Research has found that many Americans are afraid of needles—a fear that could further slow an already rocky rollout of Covid-19 vaccines. In response, experts are recommending strategies ranging from revamped public messaging to brand-new technology aimed at getting rid of the needle altogether. 

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A fear of needles

According to an analysis of studies from around the world that researchers at the University of Michigan (UM) published in the Journal of Advanced Nursing in 2018, 20% to 30% of adults are concerned about needles. Some have only a mild anxiety, but others report a phobia so strong it would prevent them from seeking medical care—and among those afflicted are a not-insignificant number of health care workers.

"There's a perception that people who work in hospitals would be less afraid of needles, because they're surrounded by them all the time, but one study found 27% of hospital employees who did not take the flu vaccine said it was because of needle fear or they did not like needles," Jennifer McLenon, an infection preventionist at Henry Ford Hospital who led the UM analysis, said.

Separately, Jeanine Guidry, an assistant professor at Virginia Commonwealth University who has studied vaccine hesitancy, said that "[f]ear of needles was one of the barriers that was a significant predictor of people saying 'I don't think I will get this vaccine.'"

In conversations with the National Vaccine Advisory Committee, Guidry also pointed out that misinformation on social media about vaccines often includes images of giant syringes. These "fear visuals get more attention" and might be remembered more than other pictures, Guidry said—and to make matters worse, even some legitimate public health ads feature exaggeratedly large syringes.

"If you use a picture of a huge syringe that looks twice the size of my head, that makes you go, 'OK, that's big,'" Guidry said. "I can't fathom what that would do to someone who has a needle phobia."

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Even public health campaigns that spotlight the vaccinations of key leaders, such as President Biden and Vice President Kamala Harris, can be uncomfortable for people with needle phobias, said Hillel Hoffman, a communications consultant who himself fears needles.

"I know those pictures are supposed to psych me up for the fact that the vaccine is safe and available, and I'm not worried at all about the vaccines' safety," he said. "But what I can't take because of my fear of needles is looking at a picture of someone with a small-bore needle buried in their deltoid muscle."

How the health care industry is responding to needle phobias

One way to reduce needle fear is by changing the way vaccines are advertised, according to Jeffrey Geller, president of the American Psychiatric Association.

Geller said that public health messaging should avoid using pictures that exaggerate the size of a needle or syringe, as those pictures "are not helpful."

Hoffmann said he believes an ideal Covid-19 vaccination campaign wouldn't directly reference injections at all. "If I were to drive by a drugstore and it had a poster in the window saying 'Come get it today for your family. Do it for the nation. Do it for the public good,' we would all know what the 'it' is," he said. "They don't have to show it."

But others in the health care industry are trying to solve the problem with "21st century science," the Wall Street Journal reports, and swap out the needle for innovative new vaccine delivery devices—some of which don't require a trained health care workforce to administer the vaccine.

For example, Enesi Pharma in England is developing methods for vaccine delivery that include dissolving implants, microneedle patches, electrical-pulse systems, nasal sprays, and pills. PATH, a nonprofit global health organization, is trying to freeze-dry vaccines in order to administer them as a lozenge that will melt into a gel under the tongue.

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And Codagenix is working on a Covid-19 vaccine, called Covi-Vac, that can be delivered in one dose via a nasal spray.

Separately, Michael Schrader, CEO of Vaxess Technologies, said the company is working on a microneedle patch that—he hopes—will combine a coronavirus vaccine with an influenza vaccine and "will [eventually] be mailed to your house every year."

"Our hypothesis from day one has been that Covid would become endemic and begin to look much more like influenza," Schrader said.

None of these technologies have finished development or clinical testing yet, so it will likely take months or years before they're on the market, the Wall Street Journal reports. And some skeptics think it's unlikely that needles—which are so affordable, readily accessible, and effective—will be going away any time soon.

But according to Jeffrey Fu, chief business officer for Codagenix, the Covid-19 pandemic is providing new technologies with a rare opportunity to move forward. "Because of the great urgency behind this, a lot of regulators are helping these device companies advance sooner than they would have if this were more of a traditional vaccine," he said.

According to David Hipkiss, who runs Enesi, "There is an absolute renaissance coming in this particular space" (Appleby, Kaiser Health News, 3/9; Douglas, Wall Street Journal, 3/3).