Multicomponent Strategies to Ease Vaccination Pain and Fear Across Ages

A multicomponent approach to vaccination distress works across the lifespan, though how it works depends on age, according to Dr. Taddio. Older adults tend to report less pain and a better experience, she explains, while younger recipients see the largest drop in fear, which she sees as the main driver of hesitancy.

Dr. Taddio stresses that no single intervention solves the problem. Pain and fear are too complex for a quick fix such as distraction alone, so her team set out to bundle the evidence into a practical system. They began with school-based vaccination, which she describes as one of the most chaotic settings, with nurses, school staff, parents, teachers, and students all involved. Working with each of those groups, they developed the CARD (Comfort, Ask, Relax, Distract) system. During the pandemic, the team extended its evaluations to community pharmacies, public health offices, and mass vaccination clinics.

Dr. Taddio explains that CARD changes an encounter in which patients typically surrender all their power into one that is participatory. Clinicians stay responsible for the injection, while patients decide how they want to be comfortable. That shared approach gives children words to ask for something different in the moment, and gives clinicians a map to follow.

She also outlines what stays in the clinician's control, including injection technique and the physical space. Cluttered rooms, long waits, and crowds all act as fear cues that build distress before the needle appears, and none of the fixes cost money.

Watch the full episode to hear how Dr. Taddio and her team developed and tested CARD in real-world settings.

In the next episode, "Patient Choice and Fear Cues: Key Changes in Vaccination Pain Management," Dr. Taddio identifies the biggest practice changes for clinicians, from collecting patient preferences ahead of time to resisting the urge to fill the silence during injections.

References:

1. Taddio A, Shah V, McMurtry CM, et al. Reducing distress during vaccine injections: 2026 clinical practice guideline update. CMAJ. 2026;198(32):E1243-E1263. doi:10.1503/cmaj.260123

2. Taddio A, Gudzak V, Jantzi M, et al. Impact of the CARD (Comfort Ask Relax Distract) system on school-based vaccinations: a cluster randomized trial. Vaccine. 2022;40:2802-2809.

3. Taddio A, Morrison J, Logeman C, et al. CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: evaluation of effectiveness outcomes from a cluster randomized trial. Hum Vaccin Immunother. 2025;21:2488064.

4. Tetui M, Grindrod K, Waite N, et al. Integrating the CARD (Comfort Ask Relax Distract) system in a mass vaccination clinic to improve the experience of individuals during COVID-19 vaccination: a pre-post implementation study. Hum Vaccin Immunother. 2022;18:2089500.