The following blog post was published in 4 parts as a guest blog on COVID19 on the website of the European Disability Forum (EDF) under the section: Disability Realities: http://www.edf-feph.org/disability-realities This is the full text.
Mind the gap. COVID-19 vaccination in institutions while existing injustices exacerbate
By Jolijn Santegoeds, 9 December 2020
The issue of vaccination of persons with disabilities in institutions brings many thoughts and questions. The prioritizing of access to vaccination by persons with disabilities in institutions is understandable. While the vaccination of persons with disabilities in institutions may sound like a simple solution, in practice, it is far from simple. The free and informed informed consent on vaccination of persons deprived of legal capacity and liberty must be guaranteed. The practical roll out of vaccination in mental health institutions will require a careful approach. The role of the pharmaceutical industry in the mental health sector may also carry some important lessons. Vaccination alone is not enough. The safest option is deinstitutionalization.
Human rights emergency in mental health institutions
Covid has sharpened inequalities and has deepened human right violations.
All over Europe, mental health care is nowadays stripped off from the gains of past decades in terms of the availability of supportive therapies, social activities, leaves and visits. The core character of institutional settings have reverted back to confinement and medication, as if the mental health system lapsed back into the past century.
The situation is even worse in many places in Central and Eastern Europe, where the availability of supportive therapies in institutions had never been realized even before the pandemic, and in numerous places the the living conditions of persons in institutions are horrendous, with groups of people confined in degrading conditions, even lacking basic hygiene measures. (See e.g. Bulgaria, Ukraine)
Even before the pandemic, there was a pre-existing human rights emergency in many institutions, with numerous practices amounting to torture and ill-treatment, including large scaled preventative and arbitrary detention, the administration of mind-altering medication without consent, seclusion and restraint, even cage beds in some countries, and forced ECT (electro-convulsive-therapy). On top of that there have been repetitive scandals in the mental health sector of e.g. exploitation, unbearable neglect, and systematic sexual abuse, as well as persistent complaints about the harm done by psychopharma. In addition, the staff in institutions is usually tasked with arranging the institutional routines and has generally little time for individualized personal support. Even before the Covid pandemic the situation in the mental health case sector demanded urgent remedy.
Even before the pandemic, there was a call to abolish such institutions, and abolish forced treatments and any other practices which cause suffering and do not amount to recovery or wellbeing. Even before the pandemic, the neglect and torment in these places brought many people to tears, and repeatedly we, Europeans, said to ourselves this had to stop.
Covid doubled the emergency
Humanitarian crisis such as war, disaster or pandemic have shown to be absolutely devastating to the conditions in institutions, causing misery and suffering of the worst kind. Considering that the mental health institutions were already unable to really meet the needs of the residents, further constraints are obviously taking a horrible toll. The measures such as lockdown made existing atrocities worse. (see Covid Disability Rights Monitor report)
Confinement, regimes of overmedication, minimized human contact, no social visits and no monitoring. At the same time there is an increased contraction risk due to staff rotations, and an increased mortality risk. So while the situation inside these mental health institutions is worse than ever, the decision was made to lock the doors, leave these people fully on their own in dangerous situations, unable to leave, and without monitoring. In all those months of lockdown measures, the people in institutions suffered the most by far. Their lives have been frozen, while they were stuck at the bottom.
Deinstitutionalization during the pandemic
The only right thing to do now, is to make real and sustainable efforts to secure the rights of persons with disabilities. Overall this starts with protecting the very lives and basic living conditions. Practical tools and methods to achieve better living conditions are deinstitutionalization, ending forced treatments (including forced medication and Community Treatment Orders), involving persons with lived experience in the design and planning and transformation of services. The UN Convention on the Rights of Persons with Disabilities (UN CRPD) offers a full set of human rights standards to be implemented.
Since the measures to protect against the covid virus will be in place for a prolonged period of time, action must be taken to transform the way support is given to persons with disabilities. The risk of contracting covid is not depending on the type of disability, it is dependent on where you live and how many people you are in contact with. Deinstitutionalisation is the safest option.
There are actual developments which show it is possible to deinstitutionalize during a pandemic, without sending people away empty handed. Investments should be made in supporting independent living and family type care, which is far more adaptive to the individual needs of the person than living in institutional settings where the institutional interests prevail over the individual needs. The covid emergency once more underlines the increased risks and increased burden that people with disabilities face in seggregated settings. Also small group homes are not safe places, due to staff rotation. Personal assistance is on average 6 times cheaper than institutional care, and safer in times of a pandemic. Without investing in the communities, existing problems like poverty and a lack of community based support will remain the driver for (re)institutionalization. Especially when considering the increase in poverty, unemployment and increased support needs resulting from the pandemic, the need for true investment in inclusive communities is evident.
