Immunization stress-related responses: Implications for vaccination hesitancy and vaccination processes during the COVID-19 pandemic

Authored By: Steven Taylor and Gordon J.G. Asmundson

Fear and willingness to receive vaccinations has become an international concern and is recognized as one of the top ten largest threats to global health during the COVID19 pandemic. Hesitancy to receive vaccinations is not isolated to the pandemic as past research indicates that only roughly 30% of American adults routinely accept their seasonal flu shot. In past pandemics (e.g., Swine flu), only 20-40% of North Americans and Europeans sought vaccination. Research early on in the COVID-19 pandemic indicated that upwards of 60% of the population worldwide were willing to receive a COVID-19 vaccine; however, willingness to accept such protection continues to waiver.

Uncertainty around vaccines primarily arises from concern about the contents included in the vaccine and stress reactions to the fear of receiving a vaccination. Furthermore, the potential for adverse reactions is widely misrepresented and overrepresented across media platforms. The purpose of this review article is to explore vaccination stress-related adverse events such as the nocebo effect, where negative expectations about receiving a vaccination can lead to the experience of unpleasant side effects (e.g., numbness, pain, headache, nausea). Immunization stress-related responses were also explored, including discussion on 1) acute anxiety and stress responses (e.g., heart palpitations, hyperventilation), 2) vasovagal reactions (e.g., a temporary increase in heart rate followed by dizziness or faintness), 3) mass psychogenic illness (e.g., headache, trembling, nausea), and 4) functional neurological disorders (e.g., sensory or physiological reactions including weakness, movement disorders). Quick management of vaccination hesitancy is critical to minimize the rapid media spread of adverse reactions and misinformation. The development of manuals for healthcare professionals to support the identification of ISRRs is essential alongside ongoing public education and awareness efforts that emphasize the importance of not discounting an individual’s lived experiences of short-term unpleasant reactions. Forewarning patients about the nocebo effects and positive reframing can help reduce the prevalence of ISRRs and awareness of the potential of mass hysteria to occur, especially when vaccinating large groups of children and youth. Lastly, it is essential to educate the public that ISRRs are natural physiological stress reactions while providing education that their response is not due to the vaccination itself.

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