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. 2023 Mar;53(4):1185-1195.
doi: 10.1017/S0033291721002609. Epub 2021 Jun 11.

Injection fears and COVID-19 vaccine hesitancy

Daniel Freeman  1   2   3 , Sinéad Lambe  1   2 , Ly-Mee Yu  4 , Jason Freeman  1 , Andrew Chadwick  5 , Cristian Vaccari  5 , Felicity Waite  1   2   3 , Laina Rosebrock  1   2 , Ariane Petit  1   2 , Samantha Vanderslott  6 , Stephan Lewandowsky  7 , Michael Larkin  8 , Stefania Innocenti  9 , Helen McShane  10   11 , Andrew J Pollard  6   11 , Bao Sheng Loe  12
Affiliations

Injection fears and COVID-19 vaccine hesitancy

Daniel Freeman et al. Psychol Med. 2023 Mar.

Abstract

Background: When vaccination depends on injection, it is plausible that the blood-injection-injury cluster of fears may contribute to hesitancy. Our primary aim was to estimate in the UK adult population the proportion of COVID-19 vaccine hesitancy explained by blood-injection-injury fears.

Methods: In total, 15 014 UK adults, quota sampled to match the population for age, gender, ethnicity, income and region, took part (19 January-5 February 2021) in a non-probability online survey. The Oxford COVID-19 Vaccine Hesitancy Scale assessed intent to be vaccinated. Two scales (Specific Phobia Scale-blood-injection-injury phobia and Medical Fear Survey-injections and blood subscale) assessed blood-injection-injury fears. Four items from these scales were used to create a factor score specifically for injection fears.

Results: In total, 3927 (26.2%) screened positive for blood-injection-injury phobia. Individuals screening positive (22.0%) were more likely to report COVID-19 vaccine hesitancy compared to individuals screening negative (11.5%), odds ratio = 2.18, 95% confidence interval (CI) 1.97-2.40, p < 0.001. The population attributable fraction (PAF) indicated that if blood-injection-injury phobia were absent then this may prevent 11.5% of all instances of vaccine hesitancy, AF = 0.11; 95% CI 0.09-0.14, p < 0.001. COVID-19 vaccine hesitancy was associated with higher scores on the Specific Phobia Scale, r = 0.22, p < 0.001, Medical Fear Survey, r = 0.23, p = <0.001 and injection fears, r = 0.25, p < 0.001. Injection fears were higher in youth and in Black and Asian ethnic groups, and explained a small degree of why vaccine hesitancy is higher in these groups.

Conclusions: Across the adult population, blood-injection-injury fears may explain approximately 10% of cases of COVID-19 vaccine hesitancy. Addressing such fears will likely improve the effectiveness of vaccination programmes.

Keywords: COVID-19 vaccine hesitancy; UK adults; blood-injection-injury phobia; needle fears.

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Conflict of interest statement

AJP is Chair of UK Dept. Health and Social Care's (DHSC) Joint Committee on Vaccination & Immunisation (JCVI), but does not participate in discussions on COVID-19 vaccines, and is a member of the WHO's SAGE. The views expressed in this paper do not necessarily represent the views of DHSC, JCVI or WHO. Oxford University has entered into a partnership with Astra Zeneca for the development of a coronavirus vaccine.

Figures

Fig. 1.
Fig. 1.
Mediational model using SEM for demographic associations with vaccine hesitancy. FOI, fear of injection; VAC.HES, vaccine hesitancy; ETH.B, Black ethnicity; ETH.WO, White other ethnicity; ETH.OM, other mixed background ethnicity; ETH.A, Asian ethnicity; ETH.O, other ethnicity; INC.2040, income group between £20k and £40k; INC.4060, income group between £40k and £60k; INC.G60, income group greater than £60k; INC.PNTS, prefer not to say income group. Reference group for ethnicity is White. Reference group for gender is male.
Fig. 2.
Fig. 2.
Forest plot of associations with vaccine hesitancy (all factors included in the same model). Reference group for gender is male and for ethnicity is White.
See this image and copyright information in PMC

References

    1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
    1. Ayala, E. S., Meuret, A. E., & Ritz, T. (2009). Treatments for blood-injury-injection phobia. Journal of Psychiatric Research, 43, 1235–1242. - PubMed
    1. Dahlqwist, E., Zetterqvist, J., Pawitan, Y., & Sjölander, A. (2016). Model-based estimation of the attributable fraction for cross-sectional, case–control and cohort studies using the R package AF. European Journal of Epidemiology, 31, 575–582. - PubMed
    1. Edwards, K. M., & Booy, R. (2019). Pain control at the vaccine injection site: New insights. International Journal of Travel Medicine, 26(6), taz053. 10.1093/jtm/taz053. - DOI - PubMed
    1. Enders, C. K. (2001). The impact of nonnormality on full information maximum-likelihood estimation for structural equation models with missing data. Psychological Methods, 6, 352. - PubMed

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