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L. Graeme Smith: Fear of needles is driving vaccine hesitancy. Here’s how to beat it

Commentary

There is a video from the BBC I watched about a month ago that I very much relate to. It shows a man, Adam, and he is mustering as much determination as he can gather to gird his will and it is not enough, it is utterly inadequate.

He is a man with a needle phobia, living through a global pandemic. Being vaccinated is critically important. He wants to get a jab. He shows up to the clinic. He spends hours working up his courage. He is overwhelmed and he cannot go through with it.

That used to be me. I am part of the estimated 3.5 percent of the population diagnosed with a “blood injection injury phobia.” General fear of needles is more widespread, though. Around ten percent of the population lives with a high fear. About a quarter of adults and two thirds of children have some fear of needles. There is evidence this is driving current vaccine hesitancy by as much as 10 percent — a crucial problem when trying to get as much of society protected from COVID-19 as possible. 

I understand the hesitancy. I avoided needles as best I could for as long as I could, ever since the first time the school nurse jabbed me as a child and my vision blurred and I keeled over in a faint. The same experience followed with every subsequent needle. I’d get jabbed, my knees would go weak, and eventually just the sight of them made me sick. In Grade 6, after my hepatitis booster, I managed to at least make it back to class. But when I felt my ears begin to buzz and every sound carried an echo inside my light and rapidly rising head, I politely excused myself and made it out into the hallway before I collapsed and lay prone until a teacher found me. 

Pale and limp, “like a ghost,” a girl in my class told me later. “We thought you were dead.” In university I got sick and had to get my blood drawn for testing. I drove up to the clinic and sat outside and wept until I finally, somehow, opened the door and walked in. The nurse was nice. She gave me a juice box. 

I say that used to be me. On March 11, 2020 the reality of the pandemic hit home for most of us in North America when the NBA canceled its games because Rudy Gobert of the Utah Jazz had tested positive for the coronavirus. Providentially, just a few days later I left my last session of exposure and cognitive behavioural therapy to get over my fear of needles. I still do not love them, but they no longer defeat me. Just in time. 

All of this said just to say: if you are afraid of needles and if this has been a particularly difficult year accordingly, if you have postponed getting the vaccines because of it, I understand. But it is better to be free of this fear. That seems impossible. It is not. It will be difficult and uncomfortable, but is easier with a plan. And if you are like Adam from the BBC video and desperate to get over your phobia, here are some practical steps you can take. (Obvious disclaimer here that I am not an expert. Consult with your doctor or trusted mental health professional and they will provide personalized guidance. This is just what helped me.)

On the advice of a psychology professor at my university I began a self-directed program of exposure therapy during my fourth year, and mainly so I’d have an experience to write about for a literary journalism class I was taking. To my genuine surprise, it was actually effective. I fell out of practice once I finished the class, but picked it up again a few years later with the help of a therapist who kept me accountable to a schedule. 

Overcoming Medical Phobias: How to conquer fear of blood, needles, dentists and doctors by Martin M. Antony and Mark A. Watling was the resource I initially used, and I am certain you will find it if not helpful then at least informative on the subject. 

The concept is simple. Exposure therapy, as the name suggests, helps you to overcome your fears by exposing you to them, little by little and only as much as you can initially handle, until as much as you can handle becomes quite a lot indeed. 

Think of the scariest movie you have ever seen and how you felt the first time you watched it. Now, take the time, and watch it ten times in a row back-to-back-to-back- etc. It is impossible for Jigsaw, Freddie, Hannibal Lecter to retain their same terrible form once the novelty of the experience is gone. Eventually with enough repeated exposure you adapt; the same blood, screams, and shifting shadows necessarily lose their horrific hold on your imagination. Your body cannot muster fight or flight urgency to the exact same stimuli, over and over again. The Exorcist is scary the first time you watch it. It is boring the one hundred-and-first time. 

Phobias are more persistent than jump scares. Still, the concept applies. To start, list out the situations and aspects related to getting a needle that are frightening. Then, develop a hierarchy and rank them from least frightening to most frightening. 

Start by exposing yourself to the least frightening activity you have listed (perhaps looking at a picture of a needle) for as long as you can, as many times as you can, until it becomes bearable. Then, next session, move on to the next activity (perhaps holding a real needle in your hands), and do not stop until each activity listed, each previously incomprehensibly difficult task (like actually getting a needle), has become dull and familiar and as easy for you as everyone else. This may take weeks or months, but you will see results if you are persistent.

Additionally, if you feel faint or dizzy during or after injections, as I used to, this is a common response known as a vasovagal syncope. Applying muscle tension in the moment will help. 

I empathize with Adam trying to get his needle through sheer brute force of will. But that is clearly not a sustainable strategy. “It feels like the world is ending in that moment,” Adam says. I know. But it is much easier to prepare yourself for the moment beforehand, to neutralize it before it can arrive and collapse down upon you. 

With phobias, your physical response follows from your mental state. Overall, understanding how much of my fear response was being caused and worsened by my own mind, my constant catastrophization, was crucial to lessening that fear and getting on with the exposures. 

Truly, starting is the most difficult part. If that is a trite statement then so be it; it is no less true for it. Here is another: It takes hard work to do the hard things worth doing, and this is worth doing. Not just to dutifully meet the demands of this moment, but because your own wellbeing will be better for it long after this virus is an afterthought. You got this.

Geoff Sigalet: No housing plan is effective without the provinces

Commentary

Over the coming days, The Hub will publish mandate letters for the incoming cabinet ministers that set out a series of bold policy prescriptions that would cumulatively tilt Canadian politics towards a different and better future.

The best antidote to anger and frustration is aspiration and purpose. The campaign has demonstrated how urgently Canada’s body politic needs such a remedy. There’s no time to waste. It’s time to get to work.