Prioritizing vaccination for persons with disabilities in institutions
Although the risk of covid contraction depends on the number of contacts, there is an increased risk on severity of covid infection and case fatality for persons with various types of disabilities. In order to protect the most vulnerable people from contracting the virus, and to ensure that nobody is left behind in getting access to vaccination, there is a good argument to prioritize persons with disabilities in institutions in the vaccination roll out.
But vaccination cannot replace deinstitutionalization. The risks of living in institutions are more than evident, and no longer can such grave suffering and immense violations of human rights be left unremedied in Europe. Any vaccination programme must be accompanied by a deinstitutionalization programme.
In addition, there are many considerations to be made regarding the practical organization of vaccinations in institutions. This starts by reflecting on how the vaccination is positioned overall, followed by practical concerns about the actual vaccination process of persons in institutions, and e.g. how to ensure that all persons will have the right to decide about vaccination themselves, including those who are deprived of legal capacity and liberty under the current systems. It appears to be a very complex issue.
Concerns about pharmaceutical marketing and the medical model
The first concern arises when noticing the typical patterns deployed by pharmaceutical markets. This could be the elephant in the room. For persons with psychosocial disabilities, the mistrust towards the pharmaceutical industry is real for many people. It is the result of oppression over decades. As a person with negative experiences with psychiatric drugs, a number of concerns regarding the vaccine development and its market positioning got my attention. There are differences and similarities between covid vaccines and mental health medication.
First of all, covid is a traceable virus and its vaccine is merely a medical intervention, unlike the mental health field where diagnoses are ‘defined’, and pharmaceutical products have varying effects on people, including very harmful, disabling and detrimental effects. The pharmaceutical industry never came up with a sense of responsibility themselves for the known harm caused by their mental health medication, including its administration under force, which left many people traumatized.
There is a substantial difference to the degree of evidence based science behind medical interventions compared to the mental health medication, which has a far less credible basis. The argument that a medical condition would require a medical response is shared by many people. The vaccine development in itself is therefore a logical response to the pandemic.
However, as an observation, the publicity on the covid vaccination shows a disturbing overlap with the mental health marketing model, especially by linking medication (vaccination) to economic output and liberty. While obviously, vaccination is a health issue, and not an issue of liberty or economy. The publicity should better focus on “what does the vaccine do to a person” instead of semantecs about “expected economic outcome of taking medication”. Economy is a different sector, and pharmaceutical products should not be linked to such claims. Vaccination is a health decision and as such it requires detailed information about possible and expected health outcomes.
To share a critical view: The “economic burden of disease”-model is actually a default marketing model of the pharmaceutical industry, focussed on portraying needs and importance of treatment and often positioning medication as only solution (medical model).The marketing model of the “economic burden of covid-disease” corresponds with the marketing of the “economic burden of untreated mental health”, creating a fearful and costly image, coupled by raising high expectations about the pharmaceutical products, such as the vaccines efficacy above 90%. Obviously, the pharmaceutical industry represents the medical model, and as such, they act in a tunnel vision of promoting medication, as seemingly “quick solutions”, pushing any alternatives to the shadows. And indeed, when you ask the medical sector to come up with a solution for the pandemic, it may not be surprising they come up with a medical tool. And indeed vaccination could actually be an effective way to prevent and reduce the spread of the pandemic.
Yet, the alarming part is that in parallel with the horrendous situation in institutions under Covid measures, the pre-existing situation in mental health institutions already highlighted the risks of a singular focus on the medical model, and on risk-management instead of ‘recovery-management’, forgetting to focus on quality of life, merely locking people up, claiming how vulnerable they are without medication. In parallel, the focus on vaccination and lockdown-measures is currently similarly overshadowing the quality of life in institutions. Perhaps it is good to stay critical to the developments. Similar to the mental health advocacy, a strategic critical counterpressure to ensure balance of perspectives may be needed, especially when noticing the striking overlap of market positioning and medical model tunnel vision, which seems to leave out the human rights context of those concerned, deliberate or not.
