As Prime Minister Narendra Modi announced that India will shift to centralised procurement of vaccines giving hopes of more vaccines that has been elusive in many states so far, a group of people Googled how to get over their biggest fear: Needles.
In the last two months, the Coronavirus pandemic has swept through India at a pace that has staggered the scientific community and overwhelmed public health officials. The solution, all experts say, is vaccination. India's inoculation campaign, meanwhile, has dragged its feet, with 23.7 crore doses administered, out of which only 4.56 crore are fully vaccinated. This means, a mere 3.3.% of our total population, stands fully vaccinated.
Yet, as vaccination remains our biggest solution in the fight against the virus, promising a faster return to normalcy, the country is struggling with many things: Vaccine availability, vaccine hesitancy due to misinformation, vaccine accessibility and one another overlooked group of people with needle phobia.
Vaishnavi Prasad, a communications and content specialist, told BOOM Live, "I've always had the fear of needles. My fear is not specific to the vaccination itself, but anything related to blood tests or injections. I know it will not hurt. But just imagining about taking a shot, my brain blows up the imagery in my head."
The idea of the needle entering the skin is very 'scary' for the 32-year-old. Describing her anxiety at the sight of a needle, she says, "I feel weak in my knees, my body starts to shut down, like there's some impending sense of doom."
Here is what mental health professionals and behavioural science experts have to say:
What is needle phobia?
It's not something new. Needle phobia is an extreme fear of needles and is recognized as a psychiatric condition. Known to the medical fraternity as Trypanophobia, it was first described by James Hamilton in his paper, as a significant impediment to public health.
Hansika Kapoor, a Psychology researcher at Monk Prayogshala, explains, "Needle phobia is a subset of Blood-Injury-Injection phobia (BII Phobia), which is associated with an anxious reaction to the exposure of blood, injuries, needles, and other medical equipment. It is a condition where people are likely to faint at the sight of blood or in anticipation of an injury/receiving an injection, leading to avoiding any situations where this may arise. It is one of a few specific phobias where nearly 80% of individuals experience some form of syncope or presyncope (a feeling that they may faint or pass out)."
Will needle phobia cause vaccine hesitancy?
Experts speculate that 70 to 85% of the population worldwide needs to be vaccinated to meet the requisite herd immunity in our fight against COVID. Therefore, every dose counts. However, people with the fear of needles can deter people away from inoculation and have serious negative consequences for communities at large.
The current COVID-19 vaccines are all needle-based.
The estimated prevalence of BII phobia is 3-4% of the general population, but there are no specific estimates for India. A study by Latif Wani et al. (2014) with a sample of 3000+ Indians revealed that the prevalence of phobia and associated fainting was nearly twice as much in women than in men. Kapoor pointed out that the fear of needles is higher among younger age groups and this fear reduces with age. "There is also some data from earlier vaccination drives (influenza) that suggest the avoidance of vaccination among 16% of adults with this phobia. Therefore, it is likely that this could become a larger concern in India's vaccination drive against COVID-19," she said.
Urveez Kakalia, a Counselling Psychologist with Practo, agreed and said that it can contribute to vaccine hesitancy, threatening the wellbeing of other more vulnerable groups like children- for whom a vaccine is still being developed. "Resistance to taking vaccines by individuals with needle phobia could also interfere with achieving herd immunity- since herd immunity requires a large portion of the population to be immunized. Sadly, most individuals will simply avoid the immunization, rather than work on the phobia itself," she added.
For many individuals, Kakalia said, working through their phobia is a difficult process and therefore, they may not feel that there is enough at stake to work on it.
What triggers needle phobia?
Mental health professionals are not sure of why some people develop phobias, while others don't. However, it is largely understood that phobias or inexplicable fears are caused because of negative personal experiences or trauma brought on by specific objects or situations. "The fear is triggered mostly by the exposure to needles or similar things like injections/vaccinations etc. It could be triggered by childhood negative experiences with immunization. Some research evidence also suggests a genetic component. The unpleasant experiences such as fainting, feeling low or unwell, pain, coupled with previous exposure to a needle, may tend to further exacerbate fear among some people," said Kakalia said.
Chandni Aggarwal, 31, a travel entrepreneur, told BOOM Live, "I am quite freaked out with needles." Recalling her childhood experiences, she laughed and said, "Once, I was so scared, I kicked a doctor. Another time I ran away from the home and my family had to search for me and get me vaccinated."
Aggarwal, however, knows that she has to get vaccinated. "I will use some distraction measures, such as holding someone's hand tightly and get it done," she said.
How to cope with needle phobia?
An individual could lie anywhere on the anxiety spectrum, from a mild fear, to moderate to severe anxiety, to extreme phobic avoidance. If an individual is on the milder end of the spectrum, then using some relaxation strategies like breathing, muscle relaxation or, visualization strategies may help to cope with the discomfort enough, to at least get immunized, said Kakalia. She also feels that seeking therapy, especially for moderate to severe phobias can give people the power as they can then work with their therapist to devise the best possible strategies and interventions that are unique to them.
"Your therapist is specially trained (you should check if this is the case while choosing a therapist) in exposure based, cognitive behavioural therapeutic strategies- which seem to be the most efficient in helping to cure phobias. Everyone's aetiology and triggers might vary, your recovery process should be as tailored to you as your unique experience. You deserve that- and therapy can give you that," she said.
So, what behavioral interventions governments and healthcare workers leverage to address it?
Last year, the World Health Organization's (WHO) technical advisory group released a "behavioural insights framework" for compliance and uptake of any COVID-19 vaccine. Making vaccine uptake "visible" to others through clinics in prominent public places or enabling people to signal that they have received the vaccine through social media or news can contribute to vaccine acceptance.
Furthermore, when people learn that others are 'increasingly' engaging in certain behaviours, they may be more likely to follow them. Communication efforts to highlight the development of news norms will be critical, especially as the COVID-19 vaccines target new groups where vaccination may not be the common or expected behaviour.
"As with several other phobias, the general therapeutic intervention involves gradual exposure to the anxiety-provoking object or situation. Flooding, as opposed to gradual exposure, has also been used." In flooding therapy, the assumption is facing what you fear in a safe environment will make you realize that the fear was unfounded. 'Flooding' is basically facing the phobia head-on while 'gradual exposure' is a slower process.
Applied tension is another common intervention, wherein individuals are required to tense up the muscles in the body, which raises their blood pressure, followed by releasing the tension. Tense and release should be followed for about 5 times. This prevents a drop in blood pressure, thus preventing situations where one faints," Kapoor said, adding to the list of tips for coping with needle phobia.
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