CS000000-A | 10/15/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 16 | October 15, 2021 | Date Range: September 14 – 27, 2021

Summary

Findings. President Biden’s September 9, 2021 call for COVID-19 vaccine requirements continued to drive social media 

conversations, news articles, and responses from politicians opposed to the requirements. In summary, there continues 

to be vocal opposition among a segment of social media users to the announcement and general workplace vaccine 

requirements. The US Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee 

(VRBPAC) voted on September 17, 2021, to approve the administration of COVID-19 vaccine booster doses. On September 24, 

CDC’s Advisory Committee on Immunization Practices (ACIP) also approved the administration of COVID-19 vaccine booster 

doses. On September 20, 2021, Pfizer and BioNTech announced they submitted data to the FDA on COVID-19 vaccine trial data 

in children ages 5 to 11 years. This announcement was accompanied by increased consumer interest in vaccinating children 

including when they will be available and safety and efficacy data. Finally, consumers continued to exhibit interest in safety and 

efficacy data on booster doses and where they could find them.

Ways to take action. Federal, state, and local partners should continue to work together to explain the rationale for updated 

guidance, respond to gaps in information, and confront misinformation with evidence-based messaging. The goal of these 

efforts is to increase confidence in COVID-19 vaccines and expand vaccine uptake more broadly. Employers should provide 

periodic updates to employees on how vaccination requirements have helped reduce the spread of COVID-19 in the workplace. 

Public health organizations should create and disseminate public health messaging that presents data on the safety and efficacy 

of other childhood vaccines for kids ages 5 to 11 years and the COVID-19 vaccine in children 12 years and older. Professional 

associations and public health organizations should develop materials and tools for healthcare providers to share with their 

patients about the benefits of receiving a booster dose and when and how to get a booster dose. These communications 

should include information addressing concerns about the risks of severe side effects. 

Contents

2 Aims and Methods

3 Social media users continued to voice their concerns about President 

Biden’s vaccine requirement announcement and general workplace 

vaccine requirements. 

4 Consumers showed an increased interest in vaccinating children under 

12 years old. 

5 Consumers continue to exhibit interest in information about receiving 

booster doses.

6 Emerging Themes

7 Continuing and Evolving Themes

8 Appendix: Inputs and Sources

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence & Demand Team, Insights Unit

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
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COVID-19 State of Vaccine Confidence Insights Report | Report 16 | October 15, 2021

Aims and Methods

By rapidly reviewing and analyzing numerous sources and inputs (see Appendix), tthe biweekly COVID-19 State of Vaccine 

Confidence Insights Report emphasizes major themes influencing COVID-19 vaccine hesitancy and uptake. These are 

characterized by the level and type of threat to vaccine confidence, degree of spread, and directionality. In addition, by 

examining how consumers think and feel, social processes, and the practical issues around vaccination, the Insights Report 

seeks to identify emerging issues of misinformation, disinformation, and places where intervention efforts can improve vaccine 

confidence across the United States.

The information in this report is only a snapshot, and certain populations may be underrepresented. Images and quotes are 

illustrative examples and are not meant to comprehensively cover all content related to the highlighted themes. 

Theme Classification

How do you classify this theme/information? 

High risk Moderate risk Low risk Positive sentiment

 May lead to vaccine 

refusals and decreased 

uptake 

 Wide reach, pervasive  

 Potential to trigger 

hesitancy to vaccination

 Moderate reach, modest 

dissemination 

 Concerning, but low risk 

to vaccine confidence 

 Limited reach, limited 

dissemination 

 Could increase vaccine 

confidence, intent, or 

motivation

 Variable reach and 

dissemination

How has this theme/idea changed over time (since last report or over the course of multiple reports)? 

Increasing

Information spreading rapidly 

Stable

Information remaining 

constant at prior level 

Decreasing

Information is not gaining further 

traction and there has been no 

indication of additional activity 
Page: 3

COVID-19 State of Vaccine Confidence Insights Report | Report 16 | October 15, 2021

Major Themes

Social media users continued to voice their concerns about President Biden’s 

vaccine requirement announcement and general workplace vaccine requirements. 

 The President’s September 9, 2021, national COVID-19 vaccine requirement announcement continued to drive social media 

conversations, news articles, and responses from politicians. Polls continue to show the President’s vaccine requirements and 

any vaccine requirements for certain occupations have resulted in divided public approval with vocal opposition among some 

consumers and some vocal support.1,2,3,4,5 Social media users continue to express their frustration6,7,8,9 and support10,11,12,13 for the 

President’s vaccine requirements and any other vaccine requirements.

