Of all of the challenges facing mass Covid-19 vaccination, fear of needles is one of the least acknowledged by public-health campaigns – estimations are that possibly at least 16% of adults worldwide have skipped some medical treatment, mainly annual flu vaccines, due to concerns about needles.
For around a quarter or more of those people, the level of anxiety and terror caused by needles coalesces into a legitimate phobia, formally called trypanophobia, that governs elements of their life and interferes with normal functioning.
The exact number of people living with this phobia is nearly impossible to know, reports TIME, primarily because many of them avoid medical care entirely, choosing instead to risk missing screening and diagnosis.
This avoidance can be far-reaching. People may choose to avoid everyday activities for fear of being injured and requiring needle-related medical care. Some young women have chosen to postpone or even forgo desired motherhood simply because of the healthcare that pregnancy and delivery requires, according to online support groups.
It’s not about pain
When Covid-19 reached pandemic designation, Scotland’s Joe McDougall had nightmares. Not, like others, about the potential path of the virus, but about the seemingly inevitable moment at which he’d be asked – or held down and forced – to receive a vaccine.
McDougall, now 39, who is terrified of needles, realised that a global pandemic meant that for the first time since adolescence, he might not be able to avoid them.
“The fear of needles is greater than the fear of the consequences,” he said. “It’s not about the pain, either.”
When he needed to check his HIV status a few years back, he says he couldn’t bear the thought of using the small auto-lancet that came with his at-home testing kit to prick his finger. So, he opted for a mind-easing solution that many would consider far worse – slicing his hand with a box cutter to get the requisite few drops of blood.
McDougall has a difficult time explaining where his fear comes from, but describes it as a sort of existential issue with needle insertion “and seeing that it’s in there”.
Being able to break down a fear of needles requires understanding every element of interacting with them that can make a person feel uncomfortable.
“People's triggers are quite specific, and they can differ,” said Jocelyn Sze, a clinical psychologist in Oakland with years of experience treating phobias.
“For some people, it's really the puncture and moving into the skin. For others, it’s this idea of a foreign substance entering their body. It could even be the smell of rubbing alcohol, or the fear of fainting.”
Some people, including trypanophobes who work in healthcare, of which Sze says there are plenty, are truly only fearful of being injected themselves, and have no reaction to seeing or even using needles on others.
But after decades of avoidance and resignation, McDougall and many others like him are now confronting their phobia.
To them, the Covid-19 vaccine is that unstoppable force. In the trypanophobia forum on Reddit, where self-identified needle avoiders gather, conversations about treatments, both professional and self-guided, increased multifold, starting in mid-2021, many centred around a general desire or need to be vaccinated against Covid.
For some, the sudden frequency with which distressing images of needles appeared on their TV screens or social-media feeds alongside Covid news stories, was also overwhelming enough to make them rethink treatment.
McDougall even wrote a letter to his local TV station in Fife, Scotland, begging them to consider using other images, though it went unaddressed.
During the pandemic, said Sze, “People who hadn’t interacted with the medical system in 20-plus years were slowly coming out of the woodwork to get support.”
This chance to better understand a hidden patient population has allowed experts to begin reimagining what the experience of routine needle-based care can look like.
Reshaping attitudes about healthcare
It’s not uncommon for children to be apprehensive about needles, and interactions early in life can easily set the tone for lifelong attitudes toward medicine. In many cases, says Sze, trypanophobia begins with a key incident in youth.
“When you look into peoples’ history with needle phobia,” she says, “most can remember vividly where they had a moment at a young age where they felt out of control and their autonomic nervous system kicks in.”
This fight-or-flight response, she adds, can become deeply ingrained over time, in some cases remaining long past the initial memory of the incident that caused it. In some cases, the fear is learned simply from watching an ill relative undergo treatment.
Studies show the numbers of people suffering from the remnants of childhood needle-based trauma could be increasing. A 2017 study showed a strong correlation between the number of childhood vaccines given on the same day and later pre-adolescent needle fear around the age of 10.
The standard number of vaccines given to children increased throughout the 1980s and 90s with the development of reliable Hepatitis B and Varicella, or chickenpox, treatments among others.
“Getting four shots in a row at age two versus before, having to get only one or two shots per visit, can increase that experience of distress for infants and toddlers”, Sze pointed out.
Public health issue
To Sze, needle phobias are a public health issue, a perspective she’s been encouraging clinicians to embrace since the pandemic started.
“In the psychotherapy world, we often use this one-on-one treatment model approach, and to me that felt insufficient to meet the demands of what was happening globally,” she said.
With the help of colleagues, Sze started the I Don’t Like Needles project, designed to offer free treatment referrals and resources to those struggling with needle phobia. From October to April 2022, the project offered free counselling sessions to those hoping to get vaccinated.
Today, Sze and fellow psychologist Julie Lustig work with Sutter Health’s California-based sensory vaccination clinic, where specialised care can be given to individuals, many with autism, who are unable to be vaccinated in a normal clinical setting. They are piloting best practices and principles they hope to share with healthcare providers more broadly.
“Because this has been a pretty silent population that has avoided a lot of medical care, there hasn’t been enough advocacy around what their needs are,” she said.
The fear is gradually being talked about more. In 2022, the US Centres for Disease Control & Prevention (CDC) added a few pages about needle fears and phobias to its website, including guidance for both adults and the parents of young children.
The test clinic Sze works with uses various interventions. “There's some simple stuff like being able to use ice or vibration to block the pain signal or letting the person know that they don’t have to watch what’s going on – you can watch a YouTube video, or listen to music,” she said.
“You also have the option of a chair that lies flat so you can lie down if you have a history of fainting.”
The key “is just working in that patient advocacy role – checking in and not assuming this person doesn't have needle phobia when you are vaccinating them”.
Covid forces the issue
McDougall and others sought out therapists in 2021 with the goal of being able to receive Covid vaccines.
When McDougall called the UK’s Covid helpline to ask about vaccination accommodations for his phobia, he was passed from supervisor to supervisor and talked to “like a freak”.
Eventually, he decided to look outside the National Health Service and found a therapist specialising in exposure therapy. This is by far the most empirically effective treatment for needle phobias, and involves making a thorough list of an individual’s triggers, from least to most severe, before eliminating them one by one through desensitisation exercises.
For McDougall, this meant repeatedly watching videos of specific injections, as well as ordering a full set of commonly used needles from a medical supplier to look at and touch.
Thanks to a friend who worked at a local vaccination clinic, he was able to make an appointment to be vaccinated alone in a side room at the clinic rather than having to sit and wait where he’d have to watch others get shots before him.
Without that accommodation and his own preparations, it’s almost certain that he’d never even have made it through the clinic door.
“Before exposure therapy, I’d driven up to a vaccination centre, had a panic attack in my car, and come home,” he said. He also found that going back for the second dose was much easier.
McDougall and others who received Covid vaccines after decades of avoiding the healthcare system have found themselves grappling with a decision: continue the gruelling work to break down their fear even more, or celebrate the victory and retreat back to an avoidance of non-acute care?
McDougall returned to exposure therapy six months ago, understanding that the doctor’s office is inevitable – and like thousands of others, holding out hope that better accommodations will exist by the time he gets there.
TIME article – How COVID-19 Changed Life for People Terrified of Needles (Open access)
See more from MedicalBrief archives:
Needle-free anaphylaxis drug thwarted by FDA
Reducing needle anxiety in children – Australian study
India launches its first nasal Covid vaccine