A View on a Virus from a Member

“Pennsylvania Psychiatrists as COVID-19 Vaccine Ambassadors” Muhamad Aly Rifai, MD, FACP, FAPA, FACLP

Almost thirty thousand Pennsylvanians have died from the severe acute respiratory syndrome coronavirus infection (COVID-19). Several safe and effective vaccines have become available in Pennsylvania and seem to be a successful and preventative measure against COVID-19. Vaccines seem to be the most promising way to achieve herd immunity to end the current pandemic. Nonetheless, there remain significant obstacles to reaching this goal, as only 56% of Pennsylvanians received vaccination and vaccine skepticism, structural barriers and simple procrastination remain prominent especially in patients with psychiatric illness. The challenge to keep those with psychiatric illness protected from COVID-19 provides a great opportunity for psychiatrists to utilize their medical knowledge, expertise and clout and apply behavioral management techniques to facilitate vaccinations in their patients. It has become apparent that patients with psychiatric illness are subject to disproportionately higher rates of COVID-19 infection and suffer more severe outcomes.

Having been residency trained in internal medicine and psychiatry, my small private practice signed up in December 2020 to become the only private practice COVID-19 vaccine provider in Northampton County Pennsylvania. Our practice received community assistance and help from our students, staff, and family. With great effort we managed to vaccinate around three thousand Pennsylvanians. I am sharing my practical experience with my fellow Pennsylvania psychiatrists; to help in combating vaccine hesitancy and to highlight the unique skill set and longitudinal connections that we, as psychiatrists, have with our patients to be effective vaccine promoters to help save lives. During our vaccination effort we have experienced patients with psychiatric illness encounter issues with decreased confidence in vaccines, health systems and policy makers. They also struggle with complacency due to lower perceived risk, “this will not happen to me”. Finally, patients with psychiatric illness have a significant issue with accessing vaccine, though this has improved over the last few months.

Pennsylvania psychiatrists are in the unique position to contribute to the success of the vaccination campaign as it has become apparent that the unvaccinated are the majority of those suffering from COVID-19 infections, hospitalization, and death during the current surge of COVID-19. Psychiatrists are in contact with their patients more frequently than other clinicians including primary care providers. Ultimately, our patients have a high trust in us and follow faithfully our recommendations.

Psychiatrist-initiated vaccination efforts to reach patients with psychiatric illness can be successful in resolving vaccine hesitancy as these conversations are more than one-time discussions and include ongoing communication, persistence and consistency as well as applying our skills in motivational interviewing and nudging. We have a significant rapport advantage with our patients, and we are a trusted source of information on COVID-19 vaccine ahead of National, State and Local messengers. The active involvement of Pennsylvania psychiatrists in the COVID-19 vaccination effort can help improve the lives of our patients and protect them from severe COVID-19 disease. It can also facilitate reducing health disparities in our patients with psychiatric illness and potentially promote herd immunity to end this pandemic. I conceptualized the COVID-19 vaccination program as a moral mandate to facilitate “shots in the arms” in the psychiatric clinic. This pandemic is an opportunity to rethink our role in improving the health of our patients and participate in preventative health care.