October 1, 2022
COVID Vaccine Needle Size Matters—So Why Aren't We Hearing More About It?

Erin McDonaugh learned she might need a longer COVID-19 vaccine needle size on Twitter. She remembers the tweet saying something like, “Did you know fat people should have a longer needle?” McDonaugh, now a personal trainer and fat activist, used to be a veterinary technician so she has experience assessing which needle length to use for animals of different sizes. But she didn’t realize the same rules applied to humans.

Armed with knowledge from fat advocates’ tweets, McDonaugh tells SELF she went into her booster appointment ready to ask questions. At the pharmacy, she asked the nurse administering her vaccine: “Are you using a long enough needle?” The nurse confirmed that she planned to use a longer-than-standard needle. “Don’t worry, I’m going to get this into the muscle tissue where it belongs,” McDonaugh recalls the nurse saying. She received her booster with a longer needle and went on her way.

According to public health experts, McDonaugh’s concerns about her booster’s needle size were founded. A 2022 paper in the journal Vaccine—coauthored by Harvard Medical School professor Fatima Cody Stanford, MD, and her former student Shradha Chhabria, MPH, MD—points to existing needle-length guidelines for vaccines and suggests that some people, especially those above a certain weight (more on this below), might be getting improperly immunized against COVID-19. The paper emphasizes a 1997 study in the Journal of the American Medical Association in particular, which found that standard-length vaccine needles were unable to penetrate the deltoid muscle (in the upper arm, around the shoulder) in “17% of men and 48% of women enrolled.”

Since COVID-19 vaccines are given intramuscularly, meaning the needle passes through the layer of fat right under your skin and injects the vaccine into your deltoid muscle, the researchers say that longer needles may be necessary for a large percentage of Americans to gain stronger COVID-19 immunity. Even so, clinical observation and anecdotal evidence suggest critical conversations about this have not become a standard in the COVID-19 vaccination effort, according to Dr. Stanford and Dr. Chhabria’s paper.

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