As vaccines rollout across the country, some mental health disorders may be getting in the way of vaccine compliance. Among the mental health disorders that are particularly vulnerable to a fear of vaccines are anxiety and anxiety or panic attacks, certain phobias, including trypanophobia (a fear of needles) and agoraphobia, obsessive-compulsive disorder (OCD), and unresolved trauma, which may particularly affect Black and brown communities.

It’s an important issue. If large numbers of people refuse to take the vaccine, it can prevent the country from reaching herd immunity, the point where even those not immunized are protected from COVID-19. At present, experts place the number of people who need to be vaccinated to reach herd immunity range from 70-90%  of the population or about 248,000 million people.

“If people are reluctant to get a vaccine, it can help to figure out why,” says Helene Dow, MSW, a private therapist in Philadelphia. “If they feel vaccines were developed and released too quickly, for example, they may need to better understand that a great deal of scientific work was done on the vaccine before the pandemic began.”

While the vaccines may have appeared to have been rushed to market, both represent years of basic scientific research and were rigorously tested in clinical trials. Plus, they both are extremely effective in preventing the coronavirus: the Moderna vaccine reaches 94% effectiveness two weeks after the second dose while the Pfizer vaccine reaches 95% effectiveness one week after the second dose.1,2  Distribution of Johnson & Johnson’s single-dose vaccine, authorized by the FDA at the end of February, is also ramping up and may be available in your area soon. The J&J vaccine is 85% effective at preventing a severe or critical form of COVID-19 that can lead to hospitalization or death.

If you are having doubts about getting the vaccine, here’s some expert advice to help you face your fears so you can get your shot.

Anxiety and the COVID Vaccine

“The best way to combat vaccine hesitancy from anxiety is with reputable data,” says  Thea Gallagher, PsyD, assistant professor and director of Outpatient Clinic at the Center for the Treatment and Study of Anxiety (CTSA) in the Perelman School of Medicine at the University of Pennsylvania. “Always choose scientific data over a ‘Mom blog’ that says vaccines cause autism or offers an anti-vaxxer conspiracy theory.”

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When it comes to anti-vaxxers, experts debate whether it’s better to try to combat their unscientific theories point by scientific point, to “scare” people into vaccine compliance by showing them the effects of the coronavirus, or to resort to strategies like those of some pediatricians who require parents to vaccinate their children or leave the practice.

“Everyone has opinions, but if you’re going to doubt science due to made-up theories or your own beliefs, I don’t think anyone is going to be able to convince you of anything different,” says Gallagher. “If you really want to lower your anxiety and understand what’s truly going on you have to trust someone—and in this case, it should be scientists who have given their lives to this research and who really want you to feel better and be less vulnerable.”

Among reliable sites she recommends for valid information are the Centers for Disease Control, which works to put out clear data as quickly as possible. Or, refer to a trusted infectious disease specialist such as Dr. Anthony Fauci or a vaccine expert such as Paul Offit, MD. Or contact your own doctor or an infectious disease doctor you trust to talk about your fears.

Other tips to combat anxiety over the COVID vaccine:

  • Check your imagination: COVID vaccine anxiety is often fueled by “what-if’s”—imagined scenarios of the many ways events can head south. For example, if you fear getting the vaccine because you might have an allergic reaction, consult the facts: one study of the Pfizer vaccine showed that allergic reactions occurred about 11.1 times per million patients.3 Know that before you receive a vaccine you must complete a questionnaire on your history of allergic reactions from earlier injections. In addition, you will be asked to remain at the vaccination center for 15 to 30 minutes to assure a reaction does not occur.
  • Run a risk-benefit analysis: Thinking of the vaccine in terms of risk vs. benefits may help reframe your COVID vaccine anxiety since the risks of contracting COVID-19 are much worse than any risk posed by vaccines. “Remember that pregnant women are currently receiving the vaccine because the risks of coronavirus are much worse than taking the shot,” says Gallagher.
  • Stay in the moment: In practical terms, Gallagher suggests setting up a clear plan: map how and when you will get to the vaccination center, how you will get the shot, how you will sit afterward to wait for any negative reaction. “Work on what you need to do to follow through with each step and avoid anticipating the worst,” she advises.

“If anxiety continues to keep you from getting a shot, or if you’ve researched everything from reliable sources and you’re still too scared to sign up for a vaccine, or if you’ve made an appointment and avoided it, then you might need to see a therapist for help,” she said.

How to Foil Your Needle Phobia (and Other Phobias, Too)

It’s not just kids that have trypanophobia, a fear of needles (as much as 30% of young adults in the general population fear shots according to a systematic review of 119 studies on the topic in 2018). 4  There’s no doubt about it, anxiety around needles is a thing: a Gallup study 5 done in 1998 and 2001 found that needles ranked among the top fears of American adults, with about one fifth (21%) saying they were afraid of needles or getting an injection.

“Needle phobia is very real and understandable,” Gallagher says. “People don’t get needles every day, so they never have the chance to habituate to them. Plus, as any evolutionary biologist will tell you, the idea of a sharp object piercing the skin doesn’t seem normal.”

