CARD - 4 Simple Ways To Help Minimize Vaccination Anxieties

August 29, 2023

As the development of newer vaccines continues to rise, the delivery of vaccinations through community pharmacies is not expected to slow down. During the COVID-19 pandemic alone, pharmacists have administered over 18 million vaccinations to Canadians1

Despite the mass amount of vaccinations delivered over the past couple of years, needle- and vaccine-related fears are not uncommon. It is especially prevalent in children and younger adults, where approximately 2 in 3 children have a fear of needles2,3. While less common, 1 in 4 adults also experience a phobia of needles3. The most common reasons for fear of needles are general anxiety and pain, which typically leads to stress responses such as dizziness and fainting4. This fear may result in hesitancy and a delay in receiving essential vaccines for preventable diseases, as well as negative attitudes towards vaccinations that may be lifelong. In fact, up to 1 in 10 people refuse to get vaccinated due to their anxieties5. However, the CARD system provides 4 simple strategies you can use to help ease your patient’s nerves.

What is CARD?

The CARD system is a clinical practice tool developed at the University of Toronto that helps to reduce fears and stress-related reactions to vaccinations. It has now been incorporated by the Canadian Immunization Guide and the World Health Organization to help practitioners safely and comfortably deliver vaccinations to their patients. One study demonstrated a 90% reduction in fear and pain responses in children when using the CARD system in community pharmacies6.  Another study conducted during the COVID-19 pandemic showed an increase in confidence among pharmacist vaccinators in addition to minimizing patients’ fears7. CARD not only provides a positive vaccination experience for patients, but also introduces coping strategies that they can carry with them and use in other future stressful situations. 

How Do I Use CARD?

How can you use the CARD system in your pharmacy? CARD consists of 4 simple strategies which can be used before, during, and after the vaccination appointment. Each strategy has specific recommendations on helping your patients have a comfortable vaccination experience:

1. C - Comfort

There are many ways to make sure your patient is comfortable during their appointment, such as encouraging them to bring an item from home that gives them comfort or to have a snack before the appointment. You can also tell children to keep their arms relaxed and jiggly, like noodles! For patients who may be at risk of fainting, telling them to squeeze their knees together may help.

2. A - Ask

Allowing and inviting your patients to ask questions can help relieve their anxieties and feel more prepared for their vaccination. You can also support the patient by asking which coping strategies they would like to use and if there is anything you can do to make them feel more comfortable. 

3. R - Relax

Providing an environment that is relaxing for your patient is essential to lessen their anxieties. This includes the way that you speak and act towards your patient. Maintaining a calm and positive demeanour and reducing any overstimulating visual cues in the room, such as removing any obstructing equipment, can help minimize fear and stress. Performing the injection in a quiet counselling room can also reduce any noise disturbances. Walking the patient through some breathing exercises is another way to help calm their nerves, as well as keeping the needles out of the patient’s sight before injecting. Out of sight, out of mind! 

4. D - Distract 

Some patients may prefer to distract themselves while they get their vaccine. This can be done by providing small toys to children both while waiting for their vaccine and during their vaccination, or playing cartoon videos to redirect their attention. Adults can also distract themselves by listening to music or preoccupying themselves on their phone. By providing them with visual and physical activities before and during their vaccination, it may help temporarily reduce their fears. 

By using the CARD system, you can provide seamless vaccinations while building meaningful relationships with your patients. The more comfortable you make your patient’s vaccination experience, the more likely they will return to your pharmacy for other future vaccinations.

Looking for a more streamlined solution to triage and manage vaccinations at your pharmacy? MedEssist can provide you with efficient and fully-customizable vaccination scheduling and communications tools. Contact us to learn more! 


1 Neighbourhood Pharmacy Gazette. Community pharmacy & COVID vaccinations. 2022. Available: (accessed June 7, 2023).

2 Taddio A. Introducing CARD (Comfort Ask Relax Distract) as a vaccine delivery program for community pharmacy-based vaccinations. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada. 2023;156(1_suppl):2S-5S. doi:10.1177/17151635221136489

3 CDC. Needle Fears and Phobia – Find Ways to Manage. March 2023. Available:,have%20strong%20fears%20around%20needles (accessed June 7, 2023).

4 Alsbrooks K, Hoerauf K. Prevalence, causes, impacts, and management of needle phobia: An international survey of a general adult population. PLoS One. 2022 Nov 21;17(11):e0276814. doi: 10.1371/journal.pone.0276814. PMID: 36409734; PMCID: PMC9678288.

5 Taddio A, Ipp M, Thivakaran S, et al. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine. 2012;30(32):4807-4812. doi:10.1016/j.vaccine.2012.05.011 

6 Taddio A, Morrison J, Gudzak V, et al. CARD (Comfort Ask Relax Distract) for community pharmacy vaccinations in children: Effect on immunization stress-related responses and satisfaction. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada. 2023;156(1_suppl):27S-35S. doi:10.1177/17151635221137682

7 Taddio A, Morrison J, Gudzak V, et al. Integration of CARD (Comfort Ask Relax Distract) for COVID-19 community pharmacy vaccination in children: Effect on implementation outcomes. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada. 2023;156(1_suppl):36S-47S. doi:10.1177/17151635221139783

← Back to Blog


Sign up for practical tips, tricks, and insights to simplifying your workflow and growing your business.
(unsubscribe anytime)

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Ready to simplify your practice and meet new patients?
Go live with your new web portal and pharmacy dashboard in less than 24 hours.
Still unsure? 
Send us a message!
Our team is here to answer any questions you have.
Support is just a click away!