Individuals, organizations, and state politicians opposed to the President’s vaccine requirements or any workplace vaccine 

requirements continue to file lawsuits to stop their implementation.14,15,16,17,18,19 Courts have ruled in favor of employer and 

school vaccine requirements.20,21 However, at least one court ruling blocked a vaccine requirement for medical workers at their 

job because the employer’s policy did not have a religious exemption.22

Some employers halted implementing vaccine requirements until they receive additional guidance from the federal 

government or pending court cases.23,24News outlets reported that employees have resigned or have been terminated 

instead of getting vaccinated; however, when reported, this included generally less than two percent of employees.25,26,27,28,29,30

Additionally, Google searches related to nurses refusing the COVID-19 vaccine increased.a News outlets also reported that 

companies and states are developing mobile phone applications to confirm vaccination status, indicating that implementation 

of vaccine requirements are underway.31,32,33,34,35

Individuals contacted CDC to learn what medical conditions 

qualify for a vaccine medical exemption or where they could get 

the necessary medical or religious exemption forms.b Individuals 

continue to use Google to search for more information related 

to exemptions.a Similarly, news outlets reported on different 

religions and religious sects’ willingness to support religious 

exemptions to the COVID-19 vaccine.36,37,38

Stories of other countries adopting air travel vaccine 

requirements may have driven social media discussions about 

the implementation similar requirements in the United States 

where consumers expressed their support and fear of such air 

travel policy.39,40,41

Ways to act: 

 Periodically update employees on how vaccination requirements have helped reduce the spread of COVID-19 in the 

workplace. 

 Provide guidance on implementing vaccination requirements, including guidance on what qualifies as a medical exemption.

 Partner with state, jurisdictional, and local health departments to support employers in addressing employee concerns related 

to vaccine requirements.

 Continue to promote the benefits of vaccination that extend beyond the workplace (i.e., protection of family, vulnerable 

populations, those with underlying health conditions). 

 Document and share lessons learned from employers who successfully implemented vaccine requirements in the workplace. 

a

Google Trends

b

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 16 | October 15, 2021

Consumers showed an increased interest in vaccinating children under 12 years old. 

On September 20, 2021, Pfizer and BioNTech announced they 

submitted data from the clinical trial of their Pfizer-BioNTech COVID-19 

vaccine in children ages 5 to 11 years to the US Food and Drug 

Administration (FDA).42 After this announcement, online searches 

related to COVID-19 vaccines for children under 12 years old increased 

to the highest level compared to any other reporting period.c Since 

the announcement and subsequent news stories43,44,45 conversations 

about the need for children ages 5 to 11 years to get the COVID-19 

vaccine have increased. Social media users questioned the necessity of 

vaccinations for this age range for several reasons, including the lack 

of long-term vaccine safety data for children,46,47,48,49 the less serious 

illness in children with COVID-19 when compared to adults,50,51,52 and the perceived lack of vaccine effectiveness in children 

due to perceived lack of effectiveness in adults.53,54 Moreover, others stated children ages 5 to 11 years should not be given the 

COVID-19 vaccine due to safety concerns, especially because of reports of myocarditis, vaccine-induced strokes, blood clots in 

infants breastfeeding from vaccinated people, and multisystem inflammatory syndrome in children (MIS-C).55,56,57,58,59

Some social media users wanted additional information 

about the difference in the COVID-19 vaccine dose or 

concentration children ages 5 to 11 years would receive 

compared to the COVID-19 vaccine adults currently 

receive.60,61,62

Other social media users and parents are eager to know when the FDA will approve COVD-19 vaccines for children, with 

some saying they would get their kids vaccinated as soon as the Pfizer-BioNTech COVID-19 vaccine receives Emergency Use 

Authorization.d,63,64,65,66On the other hand, one national poll found that US adults were largely unconvinced that COVID-19 

vaccines were necessary and appropriate for children ages 5 to 11 years.67

Ways to act: 

 Create and disseminate messaging that presents data on the safety and efficacy of other childhood vaccines for kids ages 5 to 

11 years and the COVID-19 vaccine in children 12 years and older.

