Dr. Brent Roussin, Manitoba's chief public health officer, receives the AstraZeneca COVID-19 vaccine at a clinic in Winnipeg on March 19, 2021.JOHN WOODS/The Canadian Press
Question: Many of my friends can’t wait to get the COVID-19 vaccine. But I have always dreaded getting shots. Is there anything I can do about my needle phobia?
Answer: Fear of needles is far more common than you might think. After all, an injection can cause some amount of pain – and we don’t usually look forward to any form of discomfort, even though it may provide long-term benefit.
In fact, one in 10 Canadian adults is so fearful of needles that “it actually interferes with their willingness to seek appropriate medical care,” says Christine Chambers, scientific director of Solutions for Kids in Pain based in Halifax.
Health experts are concerned that needle fears will contribute to vaccine hesitancy and prevent some from getting a COVID-19 shot.
Many factors contribute to vaccine hesitancy, including distrust of authority and other attitudes that can be difficult to overcome.
Canada pre-purchased millions of doses of seven different vaccine types, and Health Canada has approved four so far for the various provincial and territorial rollouts. All the drugs are fully effective in preventing serious illness and death, though some may do more than others to stop any symptomatic illness at all (which is where the efficacy rates cited below come in).
- Also known as: Comirnaty
- Approved on: Dec. 9, 2020
- Efficacy rate: 95 per cent with both doses in patients 16 and older, and 100 per cent in 12- to 15-year-olds
- Traits: Must be stored at -70 C, requiring specialized ultracold freezers. It is a new type of mRNA-based vaccine that gives the body a sample of the virus’s DNA to teach immune systems how to fight it. Health Canada has authorized it for use in people as young as 12.
- Also known as: SpikeVax
- Approved on: Dec. 23, 2020
- Efficacy rate: 94 per cent with both doses in patients 18 and older, and 100 per cent in 12- to 17-year-olds
- Traits: Like Pfizer’s vaccine, this one is mRNA-based, but it can be stored at -20 C. It’s approved for use in Canada for ages 12 and up.
- Also known as: Vaxzevria
- Approved on: Feb. 26, 2021
- Efficacy rate: 62 per cent two weeks after the second dose
- Traits: This comes in two versions approved for Canadian use, the kind made in Europe and the same drug made by a different process in India (where it is called Covishield). The National Advisory Committee on Immunization’s latest guidance is that its okay for people 30 and older to get it if they can’t or don’t want to wait for an mRNA vaccine, but to guard against the risk of a rare blood-clotting disorder, all provinces have stopped giving first doses of AstraZeneca.
- Also known as: Janssen
- Approved on: March 5, 2021
- Efficacy rate: 66 per cent two weeks after the single dose
- Traits: Unlike the other vaccines, this one comes in a single injection. NACI says it should be offered to Canadians 30 and older, but Health Canada paused distribution of the drug for now as it investigates inspection concerns at a Maryland facility where the active ingredient was made.
How many vaccine doses do I get?
All vaccines except Johnson & Johnson’s require two doses, though even for double-dose drugs, research suggests the first shots may give fairly strong protection. This has led health agencies to focus on getting first shots to as many people as possible, then delaying boosters by up to four months. To see how many doses your province or territory has administered so far, check our vaccine tracker for the latest numbers.
“Vaccine hesitancy is complicated,” says Anna Taddio, a professor of pharmacy at the University of Toronto. “But if the only reason you’re not getting a vaccine is because of the pain and fear of the needle, then we can do something about that. "
Indeed, in recent years there has been a lot of research aimed at reducing unnecessary suffering in children getting needles and undergoing other medical procedures. Some of the same approaches used to ease discomfort in kids work just as well for adults.
For instance, topical anaesthetics, or numbing creams, will minimize the sting of a needle when applied to the skin about 30 minutes to an hour before the injection. These products – which include Emla, Ametop and Maxilene – can be purchased in a pharmacy without a prescription.
Dr. Taddio notes that some people will take a common pain reliever such as ibuprofen or acetaminophen before a vaccination, hoping it will minimize the needle’s sting.
However, studies have shown that these oral medications are not actually very effective at alleviating the acute type of pain that comes from the stick of a needle.
She adds that such drugs can still help manage the sore arm, fever and other temporary side effects that some people experience a day or so after an inoculation. But don’t count on them to make the jab hurt less. Instead, for that type of relief, opt for a numbing cream.
Dr. Chambers says that mental distractions also have an important role to play in pain reduction.
“Science has shown that when you are distracted, it doesn’t hurt as much. Just shifting your attention to something other than the needle can be incredibly helpful,” she says.
“Many vaccinators are very skilled at this approach. They will start what seems like a casual conversation while preparing to give you a vaccine, but their real goal is to take your mind off the procedure.”
Although pain-management strategies can be extremely effective, some people will need other kinds of support to dispel their dread of needles.
Fear of needles can be thought of as being on a spectrum from low to high, says Meghan McMurtry, an associate professor of psychology at the University of Guelph.
In extreme cases, it can become a phobia – a diagnosable mental-health disorder – characterized by excessive levels of anxiety and impairment that is out of proportion to any possible danger posed.
“In our culture, we have a habit of saying that ‘it is just a little poke,’ and we are dismissive of adults who express fear toward needles,” says Dr. McMurtry. “But for people with high levels of needle fear, it’s not just a little poke, it is actually terrifying.”
These very elevated levels of fear are best treated with exposure-based therapy provided by a specially trained health-care professional such as a psychologist.
As part of the therapy, individuals first create a list of everything they find frightening about needles. They then face each of their fears in a graduated fashion – from least to most worrisome.
“They learn that they can actually survive their fear, and the fear will come down over time,” says Dr. McMurtry.
There’s no doubt that many people have an aversion to needles. If all those with the slightest degree of needle fear shun the injection, their collective avoidance could potentially undermine the overall success of the COVID-19 vaccine rollout.
A relatively high percentage of the population – 70 to 80 per cent – must be inoculated to achieve community immunity and curb the spread of the virus.
For that reason, experts believe that people with needle fears need to be made aware that there are ways to deal with their concerns. “Just knowing that effective solutions exist could make a big difference,” says Dr. Chambers.
Paul Taylor is a former Patient Navigator Adviser at Sunnybrook Health Sciences Centre and former health editor of The Globe and Mail.