Vaccine-related Fears Reduce Vaccine Uptake, Increase Vasovagal Symptoms for Flu, COVID-19 Vaccines

Young age was associated with vaccine-related fears that lowered vaccine uptake and increased symptoms of dizziness and lightheadedness during vaccination.

Vaccine-related fears not only reduce vaccination, but also increase symptoms of dizziness and lightheadedness at the time of injection, according to a study published in Applied Psychology: Health and Well-being.

Vaccine-related fears can affect people so much that they may get a flu shot 1 year but skip it when the next season comes around, the study found.

Researchers recruited participants who were at least 18 years of age and living in the United States through Amazon Mechanical Turk to participate in a long-term study of how vaccine-related fears influence flu shot outcomes. The pandemic enabled an evaluation of COVID-19 vaccination intention and uptake as well.

They conducted 3 surveys over the course of approximately 2 years. In October 2019, 2508 participants were queried about the existence and severity of vaccine- and blood draw-related fears.

Responses were received from 1077 participants in May and June 2020, including 591 who had not gotten their most recent flu shot and 486 who had. Patients reported the degree of any feelings of faintness, dizziness, weakness, and lightheadedness experienced while getting their most recent flu shot.

Participants were also asked about their intention to get a flu vaccine the following season, and a COVID-19 vaccine when it became available. A final survey administered in June and July 2021 included reports from 643 remaining participants on whether they had received a flu and COVID-19 vaccine.

An analysis of survey responses suggested that the combination of vaccine-related fears and feelings of dizziness and lightheadedness lowered intentions to get flu vaccinations. Many participants expressing lowered intentions ultimately did not get vaccinated. Study findings demonstrated that some participants who were vaccinated in the 2019-20 season also opted out during the 2020-21 flu season.

“We should not assume that a person who has been vaccinated in the past will automatically get vaccinated again,” said Jennifer Kowalsky, BSc, MPH, MS, PhD, assistant professor of psychology at The Ohio State University Newark Campus.

The analysis found that a combination of fear and feelings of dizziness and lightheadedness with a 2019-20 flu shot also contributed to lower uptake of COVID-19 vaccinations when they became available.

Additionally, the results revealed a link between younger age and greater vaccine-related fears and more symptoms of dizziness and lightheadedness during and after a flu shot. Regardless of which aspect of vaccination scared people—including needles, pain, feeling faint, or possible adverse effects—a higher level of overall fear was associated with more intense symptoms, dizziness, or lightheadedness.

Researchers expressed concerns over these symptoms.

“These symptoms have health and safety implications, because they increase the risk of falling,” Kowalsky noted. “For clinicians, it's relevant to have this in mind, that fear can predict those reactions. If someone shares they are feeling fearful, keeping a close eye on them is important because they may be at risk for those feelings of dizziness or lightheadedness.”

Researchers already knew these fears and symptoms exist. However, Kowalsky suggested that this study shows their impact on outcomes point to the need for interventions that address fear and potential dizziness at the time of vaccination, a topic that has not been studied much.

“Interventions could be developed that help people face fears—people who want to get vaccinated but have fears holding them back,” Kowalsky said. “Beyond targeting fears, we could also improve the experience when the person is getting vaccinated to reduce the risk and severity of symptoms.”

Kowalsky shared a technique recommended by the World Health Organization that could help people sustain oxygen flow to the brain when they’re getting a vaccine, potentially helping fend off feelings of lightheadedness. The technique, called applied muscle tension, involves crossing your legs and repeatedly tightening core and lower body muscles to briefly raise blood pressure.

Kowalsky noted that she found that this practice can reduce vasovagal symptoms, the feelings of lightheadedness and dizziness, with people highly fearful of blood and needles undergoing a simulated blood draw in a study in 2018. She intends to conduct further research to evaluate the technique's efficacy in vaccine settings.

Kowalsky’s research on vaccination was an extension of her research program on fear and vasovagal symptoms' influence on blood donation, which has dropped globally since 2020 despite being among the world's most successful public health interventions.

“People who are afraid to have blood drawn still give blood, and people who are afraid of vaccines still get vaccinated,” she concluded. “But knowing some don't go through with getting a subsequent shot creates intervention opportunities to address the effect of fear on vaccine adopters. Their experience matters.”


How vaccine-related fears affect the flu shot experience. ScienceDaily. News release. July 21, 2022. Accessed July 25, 2022.

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