Is fear of needles part of vaccine hesitancy?

The NY Times has an opinion piece up today about the fear of needles and how that may be playing a role in vaccine hesitancy for some people. The basic idea is that adults may have all sorts of reasons for refusing the vaccine but those who are afraid of needles might be embarrassed to admit the real reason they are hesitant.

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.

Of course that’s not true for everyone who is refusing to get the vaccine but there are probably a lot of people who find it easier to say “I’m not convinced I need it” than to admit “I worried I might pass out in the middle of CVS.”

Lots of people are afraid of doctors or dentists. Some people really freak out when they hear that dental drill. None of that has ever bothered me at all but needles are another matter. Ever since I was a kid I’ve had a serious reaction to them. When I was 13 I had to get some shot or maybe it was a blood test. I don’t recall the details. What I do remember is that I got dizzy and fell over. I would have gone head first into the floor if my step-father hadn’t grabbed me on the way down. And yeah, you can probably imagine how many times that story got told and retold by my parents, two sisters and three step-brothers growing up.

Unfortunately, I never really grew out of it. In college the Red Cross would routinely come through to collect blood for local hospitals. I stayed as far as possible away from these blood drives until one year I decided I was going to go to impress a girl who had told me she was going. I was sure that whatever had happened when I was 13 was in the past but no, it wasn’t. As soon as I got in the makeshift waiting area I could feel the blood draining from my face. I started sweating but refused to give in and leave. I somehow made it through the insertion of the needle into my arm but about halfway through my donation all of my veins contracted to the point that no more blood would come out. My blood pressure dropped and nurses rushed over to see what was wrong. Seeing I wasn’t looking too good, they gave up and removed the needle. Worst of all, I was told since the bag of my blood wasn’t full they’d have to throw it away.

For me, giving blood is really the worst case scenario. I frequently think that old age is going to be tough for me as doctor’s visits become more common. By contrast taking a quick shot in the shoulder with a tiny needle doesn’t cause me anxiety these days. Still I was a little nervous when I signed up to get my vaccine because, well, I have this history. In fact, I signed up for the Johnson & Johnson shot specifically because I wanted to only have to deal with the needle once. And then two days before my appointment J&J was put on hold.

I wound up getting the Pfizer shot at my local Walgreens which meant going twice. During the first visit I felt fine waiting about 15 minutes for my turn. After giving me the shot the doctor said I needed to hang around the store for about 15 minutes to make sure I didn’t have a reaction. So I got up and then I started to feel that old sinking feeling of falling blood pressure and borderline dizziness. I walked around for a few minutes trying to force my body to just get over it. But that’s the thing about this stupid physical reaction, you have no conscious control over it. Your mind can continually tell your body it’s being stupid and needs to snap out of it but your body is not listening and is in fact threatening to make your brain shut up by failing to send enough blood to your head. After about 3-4 minutes of this internal conflict I went out to my car and waited there. If I was going to embarrass myself, I’d rather do it somewhere slightly less public. In my case just getting outside into the warm sun helped me snap out of it.

When I went back for the second shot a month later I really thought about the whole process. And the more I thought about it I knew I wasn’t actually afraid of anything. My only anxiety at all was that I’d embarrass myself because of a physical reaction I can’t control. Fortunately, the second shot went a lot smoother than the first. There were fewer people so the delay was shorter before I went behind the curtain. The doctor who gave me the shot told me to drink water so I immediately went and bought a bottle of water which served as a brief distraction. As a result, I never felt dizzy and I stayed around the full 15 minutes, texting my family that I was done. For me it was a small victory over a very old foe.

It turns out that for people with this problem, distraction is one of the things that works.

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.

I’d never heard that before today but it certainly seemed to work for me. In general I do think anticipation has something to do with it. A long wait gives your mind too much time to buildup anxiety about what may or may not happen. It really does help to just move things along.

I’m sure there are people out there who have similar experiences because I heard from some of them on Twitter when I wrote about this last month. And I’m sure there are some whose experiences are much worse than mine. They aren’t comfortable getting a shot at all, much less in a public place like a drug store. They also probably aren’t going to tell anyone outside their family the real reason they are hesitant about it.

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