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| EDITORIAL |
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| Year : 2020 | Volume
: 2
| Issue : 3 | Page : 177-180 |
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The “World Association of Social Psychiatry Position Statement” Revisited in Light of COVID-19 Vaccination
Nitin Gupta1, Debasish Basu2
1 Gupta Mind Healing and Counselling Centre, Chandigarh, India
2 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| Date of Submission | 15-Dec-2020 |
| Date of Acceptance | 16-Dec-2020 |
| Date of Web Publication | 24-Dec-2020 |
Correspondence Address:
Dr. Nitin Gupta
Gupta Mind Healing and Counselling Centre, Chandigarh - 160 009
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/WKMP-0196.304819
How to cite this article:
Gupta N, Basu D. The “World Association of Social Psychiatry Position Statement” Revisited in Light of COVID-19 Vaccination. World Soc Psychiatry 2020;2:177-80 |
After the onset of the COVID-19 pandemic, scientists, as early as March 16, 2020, started working in earnest to develop a vaccine against the virus.[1] In their write-up in June 2020 in JAMA, Bollyky et al.[1] reported that across more than 12 countries, there were eight vaccines undergoing clinical trials and around 100 were in preclinical phases. As of now, it is known that there are three vaccines, i.e., Pfizer BioNTech, Oxford Uni-AstraZeneca, and Moderna, that are potentially available for use and awaiting approval in various countries.[2]
The readers of the World Social Psychiatry Journal may be wondering as to why are they having to read about a medical topic of vaccination in their journal of social psychiatry? To understand the basis of that, I would like to focus the readers' attention on the Position Statement by WASP, which outlines the various responsibilities and activities to be undertaken by WASP and its member societies in combating COVID-19.[3]
Although work had been on in full swing, and at breakneck speed, to develop vaccines against COVID-19 virus, there had been additional work occurring in parallel to deal with other concepts key to the effective uptake and delivery of vaccination later on. Vaccine hesitancy, i.e., people choosing not to vaccinate, was named as one of the top ten threats to global health in 2019 by the World Health Organization (WHO).[4] The reasons for “vaccine hesitancy” are complex, but lack of confidence in vaccine safety, driven by concerns about adverse events, has been identified as one of the key factors,[4] which in the case of COVID-19 assumes significance as the vaccines are being developed at a pace which outstrips the development rate of any routine vaccine; the time mentioned being typically between 10 and 15 years.[5]
Apart from “vaccine hesitancy,” the pandemic has led onto significant and far-reaching adverse social and economic consequences due to which delivery of vaccines in an equitable manner across the whole world assumes additional importance using principles of flexible, trusted governance and open collaboration.[1]
Currently, the concept of Vaccine Nationalism (policy of countries to secure doses of vaccines for its own citizens through prepurchase agreements with manufacturers before they are made available in other countries) is operating as nearly 50% of the COVID-19 vaccine under production has been booked by the rich countries (USA, United Kingdom [UK], Australia, Japan, European Union, Switzerland, Israel, Hong Kong, and Macau) which is putting poor countries at risk, and it seems that we have not learned from our previous mistakes of the H1N1 (Swine Flu) outbreak when a similar situation occurred.[6] This will have prolongation of the pandemic, leading to potentially disastrous physical and mental health and economic and social consequences. In fact, the WHO Chief Tedros Adhanom Ghebreyesus has appealed for equitable distribution of COVID-19 vaccines and adequate funding for the WHO COVAX facility.[7]
In addition, the WHO has a dedicated webpage on COVID-19 vaccines[8] addressing various facets related to the same. Through its Strategic Advisory Group of Experts (SAGE) on Immunization, the WHO has further brought out two key documents in September 2020 and November 2020, respectively, viz., (i) “The WHO SAGE Values Framework for the allocation and prioritization of COVID-19 vaccination,“[9] (ii) “The WHO SAGE Roadmap for prioritizing uses of COVID-19 vaccines in the context of limited supply,”[10] and (iii) vaccine-specific recommendations (this document to be brought out yet). In addition, much before that in June 2020, trans-Atlantic work had occurred from the John Hopkins University, USA, in terms of a policy document on “Readying populations for COVID-19 Vaccines.”[11] Along with this, policy documents have emerged at different time frames from other countries such as the UK, Australia, Germany, and Canada.
