Gustave Perna, the Army four-star general tasked with the logistical challenges of storing and distributing the anticipated COVID-19 vaccine, said on a 60 Minutes interview with CBS in November: “My worst nightmare is that we get vaccines to the American people and they don’t take them. Shame on us.”

If indeed Americans refuse to take the vaccine it may not be the fault or shame of Gen. Perna but of all of us.

A major obstacle to obtaining the herd immunity that vaccinations provide will not likely be logistical problems like distribution and storage of the vaccine. A very significant factor will be something called “trypanophobia,” an extreme fear of needles or hypodermic injections.

Trypanophobia is not just a problem for average Americans but might even affect medical professionals as well. The CBS interview quotes Judith Persichilli, the health commissioner in New Jersey, who acknowledges that even healthcare providers may be affected by a fear of needles. A survey of 2,000 physicians and nurses, found that only 60 percent of doctors and just 40 percent of nurses would agree to be vaccinated.

How Widespread Is the Fear of Needles in the General Population?

The numbers are actually quite shocking. Studies vary widely, due to methodology, but about 10 percent of the population seem to experience the Vasovagal Reflex (fainting) at the prospect of being injected. As much as 23 percent of the population may have a fear of needles. That represents over 60 million people who may decline to receive the vaccine. The actual number may be much higher than we even think. Because some of these studies are done in a medical environment it is easy to imagine that those most fearful of needles wouldn’t even participate in a study.  Additionally, because we vaccinate so much more than we did 20 or 30 years ago, the average age when people develop needle-phobia has decreased to 5.5.

Given that the COVID-19 vaccine is said to include two injections 21 days apart you see the problem. People with a fear of needles must, “screw their courage to the sticking place” for not just one injection, but two.

A Vaccine May Also Have Another Enemy

To those who fear needles, we should add latrophobia or “White Coat Syndrome” which is a fear of going to the doctor. This phobia may accompany trypanophobia. Those who suffer from Latrophobia ascribe it to a fear that the doctor will find something wrong with them which will require treatment.

Medical studies show that fear of going to the doctor may affect only three percent of the population. This is not an insignificant number when you are trying to vaccinate a population of over 350 million. The actual number might be much higher and masked as concerns about affordability, being too busy or self minimizing the seriousness of their condition. A 2018 survey of 2,000 adults done by a hearing aid company found that 60 percent of respondents had avoided being seen by a doctor for serious medical issues (like loss of hearing) they were concerned about. The average person delayed an initial visit to a doctor for 11 months. The 26 percent of people who stated they avoided the doctor because they didn’t want to get an unwanted diagnosis suggests that latrophobia may rival fear of needles in complicating the ability to administer the new COVID-19 vaccine to the American people.

General Perna and the Army may do an outstanding job in making this new vaccine available to our citizens, but if people refuse to get vaccinated the government may not have much choice but to force vaccination on the most reluctant among us.

I hope that we will recognize that legitimate issues may be at the heart of widespread vaccination refusal and take that into account when considering compulsory measures.

This article was originally published in November 2020. It has been edited for republication.