Injection fears and COVID-19 vaccine hesitancy

Daniel Freeman, Sinéad Lambe, Ly-Mee Yu, Jason Freeman, Andrew Chadwick, Cristian Vaccari, Felicity Waite, Laina Rosebrock, Ariane Petit, Samantha Vanderslott, Stephan Lewandowsky, Michael Larkin, Stefania Innocenti, Helen McShane, Andrew J Pollard, Bao Sheng Loe

Research output: Contribution to journalArticlepeer-review


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: 15,014 UK adults, quota sampled to match the population for age, gender, ethnicity, income, and region, took part (19th January-5th 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; 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: 3927 (26.2%) screened positive for blood-injection-injury phobia. Individuals screening positive (22.0%) were more likely to report COVID-19 vaccine hesitancy than individuals screening negative (11.5%), odds ratio=2.18, CI: 1.97-2.40, p <.001. The population attributable fraction 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 <.001, Medical Fear Survey, r=0.23, p= <.001, and injection fears, r=0.25, p <.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.

Original languageEnglish
Number of pages11
JournalPsychological Medicine
Early online date11 Jun 2021
Publication statusE-pub ahead of print - 11 Jun 2021

Bibliographical note

Copyright © The Author(s), 2021. Published by Cambridge University Press. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

Funding: The study was jointly funded by the NIHR Oxford Biomedical Research Centre (IS-BRC-1215-20008) and NIHR Oxford Health Biomedical Research Centre (BRC-1215-20005). Daniel Freeman is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR or the Department of Health and Social Care. Stephan Lewandowsky received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No. 964728 (JITSUVAX). Felicity Waite is funded by a Wellcome Trust Clinical Doctoral Fellowship (102176/B/13/Z).


  • COVID-19 vaccine hesitancy
  • UK adults
  • blood-injection-injury phobia
  • needle fears


Dive into the research topics of 'Injection fears and COVID-19 vaccine hesitancy'. Together they form a unique fingerprint.

Cite this