Filipinos living with severe mental illness (SMI), priority for vaccination

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By: K Ballesteros / kabanata13.net / twitter: @silangan_
February 6, 2021

 

Before vaccinations to combat the spread of COVID-19 begin in the Philippines, national and local government units must address and then quell rampant vaccine anxiety. The government must implement policies to strengthen Filipinos living with severe mental illness (SMI)’s inclusion as a vulnerable community and as among those considered a high priority for the first round of vaccination.

Vaccine hesitancy and anxiety in the Philippines

A 2019 study about vaccine confidence in the Philippines emphasized social media’s role in the “viral spread of anxieties, beliefs, and rumors” directly contributing to vaccine anxiety (Larson, Hartigan-Go, & de Figuiredo, 2019). This is compounded by the unprecedented and extreme pressure of a rapidly worsening pandemic. Not only was vaccine hesitancy a reality on the ground before the COVID-19 pandemic, but the rapid pace of development of the vaccine contributed to the Filipino public’s distrust. News organizations have earlier emphasized how vaccines take years to develop and test via large-scale clinical trials. But the research and development of vaccines to help combat the global effort to stem the rate of COVID-19 infections had been fast-tracked (Mental Health America [MHA], 2020).

The University of Santo Tomas (UST) CoVAX Vaccine Awareness Team in January 2021 spearheaded the most recent COVID-19 vaccine survey. The survey revealed less than 60 percent of 15,600 respondents were willing to be vaccinated against COVID-19 (Sabillo, 2021; CNN Philippines, 2021). This study was cited by former Department of Health (DOH) secretary Dr. Esperanza Cabral to explain the Filipino public’s attitude about the imminent inoculation. The same study revealed that an overwhelming majority of Filipinos surveyed (over 15,600 participants) currently distrust available vaccines, their efficacy against the original and emerging strains, the cost of being vaccinated, and the authenticity of vaccine samples available in the country (CNN Philippines, 2021; Sabillo 2021). “Ang unang dapat gawin ay malawakang information and trust campaign para ang mga tao ay magkaroon ng kumpiyensa na magpabakuna,” said Dr. Cabral via CNN Philippines (2021 [X]). These concerns highlight Filipinos’ anxiety towards vaccines as preventive medicine, the precariousness of the national healthcare system, and the role and influence of information media in creating vaccine confidence.

MHA recognizes a similar pattern of anxiety in Americans. In a key document, the MHA stated that “If the events of this year have diminished your trust in oversight and the government, it may feel like you’re being used as a guinea pig rather than being protected” (MHA, 2020). MHA recommends, among others, purposefully studying vaccines’ progress and relying on credible sources, including the New York Times Coronavirus Vaccine Tracker. For Filipinos, however, the concerns become more about access to and the authenticity of vaccines provided by the Philippine government. According to the UST-CoVAX survey, 98 percent of their respondents were worried about distributing fake vaccines (CNN Philippines, 2021). As always, the issue is trust in public officials; the survey further revealed that 71.6 percent of respondents were willing to get inoculated “after politicians receive the vaccine” (CNN Philippines, 2021).

“We do not know when [other vaccines] will arrive.”

Nations like the US and the UK reported that their vaccination programs prioritize older adults as the most vulnerable. In contrast, Indonesia’s vaccine strategy instead focused on inoculating young adults of working age between 18 and 59 (Sullivan, 2021).

According to a National Public Radio (NPR) report, the Jokowi Administration’s new health minister cited two significant factors informing their strategy: economic recession and the unknown effects of the Sinovac vaccine (Sullivan, 2021). According to interim data, the Sinovac-produced vaccine has only 65.3 percent efficacy (Widianto, 2021). Jakarta Center for Strategic and International Studies researcher Mumammad Habib Abiyan Dzakwan stated that Indonesian-led clinical trials excluded adults aged above 59, and so “we are not pretty sure about the safety of this vaccine to this group” (Sullivan, 2021).

Like other Southeast Asian countries, the Philippines is poised to begin administering the Sinovac vaccine (Ratcliffe, 2021) despite doubts about its efficacy (Widianto, 2021; Ratcliffe, 2021; Sullivan, 2021). According to reports from UK’s The Guardian, the Philippines, Myanmar, and Thailand have all committed to using the SinoVac vaccine on large portions of their population (Ratcliffe, 2021). Indonesian Health Ministry spokesperson Dr. Siti Nadia Tarmizi reframed this choice in the light of an alarming, grim reality: “We are not waiting for a better vaccine because we do not know when it will arrive in Indonesia” (as quoted in Ratcliffe, 2021).

Naming the most vulnerable

According to the Philippine Statistics Authority, 14 percent of the population, or 1.4 million Filipinos, currently live with a mental disorder (as quoted in Lally, Tully, & Samaniego, 2019). The same government body recognizes that “mental illness is the most prevalent form of morbidity.” However, only 88 mental health issues are currently reported for every 100,000 Filipinos (Magtubo, 2016). From a 2014-16 survey conducted by the Philippine Health Information System of 14 public and private hospitals, 42 percent of 2,552 patients were treated for schizophrenia (Lally et al., 2019; Coronel, 2018). These statistics illustrate the trend of under-reporting, which continues to plague the Philippine mental health sector.

While it is easy to announce that the current policy will “prioritize frontliners and other members of the vulnerable sectors of [Philippine] society” (CNN Philippines, 2021), the ethical duty of care is twofold. This consists of procuring the correct quantity of vaccine shots and accurately identifying society’s sub-sectors to be prioritized. The World Health Organization (WHO) ‘s guidelines on the ethical framework for vaccination include those who are disproportionately afflicted by COVID-19 due to factors including “age, profession, medical status, or socioeconomic factors” (De Hert, Mazereel, Detraux, & Van Assche, 2021).

