves at risk for a preventable disease, receive peer support, are positively influenced, and have a belief in the effectiveness of the vaccine.

Previous research has reported that vaccine education by a health care professional increased vaccination by 4-fold

Furthermore, the authors noted that negative perceptions that the vaccine itself cause the illness can have a direct impact on avoidance and hesitancy. Therefore, healthcare providers and mental health professionals should directly address these issues, particularly by referring to vaccine data from high-risk groups in clinical trials.

“There may be a delicate balance between factors that facilitate immunization, such as perceived fear of infection, and those that reduce uptake, such as concurrent general anxiety,” Warren and colleagues wrote.

Overcoming System-Level Barriers and Solutions

Systemic barriers was defined in relation to access, acceptability, awareness of services, cost, as well as other practical considerations. 

In one strategy, the authors suggested running vaccination clinics parallel to mental health services, which can increase vaccination rates by up to 25%.

“Transportation to the vaccination clinics, even when colocated with a mental health service, may be a significant barrier, especially for infrequent service users,” the authors wrote.

“Therefore, one solution may be to embed vaccination clinics within mental health services, although none have been evaluated to date and to our knowledge.”

Other solutions included encouraging concurrent family vaccinations, implementing emergency legislation to expand the amount and type of healthcare professional that can administer the vaccination, and providing a vaccine—especially the COVID-19 vaccine—free of charge.

Conclusions

The authors stressed the importance of planning and developing policies to ensure rapid delivery of the COVID-19 vaccine, especially considering that the pandemic has taken a significant toll on mental health across the country.

“Importantly, interventions should target both the individual and system level, including active engagement, education, and peer support,” Warren and colleagues concluded. “Mental health clinicians have a key role in advocating for priority access to a COVID-19 vaccination for those with SMI, as well as facilitating its uptake.”

The article, “Maximizing the Uptake of a COVID-19 Vaccine in People With Severe Mental Illness: A Public Health Priority,” was published online in JAMA Psychiatry.