Dear Minister of Intergovernmental Affairs,

I am honoured that you have agreed to serve Canadians as the Minister of Intergovernmental Affairs.

As you know, Her Majesty’s government faces many challenges that will require co-ordination, trust, and respect between federal and provincial authorities. We cannot manage the COVID-19 health crisis, encourage economic recovery, nor tackle issues such as unaffordable housing, threats to the environment, divisions in national unity, and reconciliation with indigenous Canadians, unless we co-ordinate federal and provincial policies. To that end, we must build trust with the provinces and territories and respect the Constitution’s division of powers.

We must also remember that the 2021 election once again revealed the stark challenges facing Canada’s national unity and reconciliation with indigenous Canadians. The Western provinces have once again voted overwhelmingly for the Conservative Party as an expression of their frustrations with the way the federal government has treated Western interests. Quebecers have elected numerous separatists to Parliament in a renewed demonstration of concerns about their unfair treatment in our confederation. And new discoveries about the past injustices on Canada’s Indian Residential Schools have underlined the need for redoubling our efforts to achieve reconciliation with indigenous Canadians.

  • Co-ordinate healthcare policy with the provincial governments to ensure the health and safety of Canadians, and to do so with special concern for fighting back against the COVID-19 pandemic. You must accomplish this with upmost respect for the provinces’ exclusive rights to legislate on the management of hospitals and municipal institutions.
  • You will also need to proactively respond to provincial needs. For example, Alberta’s Minister of Municipal Affairs has written to the federal Minister of Public Safety to request assistance in increasing aero-evacuation capacity and augmenting Alberta Health Services staff. COVID-19 has hit Alberta hard, and as Minister of Intergovernmental affairs I ask that you work with the Minister of Public Safety, the Minister of Health, and provincial counterparts to establish a COVID-19 emergency response committee for assisting provinces that find themselves in Alberta’s situation. The committee will help foster clear lines of communication between the federal government, provinces in crisis, and those with more manageable hospitalization numbers, and will also develop measures for what kinds of resources will likely be required in different scenarios. We must learn from the COVID-19 crisis as it develops and enters new phases.
  • COVID-19 has exacerbated the economic challenges facing Canadians, especially the middle class. A swift recovery requires that our economic policies must be enacted in partnership with provincial governments. You must work with the Minister of Finance and the provinces to find ways of incentivizing and supporting Canadian workers across the country. This work will involve encouraging free trade between the provinces by inviting the first ministers to renegotiate the Canadian Free Trade Agreement and encouraging the removal of more barriers to inter-provincial trade in exchange for significant reforms to transfer payments and tax swaps (e.g. the elimination of the GST).
  • In the 2021 election it became clear that Canadians of almost every political party supported reforms addressing the increasing unaffordability of housing. No housing policy plan will be effective at making houses more affordable without the involvement of provincial governments. One of your key tasks as Minister will be to meet with the premiers to negotiate standardizing provincial taxes on foreign buyers of residential property in tandem with new exemptions for out-of-province Canadian home buyers. The new tax regimes should be agreed to alongside federal commitments to encourage the construction of residential housing.
  • It is also important to work with the provinces in designing policies that will help Canada protect its environment, which requires meeting its commitments at the Paris Agreement. That means reducing greenhouse gas emissions. In the References Re. Greenhouse Gas Pollution Act, the Supreme Court upheld the constitutionality of federal legislation imposing a pricing backstop on greenhouse gas emissions in the provinces. But the decision also highlighted just how narrow the federal government’s jurisdiction is under the “Peace, Order, and Good Government” clause of the Constitution Act, 1867. As minister, you must work with the provinces to ensure that the regulatory backstop is not applied arbitrarily in ways that devolve into the kind of punitive taxation that the Supreme Court suggested would be unconstitutional.
  • But there is much more to protecting the environment than climate change. Other threats to the environment will require you to work with the provinces for constitutionally respectful solutions. For example, Pacific salmon and steelhead stocks have declined in many areas. Provincial and federal policy must be co-ordinated to ensure that salmon and steelhead stocks are protected. This will require you to better co-ordinate policy with the Department of Fisheries and Oceans and British Columbia’s Ministry of Forests, Lands, and Resource Management. Funding for the federal Pacific Salmon Initiative and efforts should be increased in tandem with increased provincial involvement and the project’s mandate should be extended to protecting wild steelhead stocks. Wild Pacific salmon and steelhead populations must not be allowed to collapse the way that Atlantic cod populations did in 1993.
  • To resolve Western alienation, you must organize a constitutional convention to negotiate with the provinces to amend section 36 of the Constitution Act, 1982 to make Canada’s equalization payments scheme more equitable, and to clarify how the division of powers relates to environmental matters. As part of these negotiations, you must also seek to have the other provinces agree to constitutionally recognize Quebec’s status as a nation and the primacy of the French language in that province. Together, these bold constitutional amendments promise to unite our country. And a meeting of the first ministers offers an exciting chance for the representatives of indigenous Canadians to make their own constitutional concerns heard.
  • Finally, as a gesture of good faith to the provinces, and in the interest of ensuring that federal policymaking respects the constitutional division of powers, you must work with the Minister of Justice to develop a “Federalism Statements” program akin to the current “Charter Statements” measure. The Department of Justice Act currently requires that every government bill is accompanied by a “Charter Statement” from the Minister of Justice explaining the effects of the proposed bill on the Charter of Rights and Freedoms. The Act should be amended to require a joint “Federalism Statement” from your Ministry and the Ministry of Justice attesting to the effects of government bills on the division of powers.

I know I can count on you to fulfill these responsibilities and help to deliver a different and better future rooted in prosperity and opportunity for all Canadians.