key: cord-0879622-owg8funy authors: Ransing, Ramdas; Dashi, Elona; Rehman, Sajjadur; Chepure, Ashish; Mehta, Varun; Kundadak, Ganesh Kudva title: COVID-19 anti-vaccine movement and mental health: Challenges and A way forward date: 2021-02-23 journal: Asian J Psychiatr DOI: 10.1016/j.ajp.2021.102614 sha: 08aee0185b22c85600f1e2151caa2ce5fdedf194 doc_id: 879622 cord_uid: owg8funy nan This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Email: ramdas_ransing123@yahoo.co.in Phone: +919503145475 Vaccination is one of the most cost-effective public health interventions in infectious disease outbreaks if it is made accessible and acceptable to the people (Lahariya, 2016) . Recently, many countries have approved some coronavirus disease vaccines and are presently adopting nationwide vaccination strategies to protect people from COVID-19 infection(Nature, 2020). However, these promising COVID-19 vaccines may not be accessible, acceptable, and affordable to people, especially those in low and middle-income countries (LMICs) due to multiple barriers such as a lack of adequate resources, safety concerns, and the emergence of an anti-vaccine movement (Burki, 2020; Nature, 2020) . In this letter, we aim to explore the potential impact of this anti-vaccine movement on the COVID-19 vaccination program and mental health. The anti-vaccine movement is not a new phenomenon and has occurred in most past infectious disease outbreaks (Hussain et al., 2018) . These movements tend to present the vaccine as more harmful than the disease itself by linking vaccines with other illnesses (e.g., in 1998, the measles-mumps-rubella (MMR) vaccine was linked with autism) (Smith, 2017) . The COVID-19 anti-vaccine movement appears to be fueled by conspiracy theories, false beliefs, a lack of confidence among stakeholders, and a presumed lack of transparency (e.g, efficacy, and safety) in the vaccine approval process(Zadrozny, 2020). In addition, many people appear to harbor low-risk perceptions of COVID-19 infection due to good recovery rates especially among the young. The COVID-19 pandemic and mitigation measures such as lockdowns have increased the prevalence of mental health issues through the disruption of mental health services (Tandon, 2021; Xiong et al., 2020) . The anti-vaccine movement may further prolong the duration of the COVID-19 pandemic and may J o u r n a l P r e -p r o o f increase mortality or morbidity, resulting in an exacerbation of health inequalities and flaring the economic and social disparities. This may lead to not only an increase in the burden of COVID-19 infection but also mental health issues in poorer and marginalized people across the different LMICs countries. Using Hagood and Mintzer Herlihy's model, people involved in the anti-vaccine movement can be categorized into three types' viz. vaccine rejecters, vaccine-resistant, and vaccine hesitancy (Hagood and Mintzer Herlihy, 2013; Smith, 2017) . This categorization helps to understand their motives, reasons, and Advocating globally for the COVID-19 vaccine will not be easy due non-availability of a one-size-fits-all model for different groups of people. However, psycho-social interventions should be developed to address the anti-vaccine movement considering local concerns, underlying beliefs, and culture. o Monitoring the social media: Promoting the idea that vaccination is "normal" and monitoring social media for misinformation is key. o International collaboration: The infodemic and anti-vaccine movement will not restrict to any specific country (Eysenbach, 2020) . Therefore, government and international J o u r n a l P r e -p r o o f agencies should be well prepared to respond appropriately, adequately, and quickly to the COVID-19 vaccine concerns. o Mental health: COVID-19 vaccination is an opportunity for mental health professionals to screen people for common mental illness through public health systems and increasing investment in mental health for a future pandemic (Adiukwu et al., 2020) . Persons with severe mental illness should be prioritized so that they can access mental health services regularly. To conclude, the COVID-19 anti-vaccine movement can affect community health, and possibly prolong the COVID-19 pandemic, and will inadvertently increase the burden of mental health issues. A systematic approach, appropriate innovative interventions, and global-public health initiatives are needed to prevent this. The authors declare that there was no funding for this work. 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