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Most people with this phobia fear a vasovagal response, where they will suddenly pass out. For people who have never passed out, the fear can still create a very strong sense of discomfort. Other symptoms can include dizziness, fainting, anxiety, insomnia, panic attacks, high blood pressure, elevated heart rate, or feeling emotionally or physically violent.

For those with serious needle phobias, exposure therapies, where patients are shown pictures of needles, working their way up to perhaps giving themselves a needle and finally–over four to nine visits–receiving an injection, may help.

But for people who know they have an unresolved needle phobia, but also want to get a COVID shot, Gallagher recommends planning ahead. After making an appointment, enlist a companion to accompany you to the vaccine site. Once you arrive, practicing diaphragmatic breathing to relax, listening to music or conversation may help divert your attention. Asking the medical person administering the shot to send you a signal when they are ready to perform the injection might offer a feeling of greater control, which in turn might reduce anxiety.

“And, once done, you might want to reward yourself,” Gallagher says.

Agoraphobia, a condition where you avoid going places that might cause you to panic due to a perceived inability to escape, can clearly interfere with receiving a vaccine. People may not want to drive or use subways or other public transportation to travel to receive a vaccine, fears that may be multiplied by the chance of getting COVID-19 once they leave their house. The best way to deal with this is to make sure that you’re adequately protected by PPE and to take reasonable safety precautions.

“The irony here is that getting the vaccine will help you with your fear of taking public transportation in the long run,” Gallagher says. If the fear persists, however, she recommended seeking professional help.

OCD and the COVID Vaccine

Obsessive-compulsive disorder (OCD) occurs when a person gets caught in a cycle of unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions—which can be physical or mental—are repetitive behaviors that a person employs to try to quiet or decrease anxiety or distress. According to the National Institute of Mental Health, OCD has a lifetime prevalence of 2.3%.

During the pandemic, any number of fears might spark OCD. People may fear spreading germs when they’re unknowingly COVID-positive or asymptomatic, or compulsively check information concerning updated COVID guidelines. Repeated handwashing or cleaning, mentally reviewing behavior (where you have been, how far or close you stood from others), superstitious behaviors (thinking seeing a certain or color or number might signify a ‘bad omen’ for illness) and health-related compulsions (asking for excessive reassurance from doctors about health symptoms) can be among the symptoms of the disorder.

“OCD symptoms may be exacerbated by the pandemic,” says Gallagher. “That’s why it’s important to follow CDC guidelines but NOT to go above and beyond what the CDC is recommending.”

“If you have a history of OCD or if you are noticing the urge to act compulsively, it would be good to seek professional help from an ERP (Exposure and Response) therapist,” she recommends.

For help in locating a therapist who specializes in treating OCD contact the International Obsessive Compulsive Order Foundation.

Dealing with Trauma

Over the years, the shameful medical history of the white medical establishment toward Black communities—including the Tuskegee Experiment and the case of Henrietta Lacks—have bred suspicion, anger, and resentment. For some people of color, this has led to unresolved trauma or even PTSD, where you sense bad things are going to continue to occur. Such feelings may create vaccine hesitancy around the COVID-19 vaccines.

“People of color have been taken advantage of by medical providers. They have every right to have these fears about the vaccine and every right to need to talk to medical providers in their community,” says Gallagher. “Their fear, anger, and resentment are valid because of how they have been treated.”

To deal with this unresolved trauma, experts suggest speaking to people in your community for advice on how to approach the issues. This may include medical providers from the community, community leaders, and church pastors who you trust.

“Be sure to acknowledge the history, and don’t let people dismiss it,” says Dow.

“If a Black person says they don’t trust the vaccine I think it’s incredibly important to be accepting and understanding of their resistance or reluctance.”

Once again, consulting reliable sources drawn from the Black and brown communities may help. One person to follow for information is Marcella Nunez-Smith, MD, MPH the co-chair of the Biden Coronavirus Task Force. Along with the CDC, another good site to consult is the Black Coalition Against Covid, an organization committed to “starting a national dialogue about COVID-19 through the launch of the Love Letter to Black America, from America’s Black doctors and nurses which is rooted in “the love of and for the Black community.”

For people of color who remain hesitant about the vaccine, Gallagher notes that it might help to recognize that getting a COVID-19 shot is not like undergoing a difficult surgical procedure, where significant medical problems could occur.

“In the overwhelming number of cases, it’s a relatively low-risk procedure that can produce a positive outcome.”

But, in the end, the decision on whether or not to take the vaccine may hinge on a broader issue involving health care disparities.

“We need people to acknowledge health care disparities and bring greater leadership to that cause,” says Gallagher.

Making the Decision to Get the Coronavirus Vaccine

When it comes to making medical choices, it is up to each of us to decide what’s in our best interest. If mental health issues prevent you from getting the vaccine, you might want to talk to a therapist. In some cases, such as for health care workers or essential workers, a vaccine may be required as part of the job, but in other cases, taking a breather to get some therapy or to take time to read more on the science of the vaccine may reduce your hesitancy.

A Spring 2020 study on anxiety during the pandemic found that about 62% of the respondents were anxious about the possibility of family and loved ones getting coronavirus. If you’re having difficulty with the thought of receiving the vaccine, you might consider that the vaccine is designed not only to protect you from COVID-19 but through herd immunity, your loved ones as well.

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Last Updated: Apr 13, 2021