Over half of adults unvaccinated for COVID-19 fear needles. Here’s what’s proven to help.
Photo by CDC on Unsplash

If you're among the 25% of Americans averse to needles, you're probably not surprised by the COVID-19 immunization stall. Even for those who want immunity, bribes with beer or lottery tickets may not be enough to override anxiety made worse by pervasive images of needles in the media.

As a physician specializing in pain management, I study the impact of pain on vaccination. Research-proven adult interventions for pain, fainting, panic and fear can make vaccination more tolerable. At a minimum, understanding the reasons needle fear has become common might make the embarrassment easier to bear.

Why needle anxiety has increased

Needle fear has increased dramatically since a landmark 1995 study by J.G. Hamilton reported that 10% of adults and 25% of children feared needles. In that paper, adult patients who remembered when their fear began described a stressful needle experience around age 5.

The childhood experiences of the patients usually related to an unexpected illness; at the time the Hamilton participants were in preschool, vaccines were scheduled only until age 2. For most people born after 1980, however, booster injections given between ages 4 to 6 years became a routine part of the vaccine experience. The timing of boosters maximizes and prolongs immunity, but unfortunately falls within the age window when phobias form. A 2012 Canadian study of 1,024 children found that 63% of those born in 2000 or later now fear needles. In a 2017 study, my colleagues and I confirmed this increase in prevalence: Half of preschoolers who got all their boosters on one day – often four or five injections at once – were still severely afraid of needles as preteens.


Unsurprisingly, needle fear affects how willing teens and adults are to get vaccinated. A 2016 study found needle fear to be the most common reason teens didn't get a second HPV vaccine. Health care workers are no exception: A 2018 study found that 27% of hospital employees dodged flu vaccines due to needle fear. And most recently, an April 2021 national survey of 600 not-yet-COVID-19-vaccinated U.S. adults found that 52% reported moderate to severe needle fear.

The shame accompanying needle fear can make it difficult to research among adults. CDC/Unsplash, CC BY


Potential solutions for adults

For children, evidence shows that addressing their fear and pain while distracting them from the procedure is most effective in reducing distress.

While adults are not just big children, combining these concepts with findings from available adult injection studies suggest a few potential interventions. For the many who want a vaccine but need some support, here's what we know:

1. Pain reduction

Relieving injection pain may reduce needle fear by giving patients a feeling of control. For example, a group of patients in New Zealand were repeatedly missing their monthly antibiotic injections for rheumatic heart disease. Their doctors created a special clinic, offering either anesthetics, a vibrating cold device or both during the shot. The interventions in 107 adults reduced pain and fear by 50% after three months. Six months later, half the patients still used the interventions, and the special "missed dose" clinic was no longer needed.

Specifically for vaccination, applying a vibrating cold device to the injection site a minute prior to injection, then pressing just above the site during injection, relieved pain and improved satisfaction for adults, and was most effective for those with needle fear. A horseshoe-shaped plastic device using sharp prongs to confuse the nerves also reduced injection pain but increased anxiety, possibly due to discomfort from the prongs themselves.

Cold spray doesn't help reduce vaccination pain for children, but has been shown to be more effective than topical anesthetics for adult injections.

2. Psychological therapy

Exposure-based therapy involves asking a patient to rank anxiety caused by parts of a procedure, like seeing a picture of a tourniquet or thinking about sharp things, and gradually exposing them to these parts in a controlled environment. Free self-guided resources are available for fears ranging from flying to spiders. However, none of the three studies testing this approach on adult needle fear showed long-term fear reduction.

One of the studies that taught techniques to reduce fainting, however, was considered a success. Fainting, or vasovagal syncope, and needle fear are often conflated. While passing out due to injections is more common with anxiety, it is often a genetic response. Tensing the stomach muscles increases the volume of blood the heart can pump, keeping blood in the brain to prevent lightheadedness during needle procedures.

Planning ahead can help make vaccine day more approachable. recep-bg/E+ via Getty Images

3. Distraction

Surprisingly, there are no studies on adults using distraction for injections. Two studies, however, have found that pretending to cough reduces pain from blood draws.

