According to a study published in Psychological Medicine, a fear of blood, injections, and other medical procedures can explain about 10% of cases of COVID-19 vaccine hesitancy in the United Kingdom. The researchers call for initiatives to make the vaccination process less anxiety-provoking, given that the success of immunization programs relies on vaccinating as many people as possible — even those with fears of injection.
An initial 2020 survey led by researcher Daniel Freeman assessed the UK population’s attitudes toward the coronavirus vaccine. The results suggested that hesitancy toward getting vaccinated was largely driven by factors like worry about side effects and concern over how quickly the vaccine was developed. But in later interviews, participants brought up a concern that the questionnaire had not addressed — fears about injection.
Fear of injection is a part of a larger phobia called a blood-injection-injury phobia, which is characterized by a fear of blood, needles, or injury. When faced with related triggers (e.g., an injection needle), people with this phobia often experience a rapid decrease in heart rate and blood pressure that leads to fainting. Freeman and his team caution that a short-term fear of injection might lead people to avoid vaccinations, leaving them unprotected from disease in the long term. They were therefore motivated to address fear of injection in a second study.
In January and February 2021, around the time of the UK’s initial coronavirus vaccine rollout, over 15,000 UK adults completed an online survey. Respondents answered various questions assessing their willingness to receive a COVID-19 vaccine once available. To assess blood-injection-injury phobia, the participants completed a scale that asked them to rate how fearful they are of certain medical procedures including receiving an injection and watching another person receive an injection.
The vast majority — 73.3% of respondents — said that they would get the COVID-19 vaccine as soon as possible. However, 4.5% said they would put off getting the vaccine, 5.1% said they would avoid getting it for as long as they could, and 4.2% said they would never get it. These 13.8% were considered vaccine hesitant.
Around 26% of respondents met criteria for a blood-injection-injury phobia, and these people were twice as likely to be vaccine hesitant. Moreover, Freeman and his team conducted a calculation called a population attributable fraction, which allows researchers to assess the extent that a specific outcome could be prevented if a risk factor was eliminated from the sample. They found that if blood-injection-injury phobia was no longer present, 11.5% of vaccine hesitancy responses would disappear.
These findings suggest that fear of injection plays a role in vaccine hesitancy, albeit a small one. “It is a highly plausible causal connection,” Freeman and his colleagues note, “and one which we find is voiced by individuals who are vaccine hesitant. However, the key caveat of this study is that all the analyses were correlational, and causation cannot be determined.”
Nevertheless, the researchers say that there are worthwhile steps that can be taken to combat fears of injection — for example, offering a way of receiving the vaccine without a needle (e.g., a nasal spray), or increasing access to psychological treatments like exposure therapy that specifically targets blood-injection-injury fears.
“The success of vital COVID-19 vaccination programmes is dependent on uptake,” the authors emphasize. “As such, we should not underestimate the importance of making the thought of the jab less anxiety-provoking for the millions of people who are fearful of injections.”
The study, “Injection fears and COVID-19 vaccine hesitancy”, was authored by Daniel Freeman, Sinéad Lambe, Ly-Mee Yu, Jason Freeman, Andrew Chadwick, Cristian Vaccari, Felicity Waite, Laina Rosebrock, Ariane Petit, Samantha Vanderslott, Stephan Lewandowsky, Michael Larkin, Stefania Innocenti, Helen McShane, Andrew J. Pollard, and Bao Sheng Loe.