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Implications of Global and Local Inequalities in COVID-19 Vaccine Distribution for People With Severe Mental Disorders in Latin America

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

In a recent article in JAMA Psychiatry, Warren et al1 propose that people with severe mental disorders (SMD) should be prioritized for the COVID-19 vaccine. They indicate that people with SMD are at higher risk of being infected by SARS-CoV-2, have increased COVID-19–associated morbidity and mortality rates, and face individual and structural barriers to participation in vaccination programs. From a global mental health perspective, we underscore that across the globe, people with SMD were typically poor, socially excluded, and in poor health even before the pandemic struck. Indeed, within almost all countries, people with SMD are among the most disadvantaged groups of all. They have been recognized by the United Nations as a vulnerable population entitled to special consideration to ensure that they benefit from socioeconomic and health development, including vaccines.2 As vaccines for COVID-19 roll out, however, most countries have not yet prioritized this group. Furthermore, the pandemic has reduced mental health services for this population in the face of increasing demand, especially in low- and middle-income countries (LMICs), where services are already minimal relative to need (eg, Latin America).3 Although we focus here on people with SMD, including those with psychotic disorders as well as bipolar disorder and major depression without psychosis, we believe that a similar argument could be made for people with other psychosocial disabilities (eg, developmental disabilities).

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Ezra Susser, MD, DrPH, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168 St, New York, NY 10032 (ess8@cumc.columbia.edu).

Published Online: May 28, 2021. doi:10.1001/jamapsychiatry.2021.1416

Conflict of Interest Disclosures: None reported.

Additional Information: The authors are responsible for the views expressed in this article; they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

References
1.
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.2020.4396PubMedGoogle Scholar
2.
United Nations. Mental health and development. Accessed May 12, 2021. https://www.un.org/development/desa/disabilities/issues/mental-health-and-development.html
3.
Pan American Health Organization. The impact of COVID-19 on mental, neurological and substance use services in the Americas: results of a rapid assessment, November 2020. Accessed May 12, 2021. https://iris.paho.org/handle/10665.2/52999
4.
Kupferschmidt  K .  New mutations raise specter of ‘immune escape’.   Science. 2021;371(6527):329-330. doi:10.1126/science.371.6527.329 PubMedGoogle ScholarCrossref
5.
Johns Hopkins University CSSE. CSSEGISandData/COVID-19. Published 2020. Accessed May 12, 2021. https://github.com/CSSEGISandData/COVID-19
6.
Maeda  JM , Nkengasong  JN .  The puzzle of the COVID-19 pandemic in Africa.   Science. 2021;371(6524):27-28. doi:10.1126/science.abf8832 PubMedGoogle ScholarCrossref
7.
Aryeetey  E , Engebretsen  E , Gornitzka  Å , Maassen  P , Stølen  S .  A step backwards in the fight against global vaccine inequities.   Lancet. 2021;397(10268):23-24. doi:10.1016/S0140-6736(20)32596-4 PubMedGoogle ScholarCrossref
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