 Upon FDA granting an Emergency Use Authorization of COVID-19 vaccinations for children ages 5 to 11 years, create and 

disseminate messages related to how the doses differ from adults and if child height and weight affects vaccination.

 Engage trusted and new partners to disseminate and amplify these messages particularly pediatricians and professional 

associations serving pediatricians.

c

Google Trends

d

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 16 | October 15, 2021

Consumers continue to exhibit interest in information about receiving booster doses. 

A recent poll found that the majority of US adults who are vaccinated desire a booster dose.68 Recent CDC website traffic data 

similarly indicate that searches related to ‘boosters’ increased compared to the previous 7-day period. Rising inquiries into the 

location and proximity of COVID-19 vaccination sites and potential side effects of the COVID-19 vaccine may imply an interest in 

uptake.eNews sources and social media platforms also displayed elevated mentions of booster doses.fCDC’s recommendation 

for booster doses may have increased interest in booster doses.  

Some consumers, including healthcare workers, expressed confusion and that they felt betrayal at being left out of approved 

groups eligible to receive booster doses when CDC’s Advisory Committee on Immunization Practices (ACIP) panel voted to 

recommend boosters for all the FDA-approved groups except those with increased risk of getting COVID-19 due to occupational 

or institutional setting exposure.g,69 CDC recommended booster doses for individuals 18 to 64 years of age whose occupational 

or institutional setting puts them at higher risk for COVID-19 exposure and transmission.70 Some consumers and healthcare 

providers (HCPs) asked questions about getting a booster dose if they got the Johnson & Johnson’s Janssen COVID-19 vaccine or 

the Moderna COVID-19 vaccine and if patients skipped a dose of the primary series of vaccines.e,71

Polls indicate that a majority of previously vaccinated consumers would receive a booster dose when available.72 However, 

some consumers are concerned that apparent variations in booster dose because of conflicting recommendations imply a lack 

of unity among scientists,73,74 limited transparency in the vaccine authorization process,75,76 disregard for what some consider 

safety signals,77 and insufficient research of vaccines with any potential long term side effects.78,79,80,81 Consumers reported a 

misalignment between vaccine authorizing systems and retail-level distribution, as booster doses have been available before 

FDA and CDC recommendations in some locations.e

Some misinformation and disinformation themes continued in this reporting period. These include arguments that the need for 

booster doses implies that the primary series of COVID-19 vaccines are ineffective,82,83 and claims that vaccines fatally harm more 

people than they save.84,85

Ways to act: 

 Expand local guidance for fully vaccinated individuals to include booster doses and corresponding vaccination status. In 

addition, explain what nonpharmaceutical interventions they will and will not need to follow after receiving a booster dose. 

 Develop or adapt pre-existing materials and tools for healthcare providers to share with their patients about the benefits 

of receiving a booster dose and when and how to get a booster dose. In addition, include information addressing concerns 

about the risks of severe side effects. 

e

Google Trends

f

Meltwater

g

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 16 | October 15, 2021

Emerging Themes 

Consumers concerned about possible interactions between COVID-19 vaccination, 

booster doses and other vaccines or health conditions are seeking answers and 

reassurance.

Consumers are concerned about possible interactions between COVID-19 vaccines and other vaccines or health conditions.86,87,88

Consumer searches of “flu shot and booster” have been highh while internal search data show that visitors to CDC.gov are 

performing similar searches on the site.[Internal] Meanwhile, there have been CDC-INFO requests by consumers and healthcare 

professionals with questions about vaccine interactions and spacing, with a handful of queries expressing mild skepticism about 

updated guidance allowing COVID-19 and flu vaccines to be co-administered.i Additionally, some consumers are concerned 

about a possible connection between COVID-19 vaccination and the onset of shingles and potential interactions between the 

COVID-19, HPV, and shingles vaccines.89,90

Ways to act: 

 Create and disseminate messages on the known safety data of interactions between vaccines, and, if available, specifically 

about the COVID-19 vaccines.

 Partner with medical and professional associations to create, disseminate and educate providers about available interaction 

data and communicate that this is a concern people have. 

h

Google Trends

i

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 16 | October 15, 2021

Continuing and Evolving Themes 

The themes below have been noted in previous reports and continue to undermine vaccine confidence. The information 

highlighted below focuses on what is new or different from previous reports. For additional context and previous 

recommendations on these themes, see previous Insights Reports.

