OPINION: The need to address "needle fear" in effort to vaccinate more people

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. ...

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. ...