Concerns about possibly ‘partially experimental’ vaccines on persons with disabilities
Another concern regarding the role of the pharmaceutical industry surfaces in the practical choice to prioritize persons with disabilities for receiving the first batches of vaccination. Considering the fact that the development of the vaccine was done under extreme time pressure, and testing processes were speeded up, the vaccine may not feel equally safe to all people, and some would call it ‘partially experimental’ vaccines. Vaccination will require trust in the integrity of the sector. Subjecting persons with disabilities to the first batches of possibly ‘partially experimental’ medication evoked many thoughts about whether this is coincidentally resembling scandals of medical and scientific experimentation on this group of persons, or whether it presents a genuine act of caring. An indicator of integrity could be whether actions be taken to prevent any harm, such as guaranteeing the free and informed consent of each individual. (also see next page)
Vaccination alone is not enough
And while millions of euros go to the pharmaceutical industry, people are stuck in institutions devoid of humanity. Their heightened risk to covid contraction is defined by the fact that they are institutionalized and therefore exposed to a higher number of contacts, while their lives have been put on hold under terrible circumstances. This is at its core a social injustice. Yet the vaccine will not remedy this social injustice. The pre-existing human rights violations such as deprivation of liberty under horrible conditions will continue also after vaccination. What does it mean to save a life? It is time to step up to the next level, and take action to end institutionalization.
What if we would invest the same commitment to making the society safe and inclusive for all, and besides vaccination, also focus on deinstitutionalization, hygiene, healthy living, personal protection, and smart inclusive solutions? Politicians have shown it is still possible to travel with hygiene and protection measures, so why not make efforts for everyone’s freedom?
Can we restyle the community, instead of detaining ‘the vulnerable’? Did the lockdown of institutions save lives, or did it mostly wreck lives? What if we will make limitless efforts for inclusion instead of exclusion? Can we do it better from here?
Broaden the approach: A social approach to the covid emergency.
Next to the medical model approach to covid, which currently entails waiting for the vaccine, there is also a social approach, aiming at safe inclusion and equality, leaving no one behind. Deinstitutionalization is the first step, and urgent policies should enable people to move out of institutions. Budgets and systems be ready for organizing community based support, relocate institutional resources to community based support, person centered, with personal assistance and budgets to enable independent living or family type care, in line with the person’s will and preferences, with equal opportunities.
The social model of covid is also important when thinking about the right to say no to vaccination. E.g. What would happen if a person in an institution refuses the vaccination. Would that have reprisals to liberty, making it more or less a Community Treatment Order where liberty is conditional to medication? This also applies to staff who may face requirements of vaccination by their bosses.
In case of refusal, the alternative would probably be to cope in the way as prior to the vaccine, and e.g. wear masks. If only non-vaccinated people will wear a mouth mask, it may lead to discrimination. Since the vaccine may not protect 100%, it could be advised to still wear a mask until the virus has reduced enough. Then the masks would just be in place a bit longer, making it invisible who got vaccinated or not.
Taking into account the need for deinstitutionalization, the need to reduce risks also for the future, and the right to free and informed consent on vaccination, including the right to refuse vaccination, it is evident that vaccination cannot be the only action undertaken to counter the covid-19 pandemic. Deinstitutionalization and full realization of the UN CRPD is the only way to protect the world from similar ravages in the future.
Practical concerns about free and informed consent in vaccination in institutions
In order to make decisions, people need information about the options and consequences, and some persons may have support needs in understanding the information or in identifying their preferences. However, if the person is deemed incapable (which may be often the case in institutions), and while taking into account the existing oppression, it may be hard to have a meaningful conversation with the staff. In a worst case scenario people may not even be informed but just rounded up not knowing what is happening, or assuming it is just any medication. And in fact, institutions may have undue influence since they do have a stake, e.g. simplifying policy making with mass vaccination.
Any instance of vaccination mispractice should be reported, and the place to report mispractices should be known to the public. Abuse may include: influencing decision-making, denying or forcing vaccination, reprisals or manipulation, unfriendly service. Active monitoring is recommended, e.g. interviewing people in institutions about the process of decision making and vaccine provision.