Consumer interest shifts from vaccine effectiveness and breakthrough infections to 

infection-induced immunity. 

Apprehension about vaccine effectiveness and breakthrough infections in vaccinated individuals led to renewed discussions 

about the superiority of infection-induced immunity, or so-called “natural immunity.” Some consumers believe they should 

be exempt from vaccine requirements and public health requirements if they previously had COVID-19.91,92 At the same time, 

news reports and social media users continue to amplify claims of ambiguous or discredited studies purporting that infectioninduced immunity is vastly more effective than vaccination.93,94,95,96 Nevertheless, news outlets present questions about the 

relationship between infection-induced immunity versus vaccine-induced immunity and its role as an overall strategy to quell 

the pandemic.97

Consumers continue to express concern about the impact the COVID-19 vaccines have on 

reproductive health.

Following a focus on male sexual health issues in the previous reporting period,98,99 social media users resumed talking about 

female reproductive health concerns amid persistent fears and continuing reports of vaginal bleeding following COVID-19 

vaccination.100,101,102,103,104,105,106

Misinformation about COVID-19 vaccines continues to spread, grows more threatening.

Social media users skeptical of vaccines and conspiracy theorists have been sharing false claims that breastfeeding infants are 

routinely dying because their mothers received mRNA COVID-19 vaccines.107,108,109,110,111,112 This has fueled outrage and anger 

directed at government and public health officials.113,114 Additionally, vocal vaccine deniers have amplified sources spreading 

misinformation and accompanying false claims about vaccine side effects and adverse events.j,115,116 Similar reporting and public 

comments are increasing fear and further eroding confidence in COVID-19 vaccines.117,118,119,120,121

j

Google Trends
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COVID-19 State of Vaccine Confidence Insights Report | Report 16 | October 15, 2021

Appendix: Inputs and Sources

Type Input Cadence Sources Tactics for Utilization

Social Media 

Listening 

& Media 

Monitoring

Communication Surveillance 

Report

Daily on 

weekdays

Google news

 Meltwater

CrowdTangle

Native platform searches

 Share of voice topic analysis to identify themes

 Emerging topics 

Meltwater Daily  Facebook, Twitter, Instagram

 Blogs

News media

Online forums

 Share of voice topic analysis

 Emerging theme topics

Identify high reach/velocity topics

OADC (Office of the 

Associate Director of 

Communication) Channel 

COVID-19 Post metrics

Weekly  Sprout Social

Native OADC account analytics

Analyze # of posts, topics 

 Success of messages, # of impressions, reach, # 

engagements

OADC Channel Comment 

Analysis

Daily on 

weekdays Native platform searches  Sentiment analysis

Identify message gaps/voids

Direct 

Reports

CDC-INFO Metrics Weekly CDC-INFO inquiry line list

 Prepared response (PR) usage report

 Cross-compare PR usage with inquiry theme 

analysis

 Sentiment analysis

Identify information gaps/voids

VTF Media Requests Weekly  Media request line list  Leading indicator for news coverage

Identify information gaps/voids

Web Metrics Weekly  Top pages

Google search queries

 Top FAQs

 Referring domains

Identify information gaps/voids,

Identify keywords/search terms, changes in web 

traffic

Research

Poll Review Weekly Harris Poll, PEW research, Gallup Poll, 

KFF 

New data related to vaccine 

hesitancy

Identify socio-behavior indicators related to 

motivation and intention to vaccinate 

Literature Review Weekly  PubMed, LitCovid, ProQuest Central 

New data related to vaccine 

hesitancy

Identify current vaccination intention

Identify barriers to vaccination

Third Party 

Reports

Tanaq Social Listening 

+Media Monitoring Report

Weekly  Meltwater

 Sprout Social

 First Draft

Native platform searches

 Trending topics

Demographic and geographic conversation 

monitoring

CrowdTangle content 

insights report

Biweekly  Facebook  Top pages (voices), groups

General trends/sentiment analysis

News analysis through posts

First Draft News Vaccine 

Misinformation Insights 

Report

Monthly  Proprietary methods  Media trends analysis

 Emerging threats and data deficits

Online vaccine narratives

Project VCTR Weekly  Proprietary methods National and regional trends in negative 

attitudes toward vaccination

Conversations around Legislation

Virality Project Weekly  Proprietary methods  Mis- and disinformation trends related to 

COVID-19 vaccine