No one likes needles. Of all the barriers to Covid-19 vaccination, fear of needles may seem trivial to overcome. But millions of American adults, not to mention children, still need to be injected to keep themselves and their communities safe. And it’s likely some of them aren’t doing so in part because they fear or just don’t like needles.
About one in four adults and two out of three children have some fear of needles, and adults may find their fears too shameful to share. This is a substantial public health problem, because a body of research shows that around one in 10 adults are so afraid of needles that they will delay or avoid vaccinations.
Vaccine hesitancy is a complex phenomenon with many contributing factors, including needle fear. Fear can be adaptive in a dangerous situation — like reacting to seeing a bear in the woods — or it can be out of proportion to the danger that’s present. Needle fear also exists on a spectrum, with people who are nervous about needles on one end and people with extreme levels of needle fear that meet the diagnostic criteria for what’s called “blood injection injury phobia” on the other. The latter is a mental health diagnosis that’s estimated to occur in 3.2 percent to 4.5 percent of people, which is most likely an underestimate given that many people do not acknowledge these fears to health care professionals and never receive a diagnosis.
High levels of needle fear, with or without a diagnosis, can affect vaccination programs. Some people might avoid getting vaccinated altogether, and others might endure it under immense distress, putting them at risk for what experts call immunization stress-related responses such as feeling dizzy or fainting during an injection. Experiencing an immunization stress-related response can worsen needle fears, both among people getting vaccinated and those who see or hear about them. The vaccine can also be falsely blamed for an immunization stress-related response, which can derail vaccination programs.
Adults shouldn’t feel ashamed if they are fearful of needles and should know that it’s common. Health care professionals and vaccination site organizers should be conscious of these fears and embrace methods to ease them. There are plenty of science-backed strategies to help.
Questions surrounding the Covid-19 vaccine and its rollout.
Organizers of vaccination programs have important roles to play in setting up their vaccination sites to minimize needle fears and immunization stress-related responses. Strategies like organizing one-way clinic flow with privacy options help avoid long lines and having people being injected “on display” for others waiting. And it doesn’t start and end at the vaccination site — people working to promote vaccines should keep needle fears in mind and consider positive and neutral images that don’t show the needles themselves.
There are also strategies for individuals to help ease their own needle fears that clinicians can teach and support. People with low to moderate needle fear can use the research-backed C-comfort A-ask R-relax D-distract, or CARD, system. This method helps people develop a coping plan for before, during and after vaccination. To prepare, those with needle fears can think about what they will wear for easy access to their upper arms. They should consider what might relax or distract them while waiting at the clinic, such as reading a book, listening to music on their phone or playing a video game. Even purchasing a topical anesthetic can be helpful.
Organizers should anticipate and support small changes or requests that can improve the vaccination experience. For example, providers can ask people being vaccinated how they want to be told the injection is starting (e.g., “1, 2, 3, here we go”) and whether they want to look at the needle or away. During the procedure, do people want to talk about something else, play on their phone or listen to guided imagery? After the vaccination, how will they be rewarded?
Reminders of coping strategies can be posted at vaccination sites, and clinicians can put people being vaccinated at ease by answering their questions and supporting their coping plans.
People who have a history of feeling faint or dizzy around needles can also practice a simple technique called muscle tension. Feeling dizzy happens when blood pressure has dropped, and muscle tension works by keeping blood pressure up. To do this, clinicians should recommend that people do repeated cycles of tensing leg and stomach muscles for 10 to 15 seconds and then releasing them back to normal (not fully relaxed) before, during and after vaccination.
People at the high end of the needle fear spectrum will most likely need another approach to manage that fear first rather than get a vaccination while extremely frightened. Exposure-based therapy is recommended. This involves the safe, voluntary and slow facing of fear. Individuals create their own list of needle-related situations, order them by how scary they are and practice facing them starting with the easiest (for example, looking at needles in a book, holding a plastic needle, watching vaccine injection videos). Each step is practiced until fear is substantially reduced, and the individual then moves to the next. With practice, people learn that their anxiety can lessen, that it is manageable and that what they are most afraid of won’t happen. Exposure is usually guided by a mental health professional but can be self-guided.
Vaccination campaigns need to address adult needle fears head on. Doing so now can lay the groundwork for better vaccination experiences as eligibility expands and children — who are even more likely to have needle fears — can get their injections. As the pandemic in the United States moves into a new phase, every vaccine counts.
C. Meghan McMurtry is an associate professor of psychology at the University of Guelph in Ontario, director of the Pediatric Pain, Health, and Communication Lab there and a psychologist at McMaster Children’s Hospital.
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