Needle Phobia: An Underappreciated Threat

Fear of needles could derail vaccine adherence for millions of Americans

By Scott E. McFarland, JD

As the nation keeps a close watch on the development of COVID-19 vaccine candidates that might signal the beginning of the end of the pandemic, a threat looms that could lead millions of Americans to avoid obtaining the vaccine: needle phobia.

Needle phobia is a “prevalent yet under-recognized and under-prioritized” issue in healthcare, according to research published in 2016 in the journal Cognitive Behaviour Therapy. Citing a number of previous studies, researchers estimated that fear of needles affects 33%–63% of children and 14%–38% of adults, contributing to “negative experiences” with needle procedures (and healthcare as a whole) for patients, caregivers, and medical providers.

Earlier this year, Trump administration official Peter Navarro estimated in a letter to the White House Coronavirus Task Force that the U.S. alone would require 850 million needles and syringes to deliver COVID-19 and flu vaccines. While any signs of progress toward a vaccine represent encouraging news, the administration’s current approach risks leaving behind the millions of Americans who likely have needle phobia—and that oversight may have dramatic consequences for vaccine adherence.

A deeper look at needle phobia
The very nature of needle phobia makes it difficult for researchers to determine how prevalent the condition is, according to a report in the British Journal of Anaesthesia. That’s because those who experience fear of needles often avoid healthcare settings, likely resulting in an undercounting and underappreciation of the problem.

Needle phobia generally begins in childhood and can contribute to negative health issues across the lifespans of those who experience it, according to Cognitive Behaviour Therapy. Although some children and adults who suffer from needle phobia learn to cope with their fear to successfully undergo needle procedures, many others face challenges in overcoming that anxiety, leading them to respond in ways that interfere with providers’ ability to properly perform these procedures, such as flailing of limbs and attempting to escape. Alternatively, they may simply not seek necessary treatment, making their condition worsen.

Needle-phobic people who have chronic conditions such as diabetes or multiple sclerosis face particular obstacles due to requiring periodic injections to maintain their health, prompting many to base treatment decisions on fear rather than evidence-based medical recommendations. Similarly, it’s easy to surmise that some needle-phobic individuals will choose to forgo the COVID-19 vaccine, not because they believe it won’t benefit their health, but simply because they fear needles. Evidence backs up this assumption. A 2012 study published in Vaccine revealed that fear of needles was the primary reason for immunization noncompliance in both adults and children.

A solution to improve vaccine adherence
For needle-phobic individuals, needle-free injection technology represents an alternative to traditional needles and syringes and holds the potential to improve vaccine adherence. This technology is designed around a high-pressure, spring-driven, stainless-steel piston and uses a needle-free syringe to inject liquid medication subcutaneously, intramuscularly, or intradermally via a specialized device. Needle-free injection technology is easy to use and provides a consistent dose of medication with fewer variables compared to a needle injection, in which proper technique is required such as ideal needle angle and depth of skin penetration.

In addition to providing a substitute option for needle-phobic people to obtain vaccines, needle-free injection technology offers several other benefits to the health industry. First, there is a potential impending shortage of traditional needles and syringes as governments across the globe scramble to gather the supplies they need to administer the COVID-19 vaccine to their populations. To roll out the vaccine in a timely manner may require exploring all options to circulate it as widely as possible, including needle-free injection devices.

Second, needle-free technology offers potential to greatly reduce needlestick injuries to providers and staff. While the precise amount of needlestick injuries experienced by U.S. healthcare workers is unknown, estimates range from 600,000 to 800,000 each year, according to the U.S. Centers for Disease Control and Prevention, with about half of these injuries going unreported. Needle-free injection technology can minimize the risk of needlestick injuries by providing a safe, user-friendly option for administering liquid medications.

Finally, needle-free injection devices offer a greener, more environmentally friendly option than traditional needles and syringes, as needle-free devices do not require disposal in sharps containers. About 16 billion injections are administered each year across the globe, but in many cases the needles and syringes used for these injections are not disposed of properly, according to the World Health Organization. This leads to risks for healthcare workers and waste handlers who may be exposed to these sharp objects and any biohazardous materials on the devices. In contrast, disposal of needle-free injectors does not require a special container and does not present the threat of a needlestick injury, thereby reducing risks and associated costs.

Although a return to normalcy may not be possible any time soon, we will hopefully have an opportunity to play a role in getting to a new normal by obtaining a COVID-19 vaccine. Once the option becomes available, however, we can’t afford to forget the substantial needle-phobic population. For these individuals, needle-free injection technology offers a way to boost vaccine adherence without inflaming their very real fears.

Scott E. McFarland, JD, is CEO of IntegriMedical LLC.