Perhaps the staff in institutions may not be the right ones to communicate or administer the vaccination. Especially in the context of forced placement and forced treatment, the staff in the institution may not be fully trusted by the users, and existing conflicts between staff and user can give complications (e.g. default rejection). Persons in restraint and seclusion are probably devoid of any social relation that would enable them to have a meaningful conversation with any of the staff. External persons, such as NGOs could perhaps come in as a neutral person to discuss this particular decision on vaccination. Moreover, all persons under forced treatment, forced placement and guardianship need to be contacted by a neutral person for the purpose of decision making on vaccination, since the element of involuntariness indicates they have a current disagreement with their existing network. The persons under guardianship, forced placement or forced treatment should be free to appoint their own assistant or person of trust to communicate their choices. Perhaps monitoring bodies, NGOs, other social service staff etc. can be useful to enable persons to make a decision independent from the guardian or institution. In some institutions this would be hundreds of persons.
Especially in neglected places, where meaningful conversations are unikely to happen, it may be crucial to bring the necessary information inside actively, targetted to the users. It could also give staff a guidance in how to deal with the situation, how to have this conversation. For the purpose of information inside institutions, perhaps a video could be made, to inform people in institutions of their rights and what is at stake with the choice of vaccination. People and groups could watch the video, and be informed. This could alleviate the staff, who can still engage in individual support.
Another suggestion is a local decision support council to support the users in the the decision making process and assist with information and consultation, e.g. comprising NGOs or family members.
The information provided to people inside and outside the hospital should be the same. Many persons with psychosocial disabilities are able to understand also general and complex information, and keeping this away from them may cause mistrust. Regular news or information should be provided and be available in the same detail as to others (and people can decide for themselves if they want to read it or not). Simple information should be provided in addition. Witholding information causes distrust and is illegal.
Perhaps, in practice a vaccination team may enter an institution to perform the vaccinations there, or a box of vaccinations is distributed to hospitals. This could lead to a number of problems. In fragile systems, boxes with vaccines could even be stolen and never reach the persons with psychosocial disabilities, especially in places where exploitation and abuse of patients is wide spread and unremedied. In case of a visit of a vaccination team, persons could be pressured to make urgent decisions while the team is there, or being told it is their only chance (now or never). The residents should be informed well in advance when the vaccination would be possible, to be able to make their own decision, which may take some time to weigh to pros and cons.
If a person is in a crisis, it may not be the right moment to discuss or administer vaccination. A person with an acute psychosis or being overmedicated may actually not remember it afterwards. This cannot be handled lightly. Enough time and support must be given to the decision making processes. If the vaccines would just be available at the institution, it could allow for “vaccination whenever the person is ready”, yet the mere distribution of boxes could also lead to unmonitored practices and undue influence, especially since disregard for legal capacity of residents inside institutions is often deeply rooted and embedded in cultures, and unlikely to change without making any exceptional efforts.
Especially in regards to persons under full and plenary guardianship, forced placement or forced treatment it may not be wise to just let institutions handle the vaccinations themselves, and it would be better if the process was embedded with external safeguards.
The idea of a simple uniform procedure with mass line ups or quick group injections cannot be applied, since all the residents have the right to free and informd consent, and they have individual needs as well. The actual diversity inside institutions is wide ranging and very mixed in practice.
People in institutions may have certain individual needs during vaccination, e.g. based on a disability (e.g. going slowly step by step, needing a support person, feeling safer not being alone in the hours after vaccination), but also regarding culture (customs) or gender (e.g. gender based violence). These needs are often intertwined with psychosocial disability, and must be accomodated in line with the will and preferences of the person. E.g. after gender based violence, a gender preference regarding nurses who administer the vaccine may be perceived as a need rather than a preference. A person with a phobia for germs may not feel comfortable in group line ups. When a person is desoriented, perhaps the vaccination can be made a memorable moment, e.g. unlike regular injections, or e.g. distribute certificates of proof. Each person is unique. In practice this will mean that a careful approach, enabling variety and flexibility is needed, to adapt to individual needs.
When a vaccination team visits an institution, they should probably visit more than once, in case people need more time for the decision. The team could announce immediately that they will come back at another date, in case people have not made their decision yet. This will also allow persons in very severe mental health crisis to possibly recover before making the choice in a more calm state. Psychosocial disabilities are characterized by fluctuations, and e.g. moodswings may cause a person to make a choice and think differently about it the next day. In case the person rejects the vaccine and later changes their mind, this should be possible. The vaccination preferrably should not be a “one day event”. A proper and respectful vaccination process requires sensitivity to individual needs.
The vaccination roll out in institutions needs a hybrid mix of hospital staff and external parties to bring the needed level of communication and trust, and to ensure a fair process to the participation of residents in the decision making and vaccination process.
