People with mental illness should be included in COVID-19 vaccination

In The Lancet Psychiatry, Victor Mazareel and colleagues clearly defined the issues related to vaccination for people with psychiatric conditions.¹ In the United Arab Emirates (UAE), COVID-19 vaccination is well organised thanks to strong government leadership. However, during the early stages of the vaccination drive in December, 2020, the national press reported mental illness as an exclusion criterion for COVID-19 vaccination.² Subsequently, in January, 2021, we received email communication from the College of Medicine and Health Sciences, Al Ain about the inclusion and exclusion criteria for COVID-19 vaccination. This message had been passed on from the Occupation Safety and Health, Abu Dhabi health services. The information was directed to all staff and faculty. Among the stated exclusion criteria for COVID-19 vaccination was a recent history of convulsion, epilepsy, encephalopathy, or mental illness. This statement was surprising, as it contributes to the stigma surrounding mental illness, which is an ongoing concern in the Middle East. According to this policy, a person with generalised anxiety disorder, panic disorder, depression, or even stable psychosis could not be vaccinated against SARS-CoV-2.

ES, on behalf of the department of psychiatry, pleaded for this decision to be reversed. An email stating our reservations against these criteria was sent to the Dean of the college, who agreed for that to be escalated to the health authorities. The exclusion criteria have now been modified, and presence of mental illness is no longer deemed an exclusion criterion for COVID-19 vaccination in the UAE.³ As psychiatrists and teachers, we would like to make our community aware that patients with mental illness should not be automatically excluded from any vaccination programme, particularly against COVID-19. Helping such patients means helping the community as a whole.

We try, as members of an academic department, to promote psychiatry and a positive view of our patient population. We hope this positive and constructive feeling is shared by our colleagues, fellow teachers, and doctors in the Middle East. Vaccination against SARS-CoV-2 cannot be imposed. Therefore, a successful campaign requires clear and unambiguous official information. All people, including those who have a psychopathology, must be able to express their wish to be vaccinated or not, and be respected in their choice. Therefore, it is essential for physicians to have the skills and ability to obtain informed consent from patients regarding administration or refusal of vaccination. Patients with both a recent diagnosis of a mental disorder and COVID-19 infection show a death rate of 8·5%, compared with 4·7% among COVID-19 patients who do not have a mental disorder.⁴ This fact alone is a major reason to actively prioritise vaccination of people with mental illness globally.