Uptake of vaccination during this pandemic is crucial for the protection of every individual, as well as the protection of others. Addressing attitudes towards vaccine hesitancy can help us gain some control during the pandemic.
Hence, the right framing could present the vaccine as a gain, instead of a risk, by leveraging on the fact that in the context of uncertainty for any individual, a behaviour that is expected to prevent a loss is more likely to be chosen.
Widespread conspiracy theories can also dampen achieving control of the pandemic by suggesting that vaccines are riskier than in reality, while downplaying the risks of a Covid-19 illness.
Conspiratorial beliefs are inversely correlated with adhering to safety restrictions and behaviours and by extension, related to pseudo-scientific practices and vaccine hesitancy.
Some with anxiety-related disorders may end up sitting on the fence, as there will be a tendency to over-inflate threats and avoid perceived vaccine-related risks, thereby increasing the tendency to become careless.
But while vaccine refusal is a real problem, the inability to get inoculated may on the other hand lead to anxiety which can precipitate or exacerbate mental health problems in those impatient to get immunised but have not been allotted an appointment date.
Relapse of mental disorders can occur but may be left unattended, perhaps due to fear of going to hospital and contracting the virus.
This can be further compounded by insufficient funds to seek treatment, possibly as a result of unemployment.
Patients with severe mental illness (SMI), in particular those with Psychotic Disorder, Bipolar Disorder or Severe Depression, are at significantly higher risk of being hospitalised or dying from Covid-19, as well as being at increased risk of SARS CoV-2 infection and Covid-19-related morbidity and mortality.
This often forgotten group is also more likely to have living circumstances, diet or co-morbidities that contribute to the increased risk of severe Covid-19 outcomes, and should therefore be prioritised for vaccination, as has been done in Denmark, the UK, The Netherlands and Germany, despite the rates of vaccine hesitancy among them being high.
It is thus imperative that a more efficient vaccine rollout strategy is needed so as to inoculate as many people as possible, taking into account the risk hierarchy for immunisation, and which should also include foreign workers who frequently come into contact with the community at large.
It is indeed disappointing to learn of some vaccination centres giving stand-by preference to a privileged few. If there was any time that would be deemed most appropriate that extra attention be channeled to mental health care and prioritising those with SMI for vaccination, it should be now.
Assoc Prof Prem Kumar Chandrasekaran is from the College of Physicians, Academy of Medicine of Malaysia.
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