After vaccination, people may also need a debriefing and follow up on how they feel. They cannot be left neglected directly afterwards, ‘as if nothing happened’. They could have side effects or an allergic reaction, or feel scared or anything else. Most of all, they cannot be left in the current conditions in institutions, exposed to a range of human rights violations and neglect. This time, their lives must be saved for real.
Combine vaccination, with decision support, monitoring, alleviation and deinstitutionalization
Any vaccination programm in mental health institutions should be coupled with a support system for decision making, and a deinstitutionalization programm.
Visiting institutions for vaccination should be combined with monitoring, which can start with simple observance of the living conditions, and e.g. ranking the priority for deinstitutionalization, alleviation and urgent action on a scale 1-5 (1 = immediate action or abolition, 5 = voluntary and acceptable). The ranking can be done per person, per group, per institution, and will enable follow up action.
In order to react instantly to some of the inhumane conditions in institutions, an alleviation budget must be present to lift the most pressing burden currenly imposed on the residents of institutions. Alleviation could comprise urgent action to ensure dignified living conditions, sanitary and hygiene provisions, food and healthy living, personal protection such as masks and so on. It also comprises ending solitude and neglect by e.g. psychosocial support, therapy options, enabling outdoor activities, social activities. This is the moment for true saviour.
A moratorium on new admissions is needed, and community based support must be readily available. Doors must be unlocked so that people are free to leave. Support should be disconnected from location, and be free from coercion. Everybody can flourish with the right kind of support.
There must be a timely follow up action to vaccination in institutions. Vaccination must mark the start of extended efforts at all levels, united in the priority to end institutionalization and to improve the quality of lives of those concerned. The united push for deinstitutionalization during the covid-tragedy with all its utmost darkness brings a thin ray of hope that amidst of all the hurt also something positive could emerge in the form of a historical development of human rights as part of the human response to the grave and systematic suffering in institutions.
Let the vaccination process be the start of truly supporting the lives of persons with disabilities, and ensure no further harm is done to this group, and not abandon them again after vaccination, but ensure they have a life worth living.
What if the vaccination team would be a rescue team, to free the people from the shackles?
A social twin track approach to vaccination
The roll out of a vaccination programme actually offers the opportunity to reach out to each citizen, to check if every person is okay, and to offer support where needed. The process of administering or inviting each person for vaccination, could be used to identify other needs simultaneously, e.g. by adding other professions or dimensions to the vaccination roll out, such as mechanisms for poverty relief or screening for other needs, turning the vaccination roll out into a hybrid holistic health protection programme.
As a result of the pandemic and pre-existing situations, people may be exposed to very hard circumstances and conditions, and have other pressing needs besides a vaccination. Currently, the vaccination process could offer a window of hope to people in need, from victims of domestic violence to those facing poverty, from persons subjected to coercion to persons left in unbearable neglect. People may actually be hoping to find relief out of urgent problems their lives. It would be painful if the vaccination team would just leave after giving the vaccination, giving the impression that a life was saved, while leaving the person under circumstances that need urgent remedy.
Health extends beyond vaccination
The vaccination process could be strengthened by adding other expertises, and focus on saving lives holistically. In fact, a holistic approach to health should be the norm. The WHO constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The UN CRPD calls for the removal of barriers that hinder full participation. In addition, the current situation under the covid pandemic demands taking action on many levels to protect the health of the population as a whole. Community based services and mental health programmes have been disrupted while people suffer under the impacts of covid. To really safeguard health, the vaccination process should reach out further than just the medical model, and encompass sensitivity to other needs as well.
Sensitization to individual needs
The vaccination process could e.g. be sensitive to spot personal needs regarding poverty, domestic violence, loneliness, disability and support, household, unemployment, broken business, housing needs, education needs, discrimination, cyber bullying, suicidal thoughts, substance abuse, etc. In institutions specific attention needs to be given to human rights abuses such as the use of restraints, solitary confinement, forced drugging, forced ECT, detention in institutions, and other practices that are in violation of the UN CRPD. Human rights violations must be brought to an end immediately. In this way, the vaccination team could become a rescue team, and the social approach to vaccination could bring us closer to a world with human rights for all.
The vaccination process gives the opportunity to reach out to those who are in need, and enable community based support. It could e.g. start with a questionnaire to spot people in need, or promoting a help line to mobilize support, or providing direct support or referral to specialized supports services and resources.