Dropping F-bombs could also help: A recent study found that swearing reduced pain by one-third compared to saying nonsense words. Distraction with virtual reality games or videos has been shown to be more effective in children, although there have been mixed results in adults.

Mentally engaging tasks may also help. A visual finding task given to children during intramuscular shots has been shown to reduce pain and fear, with 97% rating the experience more pleasant than previous blood draws. Adults may need a more complicated task, but a similar intervention could work for them as well.

Use multiple interventions and go in with a plan

To reduce needle fear, research suggests the more interventions, the better. A 2018 study summarizing research on vaccine pain concluded that patient-operated cold and vibration devices combined with distraction techniques were most effective. Canada has implemented a practical national needle fear intervention for their vaccine rollout, emphasizing preparing ahead to help make vaccine day more comfortable.

Adults who don't like needles are in the majority. Taking control of your vaccination experience may be the best way to combat needle anxiety.

Amy Baxter is a Clinical Associate Professor of Emergency Medicine at Augusta University.

This article previously appeared on The Conversation. You can read it here.


Courtesy of Amita Swadhin
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In 2016, Amita Swadhin, a child of two immigrant parents from India, founded Mirror Memoirs to help combat rape culture. The national storytelling and organizing project is dedicated to sharing the stories of LGBTQIA+ Black, indigenous people, and people of color who survived child sexual abuse.

"Whether or not you are a survivor, 100% of us are raised in rape culture. It's the water that we're swimming in. But just as fish don't know they are in water, because it's just the world around them that they've always been in, people (and especially those who aren't survivors) may need some help actually seeing it," they add.

"Mirror Memoirs attempts to be the dye that helps everyone understand the reality of rape culture."

Amita built the idea for Mirror Memoirs from a theater project called "Undesirable Elements: Secret Survivors" that featured their story and those of four other survivors in New York City, as well as a documentary film and educational toolkit based on the project.

"Secret Survivors had a cast that was gender, race, and age-diverse in many ways, but we had neglected to include transgender women," Amita explains. "Our goal was to help all people who want to co-create a world without child sexual abuse understand that the systems historically meant to help survivors find 'healing' and 'justice' — namely the child welfare system, policing, and prisons — are actually systems that facilitate the rape of children in oppressed communities," Amita continues. "We all have to explore tools of healing and accountability outside of these systems if we truly want to end all forms of sexual violence and rape culture."

Amita also wants Mirror Memoirs to be a place of healing for survivors that have historically been ignored or underserved by anti-violence organizations due to transphobia, homophobia, racism, xenophobia, and white supremacy.

Amita Swadhin

"Hearing survivors' stories is absolutely healing for other survivors, since child sexual abuse is a global pandemic that few people know how to talk about, let alone treat and prevent."

"Since sexual violence is an isolating event, girded by shame and stigma, understanding that you're not alone and connecting with other survivors is alchemy, transmuting isolation into intimacy and connection."

This is something that Amita knows and understands well as a survivor herself.

"My childhood included a lot of violence from my father, including rape and other forms of domestic violence," says Amita. "Mandated reporting was imposed on me when I was 13 and it was largely unhelpful since the prosecutors threatened to incarcerate my mother for 'being complicit' in the violence I experienced, even though she was also abused by my father for years."

What helped them during this time was having the support of others.

"I'm grateful to have had a loving younger sister and a few really close friends, some of whom were also surviving child sexual abuse, though we didn't know how to talk about it at the time," Amita says.

"I'm also a queer, non-binary femme person living with complex post-traumatic stress disorder, and those identities have shaped a lot of my life experiences," they continue. "I'm really lucky to have an incredible partner and network of friends and family who love me."

"These realizations put me on the path of my life's work to end this violence quite early in life," they said.

Amita wants Mirror Memoirs to help build awareness of just how pervasive rape culture is. "One in four girls and one in six boys will be raped or sexually assaulted by the age of 18," Amita explains, "and the rates are even higher for vulnerable populations, such as gender non-conforming, disabled, deaf, unhoused, and institutionalized children." By sharing their stories, they're hoping to create change.