The underlying reasons that probably can be linked with the intensive work from different countries across the world, especially WHO and USA, are that breaking of transmission of the pandemic can occur through successful vaccination, which is possible only if there is adequate “herd immunity,” which requires vaccine uptake rate of minimum 70%.[12] This can only be achieved if one is able to also address the generic threat of “vaccine hesitancy” which is more significant with COVID-19 vaccines.[9]
In fact, being cognizant of the above issues, scientists and researchers from across the world have been working in parallel during the course of development of COVID-19 vaccines, a key among them being anthropologists, psychologists, internists, public health specialists, etc. Opinion pieces and surveys have been published/written which have looked at the public response rate for vaccine uptake, being as low as 33% in the early May 2020[13] to 58% in November 2020 in the USA.[14] On the other hand, a survey on 1252 parents and guardians in the UK found that nearly 90% were willing to take the vaccine, but those from lower-income households and ethnic minority groups were more likely to reject it.[15] From Germany, a survey on 30,000 adults in the months of June to July 2020 revealed that 70% were willing for voluntary vaccination if the vaccine was without any side effects.[16] Another survey from Turkey in May 2020 on 3936 respondents had shown a “vaccine hesitancy” rate of 34%, i.e., vaccine uptake of 66%.[17] In fact, concerning, most of the 15 countries polled in a World Economic Forum/Ipsos poll in August 2020 and October 2020 showed a decrease in overall respondents from 77% to 73% who said they would take a COVID-19 vaccine.[18],[19]
Hence, we can see that the figures for COVID-19 vaccine hesitancy are quite variable and tend to be on the higher side, which will probably not lead onto production of adequate herd immunity. To address this issue, behavioral scientists and public health researchers have put forward suggestions to facilitate vaccination uptake and reduce “vaccine hesitancy,” viz., removal of physical and psychological barriers to vaccination, establishing incentives, preparing healthcare providers, turning to experts and authority figures, and making concessions and direct and honest communication.[13],[20],[21]
Nevertheless, keeping in view that vaccination has started with the Pfizer BioNTech vaccine in the UK where two National Health Services workers experiencing an anaphylactoid reaction has been reported,[22] such adverse events will not lift the confidence of the public, especially where the vaccine uptake is linked with the notion of the absence of side effects,[16] or this vaccine requires two doses and people may miss out on the second dose. It is well spelled out that COVID-19 vaccination will be rolled out in various phases, and it will only be till mid-2022 that the whole population is most likely to be vaccinated.[8] Hence, mental health professionals (MHPs) can draw upon the principles enshrined under the Position Statement of WASP, i.e., professional societies and professionals in the field of mental health to act in coordination with the relevant agencies working in the area in their respective fields and geographical locations, and to encourage all the citizens to get information about all aspects of the COVID-19 vaccine only from reliable scientific sources such as the WHO and authorized local government and health services through their media and websites.[3] Working under these principles, MHPs can work in a collaborative manner with key vaccine specialists (anthropologists, epidemiologists, public health specialists, etc.)/organizations and the government over a sustained period of time in enhancing the vaccine uptake and reducing “vaccine hesitancy,” addressing social inequality, and managing psychosocial issues arising in relation to the vaccination process. To buttress my statement, I quote from a recent special issue of Frontiers in Immunology, where Geoghegan et al.[4] emphasized that “Healthcare workers remain key influencers on vaccine decisions.”
At the time of writing of this Editorial, it was only 5 days prior that the first vaccine outside of trials was administered in the UK.[23] Before this, and as an ongoing exercise, experts are attempting to determine the priority candidates for vaccination. The WHO and countries across the world have come up with their own criteria, frameworks, and lists. In the USA, the National Academies of Sciences, Engineering, and Medicine have proposed an ethical framework for equitable allocation of COVID-19 vaccine.[24] On similar lines, the WHO has also proposed its framework. There are three universal ethical principles, viz., (i) harm minimization and maximization of benefit; (ii) prioritizing of populations that may experience greater health burdens due to their age, profession, medical status, or socioeconomic factors; and (iii) during allocation and prioritization, everyone is treated equally with respect, worth, and dignity and has equal opportunities.[25] The common priority groups for all countries are people aged above 65 years and those with severe medical comorbidities.[26],[27],[28],[29]
