COVID vaccination and mental health: An Indian perspective.

India started its vaccination campaign on January 16, 2021, for the prevention of the spread of the Coronavirus. The first vaccine dose was administered to a sanitation worker in New Delhi. India achieved cumulative vaccination doses of 1 billion in the general population till October 21, 2021. It has been the unified efforts of the government agencies, vaccine manufacturers, healthcare workers, and mental health professionals and vaccinated citizens that have led to this remarkable achievement. This historical landmark makes India the second country after China to achieve the target of one billion. The experience in conducting mass immunization programs in India at a national scale along with the participation of the public as well as the private and voluntary sectors aided in achieving these numbers (Bagcchi, 2021). The speed with which vaccines were developed has been spectacular. Vaccines have developed in China, India, and Russia and are being distributed across the world (Tandon, 2021a).

COVID vaccination in India had observed multiple mental health issues in general population like hesitancy, fear of side effects, issues of access and stigma and misinformation. In India, even health care professionals have reported a negative view of the vaccine in the early part of the vaccination programme due to concern regarding its efficacy (Velumani, 2021). The factors for the initial phase of poor momentum of vaccination in India were the belief that COVID-19 does not exist and large scale antivaccine movement (Samarasekera, 2021, Ransing et al., 2021). Among people who were willing to vaccinate, some hesitancy was documented regarding the safety of the vaccine (Dodd, 2021). All over the world vaccine intention rates were inconsistent, ranging from 27.7% to 93% in different countries (Al-Amer, 2021). Inadequate mental health literacy and lower education levels among general population were contributing factors for refusal to be vaccinated in some countries (Dodd, 2020). Besides catering to the increased psychiatric morbidity in response to COVID 19 and the neuropsychiatric sequelae of COVID 19, mental health professionals had played their role in public health education and promotion (Banerjee, 2021; Brewer, 2021). Later on widespread efforts of mental health professionals and scientific information, education and communication activities carried out by the government agencies in India helped in disseminating scientific data about vaccination in India.

The listing of persons with severe mental illnesses as priority was lacking in India despite studies reporting an association between various mental health issues and increased risk of COVID active infection (Mazereel, 2021; Jakhar et al., 2021). The higher mortality was related to disease and there was an increased risk of suicide in persons with severe mental illnesses. Persons with severe mental illnesses should be a priority group for receiving the vaccination against the COVID-19 pandemic (Tandon, 2021b). During COVID 19 pandemic general population surveys in India reported poor sleep quality, stress, anxiety, depression, and psychological distress (Krishnamoorthy, 2020). These vaccines were not provided to persons with severe mental illness due to various hurdles such as stigma, poor vaccine availability and lack of knowledge. Since May 1, 2021, all individuals with severe mental illnesses were vaccinated and it accentuates the need for special efforts to reach these groups (Kumar, 2021). COVID-19 has provided lessons and the focus needs to be on collective problem solving and an impetus for reducing health disparities among various sections of society (Tandon, 2021a). Thus India followed a priority-based programme for vaccination based on certain groups having a high risk of COVID virus infection, severe clinical manifestations, and a worse prognosis (Varshney, 2021). Community interventions, innovative programs, capacity buildings for Covid-19 vaccinations, multiple agencies collaboration were needed at a larger scale in India (Ransing, 2021).

The negative beliefs due to widespread anxiety and depression and acute exacerbations in persons with psychiatric disorders during a pandemic could lead to avoidance and refusal among them to get vaccinated (Suhas, 2021). In India even though it was not feasible to compare the person who was vaccinated and who were not vaccinated on the basis of their mental health but some positive behavioral changes were reported in vaccinated citizens. The anxiety and fear of the pandemic have come down significantly in the vaccinated population. Socialization has improved in persons with vaccination which could correlate with positive mental health. The economic activity improvement was also an important factor in this behavioral change (Arce, 2021). The lesser the vaccine hesitancy the more improvement in mental health was reported. During the pandemic, there were anxiety, apprehension, and fear of getting infected, and fear of death. The person vaccinated has feelings of assurance, would have fewer chances of admission in COVID wards, and decrease mortality after vaccination.

It was found that the person experienced lower stress levels after being vaccinated with the first dose of the COVID vaccine. The short-term benefit of vaccination in improving mental health was illustrated in a survey on more than 8000 adults which revealed low distress levels after receiving the first dose (Arce, 2021). Even though there is not much evidence of the biological effects of vaccines that can improve mental health. But reports of vaccination improving mental health, in general, are documented (Arce, 2021). The overall effect of vaccination on positive outcomes was observed in both vaccinated and unvaccinated due to reduced prevalence rates of COVID infection in the population. The vaccination drive has gained momentum in India and needs a door-to-door campaign. In brief, In India, the continued need for prioritization of the marginalized group of persons with severe mental illness for vaccination has to be emphasized in light of the positive effect of COVID vaccination on mental health. India should not loose grip on successful COVID vaccination programme and should continue efforts and is yet miles and miles to go to achieve all vaccination targets in remote rural areas and persons with severe illness. More research exploration on the effects of COVID vaccination on mental health issues of the affected population in India is suggested.