A storm in a teacup: older adults’ low prevalence of COVID-19 vaccine side-effects and their link with vaccination anxiety

The widespread COVID-19 pandemic led to unprecedentedly rapid vaccination development (Graham, 2020). One topic less addressed is vaccine side-effects and their link with anxiety, a condition detrimental to older adults (Bodner et al., 2021). General anxiety was found in 2.4% of those receiving the Pfizer vaccination (Kadali et al., 2021). Based on the Johnson & Johnson, Janssen vaccination findings, Hause et al. (2021) suggested that common side-effects typical of anxiety, for example, nausea, were driven by anxiety. As psychological factors may impact the immune system (Madison et al., 2021), anxiety may even link with side-effects atypical of anxiety (e.g., swollen-lymph-nodes). In addition to general anxiety (Kadali et al., 2021), research showed that vaccination itself may trigger anxiety, for example, its rapid development or an irrational misinformed perception of it being more dangerous than COVID-19 (Bodner et al., 2021). Thus, we examined in older adults the linking of vaccination anxiety with vaccination side-effects (both typical and atypical of anxiety), whilst controlling for general anxiety. A representative Israeli sample of vaccinated community older adults participated in this study (N= 939, mean age 68.9 ± 3.43, range 65–85; 59.9% females, 47.2% with academic education; 75.5% married/living with partner). The study was conducted between January 25th and February 4th, 2021; on January 25 cumulative COVID-19 vaccination doses administered per 100 people were 46.73, and on February 4, 62.72. Participants provided informed consent to procedures approved by authors’ university institutional review board and responded 28.15 ± 9.47 days after the first of two Pfizer BNT162b2 mRNA COVID-19 vaccinations. Questionnaire were disseminated via a polling company. Participants rated (1-not suffering at all to 5-suffering very severely) each vaccination sideeffect (based on the FDA1 and Israeli Ministry of Health2), see Table 1. A single item asked to “please rate their vaccination anxiety” (1-not-at-all to 5very-much). We also assessed general anxiety levels (GAD-7, Spitzer et al., 2006, α= 0.94). Additionally, participants were asked to subjectively rate their general health (ranging from 1-very bad to 5-very good, Idler and Benyamini, 1997). Side-effects were rare (see Table 1). The average side-effect score was unrelated to number of days from vaccination, higher in females (1.26 vs. 1.18, t= 3.81, p< 0.0001), decreased with age (r= − 0.10, p< 0.0001), negatively linked with subjective health (r= − 0.19, p< 0.0001), positively associated with GAD (r= 0.23, p< 0.0001), and vaccination anxiety (r= 0.399, p< 0.0001). Neither GAD nor vaccination anxiety linked with “days since vaccination” (p’s> 0.63). Correlations of anxietymeasures with side-effects both typical (see Table 1, depicted by ϩ) and atypical of anxiety were respectively similar (GAD, r= 0.209, p= 0.0001 vs. r= 0.224, p= 0.0001; vaccination anxiety, r= 0.341, p= 0.0001, vs. r= 0.39, p= 0.0001). Limiting typical side-effects to nausea, chills, headaches, and dizziness yielded the same results. Critically, partial correlations show that vaccination anxiety maintained its link with sideeffects even after controlling forGAD and subjective health (r= 0.36, p= 0.001). These results rejoin previous results attesting to vaccination safety and to side-effects decreasing with age (Polack et al., 2020). Vaccination anxiety (Bodner et al., 2021) did not dimmish with time since vaccination, suggesting that such anxiety is less rational. Vaccination side-effects, both typical and atypical of anxiety, similarly linked with anxiety, indicating that rather being driven by overlapping symptoms (Hause et al., 2021), anxiety perhaps impacts the immune system (Madison et al., 2021). Although vaccination anxiety also stems from irrational misinformation (Berry et al., 2021), results suggest that it may be important to one’s physical health. Alongside this study’s strengths (e.g., a large representative sample, measuring both typical and atypical side-effects and their link with vaccination anxiety, whilst controlling for both subjective health and GAD), limitations are noted. First, we focused on a specific age group and a single vaccination. Moreover, we used a single vaccination-anxiety item which may not as reliable or understood as the longer index (Bodner et al., 2021). Furthermore, although slightly mitigated by the above partial correlations, future research should control for additional factors that might impact anxiety level, for example, therapy, psychiatric, or medical history. Finally, causality could not be discerned 1https://www.fda. gov/media/144414/download 2https://en.globes. co.il/en/article-covid-vaccine-side-effects-in-israel-matchtrials-1001359338 International Psychogeriatrics (2021), 33:12, 1335–1337 © International Psychogeriatric Association 2021