"Listening to stories is also a powerful way to build empathy, due to the mirror neurons in people's brains. This is, in part, why the project is called Mirror Memoirs."

So far, Mirror Memoirs has created an audio archive of BIPOC LGBTQI+ child sexual abuse survivors sharing their stories of survival and resilience that includes stories from 60 survivors across 50 states. This year, they plan to record another 15 stories, specifically of transgender and nonbinary people who survived child sexual abuse in a sport-related setting, with their partner organization, Athlete Ally.

"This endeavor is in response to the more than 100 bills that have been proposed across at least 36 states in 2021 seeking to limit the rights of transgender and non-binary children to play sports and to receive gender-affirming medical care with the support of their parents and doctors," Amita says.

In 2017, Mirror Memoirs held its first gathering, which was attended by 31 people. Today, the organization is a fiscally sponsored, national nonprofit with two staff members, a board of 10 people, a leadership council of seven people, and 500 members nationally.

When the pandemic hit in 2020, they created a mutual aid fund for the LGBTQIA+ community of color and were able to raise a quarter-million dollars. They received 2,509 applications for assistance, and in the end, they decided to split the money evenly between each applicant.

While they're still using storytelling as the building block of their work, they're also engaging in policy and advocacy work, leadership development, and hosting monthly member meetings online.

For their work, Amita is one of Tory's Burch's Empowered Women. Their donation will go to Mirror Memoirs to help fund production costs for their new theater project, "Transmutation: A Ceremony," featuring four Black transgender, intersex, and non-binary women and femmes who live in California.

"I'm grateful to every single child sexual survivor who has ever disclosed their truth to me," Amita says. "I know another world is possible, and I know survivors will build it, together with all the people who love us."

To learn more about Tory Burch and Upworthy's Empowered Women program visit https://www.toryburch.com/empoweredwomen/. Nominate an inspiring woman in your community today!

Officer Stagg meeting Sherry Smith on WISH-TV.

Indianapolis Police Officer Jeff Stagg selflessly maintained the roadside memorial of Shelby Smith, who had been killed by a drunk driver. He picked up trash and placed little plastic flowers, figurines and rocks around it to keep it presentable. Though Shelby died nearly 22 years ago, Officer Stagg didn't want her to be forgotten. And now, his act of kindness won't be forgotten either.

Passerby Kaleb Hall (@kalebhall00 on TikTok) noticed the officer cleaning up the site and asked him what he was doing here. Kaleb had already thought the behavior a little uncharacteristic, "a cop cleaning up trash in the hood," so he went over to inquire.

After explaining that Shelby's memorial was in his patrol area and that he guessed her family had moved away, Officer Stagg told Kaleb, "no one's keeping it up anymore, so I just wanna make sure it stays kept up."

Stagg had noticed the memorial had become surrounded by overgrown grass, weeds and trash. After driving past it every day, Officer Stagg thought enough was enough.


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When a pet is admitted to a shelter it can be a traumatizing experience. Many are afraid of their new surroundings and are far from comfortable showing off their unique personalities. The problem is that's when many of them have their photos taken to appear in online searches.

Chewy, the pet retailer who has dedicated themselves to supporting shelters and rescues throughout the country, recognized the important work of a couple in Tampa, FL who have been taking professional photos of shelter pets to help get them adopted.

"If it's a photo of a scared animal, most people, subconsciously or even consciously, are going to skip over it," pet photographer Adam Goldberg says. "They can't visualize that dog in their home."

Adam realized the importance of quality shelter photos while working as a social media specialist for the Humane Society of Broward County in Fort Lauderdale, Florida.

"The photos were taken top-down so you couldn't see the size of the pet, and the flash would create these red eyes," he recalls. "Sometimes [volunteers] would shoot the photos through the chain-link fences."

That's why Adam and his wife, Mary, have spent much of their free time over the past five years photographing over 1,200 shelter animals to show off their unique personalities to potential adoptive families. The Goldbergs' wonderful work was recently profiled by Chewy in the video above entitled, "A Day in the Life of a Shelter Pet Photographer."