COVID-19 vaccines, hesitancy and mental health.

Factors involved include confidence (trusting or not the vaccine or provider), complacency (seeing the need or value of a vaccine) and convenience (easy, convenient access to the vaccine) 3 4 Importantly, attitudes to vaccination can change and people who are initially hesitant can still come to see a vaccine’s safety, efficacy and necessity 5 Developing strategies to address hesitancy is key 6 The expedited development and relative novelty of the COVID-19 vaccines have led to public uncertainty 4 In addition, efforts to explain the mode of action of these vaccines involve a degree of complexity (eg, immune response and genetic mechanisms), which is difficult to communicate quickly and simply Suggestions for change include offering specific discussions from mental health professionals and peer workers, vaccine education and awareness focused for those with SMI, vaccination programmes within mental health services (with coexistent organisational change to facilitate this), alignment with other preventative health strategies (such as influenza vaccination, smoking cessation, metabolic monitoring), focused outreach and monitoring uptake 13 Monitoring of vulnerable groups vaccine uptake itself presents problems In the case of mental illness, multiple long-term conditions across mental and physical health domains as well as socio-economic factors means that both vulnerability and inequality are likely to be additive 11 However, vaccine impact may be greater among the most vulnerable despite lower vaccine uptake because the baseline absolute risk is so high 15 Therefore, in the context of a COVID-19 vaccine programme, even if vaccine uptake falls short in some high-risk groups, even small increases in vaccine uptake will still have significant health benefits 14 Uptake of vaccination is crucial both for the individual and protection of others