In this context, it is important and relevant to highlight that people suffering from severe mental illnesses (SMIs) actually are part of this priority group simply due to the fact that they commonly suffer with comorbidities (cardiovascular diseases, diabetes mellitus, respiratory tract diseases, malignancy) which predispose them to developing COVID-19 infection, apart from having a 3.7 times higher mortality rate than the general population.[25],[30] High rates of nicotine use, homelessness, noncompliance, overcrowding, anosognosia, being “socially distanced,” etc., all contribute to patients with SMIs being “at high risk.”[25],[30] In fact, a very recent case–control, population-based study from the USA using e-health records and representing 20% of the total population showed that patients with a recent diagnosis (in the last 1 year) of mental disorder (especially depression and schizophrenia) were at a significantly high risk of developing COVID-19 infection.[31]
Hence, based on the above-mentioned compelling evidence, a strong argument for patients with SMIs to be prioritized and be included in the first phase of vaccination has been put forth.[25] Most recently, further support has been lent by the Joint Committee on Vaccination and Immunisation, the UK, who in their advice dated December 2, 2020, have included “severe mental illness” under the risk group (i.e., where there is good evidence that certain underlying health conditions increase the risk of morbidity and mortality from COVID-19). To the best of our knowledge, the UK is the only country to do so and must be commended for this progressive act.[26]
Working on the aspect of getting SMI included as a “high-risk illness” and “people suffering with SMI” included as a priority category will need robust service delivery, advocacy, and coordination as outlined in the following components of its Position Statement, i.e., “WASP appeals to its 27 member societies and specialty sections to offer expert services and support to the affected populations in their respective countries and to assist local agencies in offering psychosocial support” and “WASP appeals to all professional societies in the field of mental health to provide comprehensive services in mental health care and psychosocial support to the COVID-19 affected populations and act in coordination with the relevant agencies working in the area in their respective fields and geographical locations.”[3]
Last, but not the least, in the process of delivery of COVID-19 vaccination, we MHPs should not forget to continue to emphasize the ongoing role of “social vaccine” (social distancing of at least 6 feet, wearing of mask, and adequate sanitization)[32] in keeping everyone safe and preventing morbidity (and mortality). By this, we MHPs will deliver care as per another component of the Position Statement of WASP, i.e., “WASP also appeals to local communities worldwide to follow the general instructions being issued by their local governments for preventing the spread of COVID-19, especially social distancing, the use of personal protective equipment such as masks and hygienic practices like frequent washing of hands to contain community spread.”[3]
To conclude, the year 2020 draws to a close with the pandemic still raging on! COVID-19 vaccines have started to arrive – a glimmer of hope on the edge of the horizon! However, our work as MHPs (under the rubric of social psychiatry) in caring for the general public, people with SMI, and others, will continue … and continue … and continue …!
The woods are lovely, dark and deep.
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.
(From: Stopping By Woods on a Snowy Evening by Robert Frost, 1921)
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| 1. | Bollyky TJ, Gostin LO, Hamburg MA. The equitable distribution of COVID-19 therapeutics and vaccines. JAMA 2020;323:2462-3.  |
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| 3. | Chadda RK, Bennegadi R, Di Nicola V, Molodynski A, Basu D, Kallivayalil RA, et al. World Association of Social Psychiatry Position Statement on the coronavirus disease 2019 pandemic. World Soc Psychiatry 2020;2:57. |
| 4. | Geoghegan S, O'Callaghan KP, Offit PA. Vaccine safety: Myths and misinformation. Front Microbiol 2020;11:372. |
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| 9. | World Health Organization. WHO SAGE Values Framework for the Allocation and Prioritization of COVID-19 Vaccination. Geneva: World Health Organization; 2020. |
| 10. | World Health Organization. The WHO SAGE Roadmap for Prioritizing Uses of COVID-19 Vaccines in the Context of Limited Supply. Geneva: World Health Organization; 2020. |
| 11. | Schoch-Spana M, Brunson E, Long R, Ravi S, Ruth A, Trotochaud M on behalf of the Working Group on Readying Populations for COVID-19 Vaccine. The Public's Role in COVID-19 Vaccination: Planning Recommendations Informed by Design Thinking and the Social, Behavioral, and Communication Sciences. Baltimore, MD: Johns Hopkins Center for Health Security; 2020. |
| 12. | Subbarao K. COVID-19 vaccines: Time to talk about the uncertainties. Nature 2020;586:475. |
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| 24. | US National Academies of Sciences, Engineering, and Medicine. Frame-work for equitable allocation of COVID-19 Vaccine. Washington: National Academies Press, 2020. |
| 25. | De Hert M, Mazereel V, Detraux J, Assche KV. Prioritizing COVID-19 vaccination for people with severe mental illness. World Psychiatry 2020. Epub ahead of print. [doi: https://doi.org/10.1002/wps0.20826]. |
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| 30. | Shinn AK, Viron M. Perspectives on the COVID-19 pandemic and individuals with serious mental illness. J Clin Psychiatry 2020;81:20com13412. |
| 31. | Wang Q, Xu R, Volkow ND. Increased risk of COVID-19 infection and mortality in people with mental disorders: Analysis from electronic health records in the United States. World Psychiatry 2020;10.1002/wps.20806. doi: 10.1002/wps.20806. Epub ahead of print. |
| 32. | Murthy RS, Gupta N. Social vaccine for the ongoing COVID-19 pandemic! Indian J Soc Psychiatry 2020;36(Suppl S1):107-11. |
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