The needed attention to individual free and informed consent to vaccination, as well as realizing a decision making support mechanism to ensure free and informed consent of persons deprived of legal capacity or liberty, would already mean a sensitization to the social context of the person concerned prior to vaccination. On top of that, a further social approach must be added to the vaccination process, to ensure every citizen is safe, and nobody is left behind with unmet needs.
While governments invest in damage control to the business sector, there is a clear need to also invest in supporting people everywhere to fulfill their basic needs and to prevent harm to their health, including mental health and suicide prevention. To support each life, regardless of the type of needs, would be an act of equality and non-discrimination.
Holistic health protection
And while covid spreads sadness and fear, people hang on to the hope that times will get better, and that the world will build back better post covid. A holistic health protection programme would reflect a fuller notion of the right to life and the diversity of needs. A vaccination roll out twinned with a proactive outreach programme aimed at providing supports where needed, could actually save lives, and increase resilience, and may as such give the feeling of hope, emergence, growth and new possibilities towards overcoming hard times. A holistic health protection programme, connecting the vaccination process to the identification and relief of urgent needs, could potentially reach the most marginalized, those furthest behind, or those who may not be able to find support on their own. Such a twin track approach is practical and useful for sustainable development.
Moving to a better future
Especially now, it is important to bring out humanity’s best side, and do more and do better. Fighting the pandemic is not only the work of health care professionals, it is a job of us all, to ensure that every person is well. Nobody has to be jobless if they are willing to support another. Also, modern technologies offer new possibilities of remote support and remote monitoring. With concerted efforts based on the UN CRPD, nobody should have to live in an institution, and certainly not be tied up or coerced. The burden of the lock down measures can be spread more equally. It is time to make efforts for the freedom and the rights of persons with disabilities on an equal basis with others.
The vaccination process offers a window to reflect on approaches to health protection. The vaccination roll out could be used to simply administer injections under the medical model of covid. Yet, the actual health needs of the populations are going beyond a vaccination only. So when the vaccination process will need to be sensitive to individual needs anyway, then why should it not be fully sensitive to the diversity of actual needs, and take a holistic health approach, fully supportive of the right to life of each individual, regardless of the type of needs, and starting with those in the most disadvantaged positions.
Economic crises in the past decade have been met with huge economic responses, where governments invested large sums of money in e.g. the banking sector, airlines, etc. to “save” these business entities. This was often at the expense of austerity cuts to the provisions for persons with disabilities, who were left to suffer without proper support while the exorbitant high incomes for company management remained in place. And the human rights violations in institutions and in the community towards persons with disabilities have continued to exist, while the rest of society was enjoying an economic recovery. Yet, economy should serve the people, and not the other way around. Economists should use their skills to foster development, instead of using economy against us.
Now the world faces a humanitarian crisis, and we demand an equally big investment in humanitarian support. Every life is worth saving. It is time to reach out to those who are in the most horrible conditions. For example the situation in Bulgarian “social care homes” cannot be left unremedied any longer, and the plan to close these institutions by 2027 is by far not enough, as that is obviously an unacceptable time for persons to be tied up in metal chains! Immediate release is needed, in every country in Europe. Nobody should live in shackles. All over the world people are freed by NGOs from shackling. Europe must do the same. 2021 should be the year of liberation from the pandemic, yet also from endemic human rights violations against persons with disabilities.
The vaccination process and the covid pandemic as a whole force us to think about what it means to have a life, and what it means to save a life. Even before the covid pandemic, the UN CRPD urged states to take action to end the marginalization of persons with disabilities. The current humanitarian crisis only increases the need for humanitarian investment.
The fact that the world can actually change is unfortunately also illustrated by the covid pandemis, and moreover the world’s response thereto. It is now time for the awareness that we can and must do better to protect the lives of persons with disabilities. The vaccination process could be a starting point to ensure eveyone has a life worth living.
What if the vaccination teams would really comprise a social rescue team?
Could we make the world a better place?
 COVID-19 Disability Rights Monitor (covid-drm.org)
 The impact of COVID-19 on mental, neurological and substance use services (who.int)
 In Japan, more people died from suicide last month than from Covid in all of 2020 – CNN
 Council of Europe anti-torture Committee urges Bulgaria to stop physical ill-treatment of psychiatric patients and social care residents and to immediately cease the shameful practice of using chains as a means of restraint – 2020 News (coe.int)
 Bulgaria to close 28 mental health facilities over ‘unacceptable’ conditions | Daily Sabah