Each night it’s the same. Story after story on the TV news is about the covid vaccination effort, and they are all illustrated with footage of needles sinking into exposed upper arms.

Could those visuals, ostensibly making this all seem routine, backfire?

More than causing squeamish people to look away or change the channel, researchers say such illustrations could hamper efforts to get a broad swath of U.S. residents vaccinated.

Bottom line: Many people don’t like needles, and that could further slow vaccination efforts as winter turns to spring when supplies are expected to multiply and efforts to get the hesitant to sign up for a dose will intensify.

“Fear of needles was one of the barriers that was a significant predictor of people saying, ‘I don’t think I will get this vaccine,’” said Jeanine Guidry, an assistant professor at Virginia Commonwealth University who researches visual communication and conducted a survey of 500 people in July.

And it’s not just TV news using what could be sensitive video footage.

Disinformation spread on social media often incorporates images of giant syringes, Guidry recently told the National Vaccine Advisory Committee, which makes recommendations to federal health officials. Social media has been a source of much incorrect information about vaccines in general, and covid specifically, designed to dissuade people from getting shots.

Such “fear visuals,” Guidry said, “get more attention,” and may be remembered longer than other types of illustrations.

Legitimate efforts to encourage vaccination may have also inadvertently sparked fear by showing exaggeratedly large syringes, said Guidry, who urged public health experts to be careful with their messages, too.

“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,’” said Guidry. “I can’t fathom what that would do to someone who has a needle phobia.”

Even attempts to reassure people by showing leaders such as Dr. Anthony Fauci or the president and vice president getting their covid vaccinations on TV can be triggering, said Hillel Hoffmann, an independent communications consultant and freelance writer in Philadelphia.

“I always turn away,” said Hoffmann, who recently wrote of his near lifelong fear of needles in a piece for Medicalbag, an online publication aimed at physicians.

“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,” said Hoffmann. “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.”

Public health experts say it’s important to get at least 70% to 80% of the public vaccinated to reach what is called herd immunity, when enough people will either have had the covid virus or a vaccination, to severely limit its further spread.

But fear of needles contributes to some people’s vaccine hesitancy.

An analysis of a broad range of studies from the U.S. and other countries on this topic by researchers at the University of Michigan showed that 20% to 30% of adults studied cited concern about needles, ranging from mild anxiety to a phobia strong enough to keep some from seeking medical care. Even many health care workers cited a fear of needles, according to the research, published in the Journal of Advanced Nursing in August 2018.

“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,” said Jennifer McLenon, an infection preventionist at Henry Ford Hospital in Detroit who completed the study while getting her master’s degree in epidemiology.

Another study found that 18% of health care workers in long-term care facilities felt the same way, she said.

An extreme fear of needles or medical procedures involving injections is technically called trypanophobia, said Jeffrey Geller, president of the American Psychiatric Association.

“Some people avoid needles because of fear of pain, some from fear of fainting,” said Geller. “And some people do faint.”

It may have an evolutionary basis, said Thea Gallagher, an assistant professor and the director of the clinic at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania. “We know from evolutionary biologists that seeing a sharp object going into our bodies is not something we are supposed to be cool with,” said Gallagher.

But Geller and Gallagher said barriers created by this fear or phobia could be lowered with careful public health messaging, along with self-help techniques individuals can practice or, in severe cases, professional assistance from a therapist.

Public health messaging should avoid drawings that exaggerate the size of needles or syringes, “which are not helpful,” said Geller, noting that the covid vaccinations involve “a small syringe and needle.”

But, as to the effect of those TV images night after night? Well, it could go either way.

“For those with a fear, it could exacerbate it,” said Geller. “For those who don’t have the fear, it could be reassuring to show that it’s a routine practice.”

McLenon, the researcher from Michigan, said she has heard, anecdotally, that those shots on TV “make people more afraid.” “Can’t we get some pictures of the vials or something else?” she suggested.

For instance, Hoffmann, the writer, said if he were designing the perfect visuals for a covid vaccination campaign, it would not refer to injections directly 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. They don’t have to show it.”

Still, McLenon and others say no one has yet studied the effect specific images about the covid vaccine have on people because it’s so new. And the desire to get back to a more normal society may help those with a fear of needles push themselves to get a covid vaccine, whereas they might not feel the same way about, say, an annual flu vaccination.

Hoffmann, who said his fear began after extensive dental work as a child, said he intends to get a shot. But when his turn comes, he said, he’ll likely be very nervous; his heart will race and he will sweat. Unlike some people with a fear of needles, he does not faint, although he understands that reaction.

“A lot of people assume that what I’m afraid of is the pain,” said Hoffmann. The worst part for him, he said, is how he can’t control his fear in that public setting. And it’s embarrassing. “I’m not alone when it happens. The person giving me the injection sees it. I can’t hide it.”

The emergency use authorization granted Feb. 27 by the Food and Drug Administration for the single-dose Johnson & Johnson vaccine is good news for people like Hoffmann. Both the Pfizer and Moderna vaccines currently available require two doses, spaced a few weeks apart. Which means facing fears twice.

Whether it’s one or two shots, experts suggest a variety of steps to help people who struggle get through the process — bring a support person, take deep breaths, stay positive, just to name a few.

“It’s nothing to be ashamed of. We come by it honestly,” said Gallagher from the University of Pennsylvania. “Anxiety is likely making it into a bigger monster” than it should be. “It’s not worth beating yourself up about.”

Facing the Fear

For the millions of Americans who have some fear of needles, there are ways to help yourself cope, say experts.

— Put it in perspective. Be positive about the reasons you are getting the vaccine and remember that the pain will be short-lived, like a stubbed toe, said Thea Gallagher, director of the clinic at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania. For those getting the two-dose regimens, “be objective about how the first one went,” she said, “and that you got through it.”

— Bring a support person. Some vaccination sites will allow this. Ask.

— Practice deep breathing or other techniques to help stay calm at the site. Eat something and drink water beforehand; it reduces the chance of fainting. And you can request being inoculated in a reclined position.

— Tell your vaccinator of your concerns. “When you get there, you can say, ‘Look, I don’t like needles.’ The health care providers are used to that,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

— Don’t be afraid to seek professional help if your fear is intense but you feel strongly about getting vaccinated. A therapist can use cognitive-behavioral techniques or exposure therapy to help, said Dr. Jeffrey Geller, president of the American Psychiatric Association.

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