Treating Needle Fears May Reduce COVID-19 Vaccine Hesitancy Rates by 10%

16 June 2021

A new large-scale study shows that a quarter of the UK adult population screens positive for a potential injection phobia. Strikingly, these individuals were twice as likely to report that they were COVID-19 vaccine hesitant – that is, they would put off getting vaccinated or indeed never get the jab. The study indicates that if all injection anxiety in the population was removed then just over 10% of instances of vaccine hesitancy might disappear too.

Researchers from the University of Oxford, funded by the National Institute for Health (NIHR) Research Oxford Biomedical Research Centre (BRC) and the Oxford Health BRC, asked a representative group of 15,014 UK adults in the third Oxford Coronavirus Explanations, Attitudes, and Narratives Survey (OCEANS-III) to rate their anxieties about needles and blood, and asked them about their willingness to receive a COVID-19 vaccine. The results concerning injection fears are published today in the journal Psychological Medicine.

Professor Daniel Freeman, study lead, Department of Psychiatry, University of Oxford, said: ‘For people with injection phobia the sight, say, of a hypodermic needle will prompt an initial increase in heart rate and blood pressure. This may be swiftly followed by a sudden decline in both. When that happens, some people faint. The COVID-19 vaccination programme means that almost everyone has had – or will soon have – to face the needle. People may certainly think twice about joining a queue for a vaccine if they fear that they might topple to the ground.’

Typically, people who are vaccine hesitant cite concern about the safety of the vaccines and scepticism about the seriousness of COVID-19. What the survey makes clear now, however, is that fear of the needle may also be playing a part.

The survey also showed that COVID-19 vaccine hesitancy is a little higher among younger people, and certain ethnic minority groups but it is not only vaccine scepticism that’s more common in these groups: it is injection fears too. This is not coincidental. Though they’re certainly not the main factor, the study shows that injection fears partially account for higher rates of vaccine hesitancy in these demographic groups.

Professor Freeman continues: ‘When it comes to controlling COVID-19, every vaccination counts. There is much that can be done to help people overcome their fear of needles. Cognitive behavioural therapy is typically fast and effective -- and can even be successfully given in group sessions. Treatment involves gradual exposure to needles and injections, beginning with simply showing pictures and videos. Fainting can be tackled too. Patients can be taught how to recognise the early signs of a dip in their blood pressure and to combat this drop by applied muscle tension.’

Professor Helen McShane, Professor of Vaccinology at the University of Oxford, highlighted that: ‘There are many different reasons for why people are hesitant about receiving a vaccine. A fear of needles is a significant factor in up to 10% of people who are vaccine hesitant. Whilst needle free routes of vaccination, such as via the nose, are being explored, at present the only approved routes of vaccination for COVID-19 vaccines are by injection. Understanding the underlying causes of this helps us address specific interventions that ultimately will increase vaccine uptake.’

Professor Sir Andrew Pollard, Director of the Oxford Vaccine Group at the University of Oxford said: ‘The coronavirus as a public health threat remains with us and those who are unvaccinated will continue to be at risk. Strategies to address protection for the unvaccinated are urgently needed, including getting access to vaccines for those without it and addressing fears and concerns of those who decline.’

The Oxford Coronavirus Explanations, Attitudes, and Narratives Survey (OCEANS III) was conducted between 19 January and 5 February 2021 with 15,014 UK adults, quota sampled to match the population for age, gender, ethnicity, income, and region. The study was funded by the NIHR Oxford BRC and the NIHR Oxford Health BRC.

Notes to editors:

For interview requests, contact Gen Juillet, Media Relations Manager, University of Oxford,

This new paper, Injection fears and COVID-19 vaccine hesitancy, is published in Psychological Medicine:

About the University of Oxford
Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the fifth year running, and at the heart of this success is our ground-breaking research and innovation. Oxford is world-famous for research excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research sparks imaginative and inventive insights and solutions.

The University Department of Psychiatry’s mission is to conduct world-class research, teach psychiatry to medical students, develop future researchers in a graduate programme, teach doctors in training, promote excellence in clinical practice, and develop and provide innovative clinical services. It supports research in four key areas: neurobiology, psychological treatments, developmental psychiatry and social psychiatry. The Department is committed to the translation of scientific discovery into benefits for patients.

About the NIHR
The National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) is based at the Oxford University Hospitals NHS Foundation Trust and run in partnership with the University of Oxford. The NIHR Oxford Health Biomedical Research Centre is a partnership between Oxford Health NHS Foundation Trust and the University of Oxford.

The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

  • Funding high quality, timely research that benefits the NHS, public health and social care;
  • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
  • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
  • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
  • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
  • Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.