CS000000-A | 10/26/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 17 | October 26, 2021 | Date Range: October 12 – 26, 2021

Summary

Findings. Employees, employers, and consumers continue to struggle with the implementation and enforcement of President 

Biden’s vaccination requirements. Protests and legal challenges persist among those opposed to the requirements, including 

the use of religious exemptions for the express purpose of circumventing compliance with requirements. On October 7, 

2021, Pfizer-BioNTech submitted initial data from their COVID-19 vaccine trial in children ages 5 to 11 years old to the FDA. 

The anticipation of the vaccine’s emergency use authorization has generated mixed feelings among social media users who 

question the safety and need to vaccinate this population, given the relatively lower rate of severe disease, compared to older 

age groups. Concern about potential vaccine side effects continues to fuel the spread of misinformation, from misconstruing 

medical journal reports, to the purported superiority of natural immunity. However, reports, news articles, and social media 

conversation indicate that, despite the opposition, there are still many people who are in favor of COVID-19 vaccination and 

vaccination requirements for both children and adults. 

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 develop 

policies that allow for paid time off for vaccination and recovery from side effects. Pediatricians should discuss potential side 

effects of vaccination with parents, while explaining the relative risk of an adverse event compared to COVID-19 complications. 

Public health practitioners should develop and disseminate simple, plain language fact sheets to help consumers choose the 

COVID-19 vaccine best suited to their individual circumstances and demographic category. Resources should also be developed 

for healthcare providers, offering guidance for conversations with consumers about natural or infection-acquired immunity 

versus vaccine-derived protections. All of these policies and communications should be written and disseminated in formats 

and languages people understand. 

Contents

2 Aims and Methods

3 Major Themes

3 Employees, employers, and consumers continue to struggle 

with the implementation and enforcement of vaccine 

requirements.

5 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 17 | October 26, 2021

Aims and Methods

By rapidly reviewing and analyzing numerous sources and inputs (see Appendix), the 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 17 | October 26, 2021

Major Themes

Employees, employers, and consumers continue to struggle with the 

implementation and enforcement of vaccine requirements. 

Employees and Employers

Across the United States, employee protests and lawsuits against workplace vaccination requirements continue.1,2 Employees 

such as healthcare workers, airline workers, police officers, and members of the armed forces have filed or plan to file lawsuits 

to block the implementation of workplace vaccination requirements.3,4,5,6,7,8 At least two police unions urged their members 

to defy vaccination requirements.9,10 Even so, some states have also enacted legislation to ban workplace vaccination 

requirements.11,12 Other states support employer vaccination requirements, joining them in appealing court decisions that 

require employers to offer religious exemptions.13,14,15,16

In addition to lawsuits, employees are organizing protests against vaccine requirements.17,18 Some of the protests fuel 

speculation that explicitly unrelated workplace issues, such as the cancelation of flights, are really protests against workplace 

vaccination requirements.19,20,21

Employees reached out to CDC-INFO reporting job terminations for failure to receive the second dose of the COVID-19 vaccine 

because of an adverse event after the first dose.a Reports of employee firings, as well as fines with workplace vaccination 

requirementsa,

22,23 could invigorate vocal vaccine deniers to continue, or even increase, messaging relating vaccination 

requirements to infringements on people’s 

freedoms. 24,25,26,27

Even though reports on employee firings 

have increased28,29,30 reports also indicate 

employer vaccination requirements 

positively impacted the number of 

vaccinated employees, and firings of 

unvaccinated employees occur at a rate of 

less than 3%.31,32,33,34

 Employers and employees contacted CDC-INFO for information about obtaining medical exemptions, paying for testing, and 

incentivizing unvaccinated employees for time spent getting tested, whether it be through paid time off or other forms of 

incentives.a Callers were also interested in whether their specific profession or employment status (i.e., temporary, new hire) 

requires vaccination, how their company can verify employees’ vaccination status, what qualifies as a medical exemption, where 

employees can get a medical exemption form, and if employers can require all new employees to be vaccinated.a

Ways to act: 

 Educate and train workers and supervisors about vaccinations and reducing the spread of COVID-19 in the workplace in 

accessible formats and language they understand (i.e., plain language, appropriate translations for non-native English 

speakers).

 Work with local public health authorities to ensure employees have safe and limited barrier access to vaccines and primary 

care services if side effects are experienced. 

 Consult with unions, local health authorities, and medical professionals to establish clearly outlined medical and religious 

exemptions and a transparent process for reviewing exemptions. The Equal Employment Opportunity Commission provides 

guidance on mandatory vaccination against COVID-19 and types of exemptions from mandates.

