For my blog today I am abridging a recent British Medical Journal 'Opinion' piece (14/01/21)

People with an intellectual disability should be prioritised for vaccination

by Keri-Michèle Lodge, Christian Brown, and Sheila Hollins.

The covid-19 pandemic continues to magnify the unacceptable health inequalities faced by people with a learning (or intellectual) disability (ID). The latest incarnation of this group’s seeming invisibility to policy-makers is the decision not to prioritise them adequately during the vaccination programme.

Last year Public Health England found that between the ages of 18-34, the death rate of people with ID from covid-19 was 30 times higher than for people in the same age group without a disability. The overall death rate for people with ID was estimated to be up to 6.3 times higher than the general population. This has been compounded by the inappropriate application of blanket “do not attempt cardiopulmonary resuscitation” orders on people with ID during the pandemic. Yet despite clear evidence of the disproportionately negative impact of covid-19 on people with ID, this group is not being prioritised for vaccination.

The Joint Committee on Vaccination and Immunisation (JCVI) considers that prioritisation should “maximise benefit and reduce harm” and “mitigate health inequalities.” Yet government policy ... has not prioritised covid-19 vaccination for all people with ID. People living in care homes for older adults have been made the first priority, yet people with ID, despite sharing many of the same risks as this group from living in congregate settings, have been treated in a more haphazard way. 

As it stands, most people with ID are a lower vaccination priority than healthy adults aged 65 and over. This prioritisation has been established despite the fact that a person with ID may find it difficult to understand and follow guidance on hand hygiene, social distancing, and wearing a face covering, or that their day to day care arrangements may provide opportunity for viral transmission via peripatetic care staff. We also know that people with ID may experience difficulties accessing in-person or virtual healthcare for covid-19 symptoms as a consequence of diagnostic overshadowing (whereby their symptoms are erroneously attributed to their ID) and discriminatory attitudes. Given all this, it is difficult to justify why a person with ID should be a lower priority for vaccination than an otherwise healthy older adult without ID.

We suggest that the government should follow the example of Germany, where people with ID, along with all employees of institutional services or community services in the disability sector and all people aged 70 or older, are being offered vaccination as a priority. 

As in Germany, we think it’s important that all people with ID are part of these prioritisation efforts. People with a mild or moderate ID face similar health inequities to those with a severe or profound ID. 

The decision to prioritise a group for vaccination is not simply a scientific exercise, it is an ethical one too. Given the profound health inequalities already faced by people with ID, everyone on existing GP registers of people with ID, along with their carers, should be prioritised in the covid-19 vaccination programme.

GF - If we really want to 'Build back better'  then all issues of health inequalities for people with learning disabilities should be seen as an urgent priority!