Needle phobias are preventing some people from getting COVID-19 vaccines. These interventions could help

A blade of grass and a lot of patience.

That was how Paul Friedlander finally got his dose of a COVID-19 vaccine in September. 

The 12-year-old has a needle phobia, and while he desperately wants to receive his second dose, his fears are proving hard to overcome. 

"My brain and my body just do not let me get this injection," he said.  

His mom, Anna Eberhardt Friedlander, is looking for the Vancouver nurse who poked a stalk of grass into her son's arm to mimic the pressure of a needle and spent over an hour comforting him before he got the jab at a pop up clinic at the University of British Columbia. 

She's hoping the nurse could again help her son overcome his fear so he could get a second dose of the vaccine but has so far not had luck finding the nurse, whom she only knows by her first name, Rosa.

The family tried to get Paul vaccinated a second time, but he said the experience was traumatizing, and they're unsure when they'll try again.

Provinces could do more to address fears

About 4.5 per cent of adults in Canada have a severe phobia of needles, according to the Canadian Psychological Association. It's characterized by a persistent fear of needles and intense anxiety or distress around having blood work done or receiving injections.

Anna Taddio studies fear and vaccination at the University of Toronto's Leslie Dan Faculty of Pharmacy.

She says while most nurses receive training in how to make people feel more relaxed around getting needles, there are a myriad easy and often free ways to put people with intense needle phobia at ease.

Offering longer appointments with lots of time to talk the procedure through or letting people walk outside for fresh air can make a big difference, she says. 

As provinces expand their vaccination programs to school-age children and unvaccinated adults, Taddio says, it makes sense for health providers to embed more accommodating practices in their vaccine rollout.

Some provinces, such as B.C., offer information on how to manage a needle phobia, but researchers say more concrete steps, such as dedicated spaces for those with phobias, could be beneficial. 

"If you actually have a fear of needles, that can be the only reason that's preventing you from getting vaccinated," Taddio said. 

Play their cards right 

Taddio and other needle phobia experts say it's important to not dismiss a person's phobia but to empower them by giving them choices. 

One strategy is called the CARD system. 

Patients are shown cards labelled with letters and told to choose their preferred intervention, Taddio says: "c" for comfort, "a" for asking questions, "r" for relax and "d" for distract. 

If someone chooses distraction, they might be given a basket of fidgeting toys to divert their attention.

Using the CARD system means staff can customize patients' experiences have better outcomes, Taddio says.

"It can reduce the vaccine side-effects that people who are afraid or anxious of needles have," she said. "It decreases what we call immunization stress-related responses. So this includes fear, pain, dizziness and even fainting." 

It's a system employed by Erin Ledrew at a special clinic offering COVID-19 vaccines and flu shots to needle-phobic people at the Centre for Addiction and Mental Health in Toronto. 

About a dozen needle-phobic people come in each day, Ledrew says.  

She says it's important to try to get someone's experience right the first time because the stress and anxiety from the visit can compound and make people unwilling to try to get a needle again.  

"We really need to pay attention to the fears that people have and trying to help support them in whatever capacity," she said. 

Facing your fears

At the age of 31, Amrita Nayak cannot stand the sight of needles, even in a sewing kit. 

In May, Amrita lined up for 40 minutes at a large vaccination clinic in Calgary and got her first dose of the COVID-19 vaccine.

Standing in line for 40 minutes as people talked about needles and receiving the jab while surrounded by other people also getting needles was an experience that left her upset and shaking.

"I could not look away from it, and I knew I was going to embarrass myself in front of everyone. So that made me really uncomfortable," she said. 

Her second dose was much better. 

At her request, her husband made an appointment for her to receive the shot in a private cubicle and kept it a secret until the last minute. Having less time to become anxious about the needle and getting jabbed in private, she says, helped her control her anxiety. 

She is now fully vaccinated and shares her story of getting the shot in an online needle-phobia community to encourage more people to get the vaccine as soon as they can. 

"There are very, very few people out there who understand what it feels like to be really scared of something that you cannot avoid," she said. 

If you have a fear, Public Health experts recommend that before you get vaccinated, you:

• Communicate with nurses about your fears.
• Ask to go outside for some fresh air.
• Practice breathing techniques.
• Ask if there's a private place where the vaccine can be administered.