Filipinos with severe mental illness (SMI) live at the intersection of these factors, making them more susceptible to contracting COVID-19 and suffering from acute symptoms. In fact, “stress, depression, loneliness, and poor health behaviors can impair the immune system’s response to vaccines” (Madison, Shrout, Renna, & Kiecolt-Glaser, 2021). According to the study “Prioritizing COVID-19 vaccination for people with severe mental illness”, those diagnosed with SMIs showed higher ratios of infection compared with patients without mental illnesses “even after adjustment for age, gender, ethnicity, the aforementioned medical conditions” (De Hert et al., 2021). The same study reveals that, aside from obesity and immunodeficiency, people with SMIs also have a two to three times higher mortality rate than the population (De Hert et al., 2021). They are more likely to develop a wide variety of physical diseases.

However, even after those living with SMIs have become properly prioritized and then vaccinated, a January 2021 study from Perspectives on Psychological Science reports that depression, stress, and other extant mental health conditions may also reduce the immune response to a vaccine (Madison et al. 2021). The study posits that SMIs alter a person’s immune systems. This causes dysregulation even before inoculation with the COVID-19 vaccine and may hinder the vaccine response. Therefore, those living with SMIs are vulnerable before their vaccination and immediately afterward, when their living conditions might compromise their health despite receiving the vaccine.

It is important to remember that those who live with SMIs must cope with symptoms of their conditions and the restrictions imposed by national and local governments to help curb the spread of infection. Those living with schizophrenia, for example, contend with social stigma as well as a specific form of loneliness. According to a 2018 CNN Philippines article, Filipinos living with schizophrenia emphasized the importance and a healthy family and community support system instead of systemic help and the dearth of awareness campaigns (Coronel, 2018). Here, Cabral emphasizes the role of healthcare providers as effective communicators in large part due to the high public trust they enjoy: “Health care providers should be playing a major role in the information campaign because they are the most trusted by people, more than politicians or attorneys” (CNN Philippines, 2021 [X]).

This is a complex issue straddling socioeconomic, systemic, and cultural fault lines, making it challenging to provide a multi-pronged, simultaneous, and multi-sector approach. The reality of a continuing pandemic has sharpened the focus on vulnerable communities, including Filipinos living with SMIs. Provisions for their care and support must consider their living conditions, their immediate communities’ capacity, and the policies that enable us to sustain these safe and humane spaces.

Join us on #UsapTayo this Wednesday, February 10, as we talk about vaccine anxiety and its effect on our mental health.

Questions:

  1. How does vaccine anxiety manifest? How do you personally handle vaccine anxiety?
  2. What are the myths about vaccines that you heard about? How can we mobilize information for vaccines?
  3. How can the national and local governments boost vaccine trust to ensure those most vulnerable?

Works Cited

De Hert, M., Mazereel, V., Detraux, J., and Van Assche, K. (2021), Prioritizing COVID‐19 vaccination for people with severe mental illness. World Psychiatry, 20: 54-55. https://doi.org/10.1002/wps.20826
Heidi J Larson, Kenneth Hartigan-Go & Alexandre de Figueiredo (2019) Vaccine confidence plummets in the Philippines following dengue vaccine scare: why it matters to pandemic preparedness, Human Vaccines & Immunotherapeutics, 15:3, 625-627, DOI: 10.1080/21645515.2018.1522468
Lally, J., Tully, J., & Samaniego, R. (2019). Mental health services in the Philippines. BJPsych international, 16(3), 62–64. https://doi.org/10.1192/bji.2018.34
Luthy KE, Beckstrand RL, Asay W, Hewett C. Vaccinating parents experience vaccine anxiety too. J Am Assoc Nurse Pract. 2013 Dec;25(12):667-73. doi: 10.1002/2327-6924.12034. Epub 2013 June 17. PMID: 24170351.
Madison AA, Shrout MR, Renna ME, Kiecolt-Glaser JK. Psychological and Behavioral Predictors of Vaccine Efficacy: Considerations for COVID-19. Perspectives on Psychological science. January 2021. doi:10.1177/1745691621989243
Magtubo, C.A. (2016). ‘Mental Health in the Philippines: by the numbers,’ MIMS Today, September 02. Available at: https://today.mims.com/mental-health-in-the-philippines–by-the-numbers (Accessed February 05, 2021).
Mental Health America. (2020). Dealing with COVID-19 Vaccine anxiety. Available at: https://mhanational.org/dealing-covid-19-vaccine-anxiety (Accessed: February 04, 2021).
Ratcliffe, R. (2021). ‘Philippines and Indonesia back Chinese COVID jab despite efficacy doubts’, The Guardian, January 14. Available at:
https://www.theguardian.com/world/2021/jan/14/philippines-and-indonesia-back-chinese-covid-jab-despite-efficacy-doubts (Accessed: February 03 2021).
Sabillo, K. (2021). ‘Online Survey: only 56% of 15,600 Filipinos say Yes to COVID-19 vaccines’, ABS CBN News, February 02 2021. Available at: https://news.abs-cbn.com/news/02/02/21/online-survey-only-56-pct-of-15600-filipinos-say-yes-to-covid-19-vaccines (Accessed: February 05 2021).
Warren N, Kisely S, Siskind D. Maximizing the Uptake of a COVID-19 Vaccine in People With Severe Mental Illness: A Public Health Priority. JAMA Psychiatry. Published online December 15, 2020. doi:10.1001/jamapsychiatry.2020.4396
Widianto, S. (2021). ‘Wariness in Indonesia as Chinese Sinovac COVID-10 jabs start’, Reuters, January 13. Available at: https://www.reuters.com/article/us-health-coronavirus-indonesia-healthca-idUSKBN29I0T1 (Accessed: February 04 2021).
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