 Develop policies that allow for paid time off for vaccination appointments and recovery from side effects.

a

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 17 | October 26, 2021

Consumers

Consumers continue to seek information and vocalize support for and against vaccination requirements. In an analysis of 

Google Trends, the terms ‘mandate,’ ‘religious exemption,’ and other key words related to those topics were common during 

this reporting period.b A common topic for callers to CDC-INFO was how to obtain a religious exemption.c While a recent poll 

highlights that nearly half of Americans view religious exemptions as valid reasons not to be vaccinated,35 some major religious 

sects voiced their opposition to religious exemptions.36,37

Battles between consumers and government continue 

to fuel the divide over the implementation of vaccine 

requirements. Videos of people protesting in the streets 

and storming council meetings, as well as calls for lawsuits, 

bans, and boycotts to stop infringements on people’s ‘health 

freedom’ highlight the challenges many governments and 

local entities face when trying to implement requirements.38, 

39,40,41,42,43 Celebrities also continue to fuel public opposition 

to vaccination, from holding concerts to raise money against 

vaccination requirements, to using social media platforms 

to bolster support for anti-vaccination movements, to 

spreading misinformation by describing COVID-19 vaccines 

as ‘toxic’.44,45,46,47,48 Some consumers also question the viability 

of the vaccination requirements, citing that because the 

requirements were only announced verbally and not written down, they are not enforceable.49, 50

Polls indicate Americans are more stressed now compared to before the pandemic started, possibly demonstrating the 

politicization, information overload, and various public opinions could be weighing on consumers.51,52,However, polls also reveal 

the majority of Americans are now in favor of vaccination requirements, including for adult workers and school-aged children.53, 

54, 55,56

Ways to act: 

 Develop plain language fact sheets explaining and educating consumers on the topics of religious and medical exemptions.

 Create messaging explaining the process and rationale for establishing national vaccine requirements. 

 Continue to converse with people in the “movable middle,” expressing hesitancy, but at least contemplative towards vaccines 

and vaccination. 

b

Google Trends

c

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 17 | October 26, 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.

Pfizer-BioNTech applied for emergency use authorization of their COVID-19 vaccine in 

children ages 5 to 11 years old.

In anticipation of Pfizer-BioNTech’s COVID-19 vaccine’s 

emergency use authorization in children ages 5 to 11 

years old, social media users expressed both mixed 

feelings and questions about the safety and need 

to vaccinate this population. Some consumers are 

hesitant to vaccinate this age group due to concerns 

over potential long-term effects (such as kidney failure, 

heart issues, or severe illness) and low perceived risk to 

children stemming from relatively low hospitalization 

and death rates compared to adults.57,58,59,60,61,62,63,64,65,66,67

However, a recent poll found that 42% of respondents 

stated they plan to get their children vaccinated as 

soon as it is available, while only 21% reported they 

would never get their child vaccinated. This may 

indicate that despite potential side effects and low perceived risk, many consumers will still vaccinate their children.68 Since 

the submission of Pfizer-BioNTech’s data, the delay in announcements to clarify the timeline for the vaccine’s emergency 

use authorization, has led to questions about the vaccine’s availability to children. 69,70 Some consumers are voicing strong 

opposition to any type of vaccination requirement for this age group, while one state already plans to require the vaccine in 

school-aged children.71,72,73,74,75 This has led to discussion about whether there will be a federal vaccination requirement for this 

age group.76,77,78,79,80

New ways to act: 

 Provide schools and parents with educational materials highlighting the importance of COVID-19 vaccination given increased 

risk of COVID-19 infection in children due to the Delta variant.

 Prioritize creating access points of vaccination in pediatrician offices while also implementing school-located vaccination 

programs to proactively address access concerns.

 Encourage pediatricians to discuss potential side effects of vaccination with parents and caregivers while explaining the 

relative risk of an adverse event compared to COVID-19 complications.

 Communicate timelines and plans for vaccination following emergency use authorization.  
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COVID-19 State of Vaccine Confidence Insights Report | Report 17 | October 26, 2021

Consumers remain concerned about vaccine side effects, both actual and speculative 

Consumers remain uneasy about known and hypothetical vaccine side effects and continue to express their concerns in web 

searches, on social media, and via queries to CDC-INFO. Consumer fears were realized when news broke that a vaccinehesitant 37-year-old mother of two from Seattle, who received Johnson & Johnson’s Janssen vaccine, died of vaccine 

induced thrombotic thrombocytopenia.81,82,83 Her family shared a controversial eulogy84 and widely circulated the 

mother’s obituary, which Twitter artfully labeled “misleading.”85,86,87,88,89,90,91

Her name was one of Google’s top rising search terms the day her story broke nationally, but the very next day, consumers 

redirected their focus back to the topics of myocarditis92,93,94,95,96 and other reactions,97,98,99,100,101,102,103,104potential long-term effects, 105,106,107 and women’s reproductive health.108,109,110,111

A BMJ editorial112 urging that reports 

of menstrual changes following COVID-19 

vaccination be systematically investigated continues 

to be misrepresented by some news outlets and social 

media users as ‘proof’ that vaccination is harmful. 

113,114,115,116,117,118 Similarly, a preprint of a non-peer-reviewed 

study about vaccine myocarditis risk was withdrawn 

due to a miscalculation that “vastly” inflated 

myocarditis risk according to a statement from the 

University of Ottawa Heart Institute, where the study 

was conducted. Before its withdrawal, the study was 

widely shared on social media and websites known to 

spread vaccine misinformation. 119,120,121,122,123 Although hate, 

misinformation, and obstinacy continue to shape the 

discussions around COVID-19 vaccines and their real or 

imagined side effects, there are indications that consumer 

mood may be shifting, although modestly and tentatively 

possibly due to implementation of requirements and 

concern over spreading the virus to vulnerable populations 

and those that are unable to get vaccinated. Social media 

users seem increasingly unwilling to let spreaders of 

misinformation control the online narrative, and apparently 

vaccinated consumers are answering falsehoods with fact checks, level-headed rebuttals, and compelling firsthand testimony 

about vaccine need, utility, and effectiveness.124,125,126,127,128,129,130,131,132,133,134,135

New ways to act: 

 Develop and disseminate plain language fact sheets to help consumers choose the best COVID-19 vaccine for their individual 

circumstance and demographic category (i.e., age, sex, medical history, current health status, job, travel plans, etc.)

 Create and disseminate a fact sheet for healthcare professionals and vaccine providers to help guide consumers through the 

decision-making process about vaccinating themselves and their families. 
Page: 7

COVID-19 State of Vaccine Confidence Insights Report | Report 17 | October 26, 2021

Consumers continue to promote the belief that “natural immunity” is superior to 

vaccination.

Search engine metrics and media analysis specified elevated consumer interest in infection-induced, or “natural”, immunity.136

Politicians and online consumers cited studies illustrating protection from natural immunity may be equal to or greater than 

vaccine-derived protection.137, 138,139,140

Multiple consumers called on CDC and other domestic health authorities to recognize natural immunity as providing protection 

against reinfection of COVID-19.141 Consumers also emphasized the claim that antibodies from previous infection should exempt 

individuals from vaccination.142,143Sources supporting natural immunity claims often oppose population-wide vaccination in 

favor of targeting high-risk individuals for vaccinations and increased testing.144

Consumers considered spokespersons or role models such as athletes, politicians, and alleged pharmaceutical insiders, have 

appeared to have renewed the discussion of natural immunity compared to vaccine-derived protection in the context of 

vaccine requirements and exemptions.145,146,147 Some 

social media users shared reports of a former 

pharmaceutical employee claiming that natural 

immunity may produce a stronger, more robust 

immune response against subsequent COVID-19 

infection than vaccine-derived immunity.148,149,150,151 On 

multiple occasions during the reporting period, 

politicians noted the exclusion of natural immunity from 

domestic discussions of effective exemptions for 

COVID-19 vaccination requirements.152,153,154

Recently, federal judges have denied two requests to 

block COVID-19 vaccination requirements on the basis of 

natural immunity.155,156,157 Establishing ‘natural immunity’ 

as equivalent or superior to vaccine-derived immunity could undermine the necessity of requiring vaccinations of all eligible 

consumers, as well as population-level immunity.   Public health officials maintain that antibody protection against COVID-19 is 

not fully understood158,159and that some research demonstrates vaccine-derived immunity is stronger and longer-lasting 

than natural immunity.160,161

New ways to act: 

 Support research that investigates the differences between natural or “infection-acquired” immunity and vaccine-mediated 

immunity in protecting people from COVID-19 by publicizing the process and results.  

 Develop a plain language fact sheet defining the term ‘natural immunity’ and explaining the differences between natural 

immunity versus vaccine-derived protection.  

 Develop healthcare provider resources to provide guidance for conversations with consumers about natural or “infectionacquired” immunity.  

 Promote testing and increase availability and access to COVID-19 tests. 
Page: 8

COVID-19 State of Vaccine Confidence Insights Report | Report 17 | October 26, 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