CS000000-A | 12/20/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 20 | December 20, 2021 | Date Range: November 9 – 29, 2021

Summary

Findings. Consumers and news outlets had questions and concerns about the SARS-CoV-2 Omicron variant. The COVID-19 State 

of Vaccine Confidence Insights Rapid SARS-CoV-2 Omicron Variant Report was published on December 10, 2021, and is available 

here: COVID-19 State of Vaccine Confidence Insights SARS-CoV-2 Omicron Variant Rapid Report. Additionally, the public 

continued to have questions and expressed frustration about vaccine guidance. Consumers also expressed growing interest in 

using alternatives to the COVID-19 vaccines, such as therapeutics and infection-acquired immunity. Finally, consumers continue 

to have questions and concerns about COVID-19 vaccines for children and COVID-19 vaccine booster doses.

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. To increase vaccine confidence 

and optimize clinical encounters, continue to disseminate messages about the safety of receiving the COVID-19 and flu vaccines 

at the same appointment for adults and children. Finally, partner with trusted messengers, especially pharmacists, vaccine 

champions, and healthcare workers, to increase their knowledge regarding the safety of receiving the COVID-19 and flu vaccines 

at the same appointment and communicate this to the public.

Contents

2 Aims and Methods

3 Major Themes

3 Consumers and news outlets had questions and

concerns about the SARS-CoV-2 Omicron variant.

3 Consumers continue to have questions and

frustrations related to vaccine guidance.

4 Continuing and Evolving Themes

5 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 20 | December 20, 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. 

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 
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COVID-19 State of Vaccine Confidence Insights Report | Report 20 | December 20, 2021

Major Themesa

Consumers and news outlets had questions and concerns about the SARS-CoV-2 

Omicron variant. 

On December 10, 2021, the CDC published the COVID-19 State of Vaccine Confidence Insights Rapid SARS-CoV-2 Omicron 

Variant Report. The report is available here: COVID-19 State of Vaccine Confidence Insights SARS-CoV-2 Omicron Variant

Rapid Report

Consumers continue to have questions and frustrations related to vaccine 

guidance. 

Consumers expressed questions about CDC guidance on quarantine measures for vaccinated individuals after exposure to 

COVID-19.1,2,3

  CDC-INFO also received calls from individuals asking if it was safe to visit family for the holidays.b Moreover, social 

media users pointed out discrepancies in CDC guidance and quarantine practices and similar guidance and quarantine practices 

in schools and public areas.4,5

Additionally, consumers questioned whether people could donate blood or blood plasma after receiving the COVID-19 

vaccine.b,6

 These questions may have been driven by reports on social media that the Red Cross had implemented guidelines 

that people should wait to give blood donations after getting a COVID-19 vaccine or booster doses.7,8,9

 However, the American 

Red Cross confirmed that “As long as donors are symptom-free, feeling well and can provide the vaccine manufacturer’s name, 

there’s no waiting period required after receiving a COVID-19 vaccine currently authorized in the U.S.”10

Consumers also continued to discuss vaccine requirement policies.11 While many recent news articles have supported vaccine 

requirements,12,13 the issue continues to polarize along political party lines.14,15,16 News stories that have emerged during this 

reporting period have outlined legislative efforts in some states to outlaw vaccine requirements for other vaccine-preventable 

diseases.c,17 The U.S. Court of Appeals for the Fifth Circuit’s order that OSHA suspend the vaccine requirements for businesses 

received traction on web searchesd,e and news reports18 with online searches from some consumers asking whether vaccine 

requirements were legal.d The court ruling was seen as a legal victory for anti-vaccine groups19 and may amplify public antivaccine sentiments.20,21,22,23

Ways to act: 

 Create and disseminate messages related to the official guidance for quarantine measures for vaccinated individuals.

 Create and disseminate messages about the safety of receiving the COVID-19 and flu vaccines during the same appointment 

for adults and children. 

 Partner with trusted messengers, especially pharmacists, vaccine champions, and healthcare workers, to increase their 

knowledge on the safety of receiving the COVID-19 and flu vaccines during the same appointment and communicate this to 

public.

 Create and disseminate messages that confirm the safety of blood donations from vaccinated individuals to the American Red 

Cross, and that the American Red Cross does not have a restriction on donating blood after receiving the COVID-19 vaccine 

primary series or booster dose. 

a

Citations in this report are illustrative examples and are not the total number of instances of the corresponding themes.

b

CDC-INFO

c

ProjectVCTR

d

Google Trends

e

SEMRush
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COVID-19 State of Vaccine Confidence Insights Report | Report 20 | December 20, 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.

Consumers express growing interest in using alternatives to the COVID-19 vaccines, such as therapeutics and infectionacquired immunity. Overall, consumers are evaluating,24 pursuing25 or condemning26 using alternative treatments instead of 

getting the COVID-19 vaccines.   In reference to the high number of cases occurring among the unvaccinated,27 some openly 

accepted the elevated risk associated with electing not to vaccinate.28 Some claimed that the emphasis on vaccines instead 

of alternative approved therapeutics might lead some to seek therapies approved for human use but not recommended 

for treating COVID-19 (i.e., fluvoxamine, hydroxychloroquine, and ivermectin).29,30,31 Anticipation of Merck’s FDA Advisory 

Committee hearing on Molnupiravir may have elevated conversations related to COVID-19 vaccines alternatives.32 Some 

consumers33 and political leaders34,35 continued to voice concerns that vaccination requirements did not include considerations 

of infection-induced immunity. 

Consumers continue to have questions and concerns about COVID-19 vaccines for children. The Food and 

Drug Administration (FDA) authorized the Pfizer-BioNTech COVID-19 vaccine for emergency use in children 5 

through 11 years of age on October 29, 2021.36 Since then, some consumers, especially parents, have been concerned 

about adverse events and unknown long-term side effects of the vaccine, citing incomplete and rushed trials as the cause 

of their apprehension.37,38,39 Some of these worries may have been made worse by reports that vaccine clinics across 

the country accidentally administered the higher adult dosage, rather than the pediatric dosage to children 5-11 years 

of age.40,41,42 However, scientists and public health professionals have said that these higher doses will not negatively affect 

children’s health.43,44 Lastly, many consumers wanted to know when COVID-19 vaccines for children under five would 

be available.45,46,47

Consumers continue to have questions and concerns about COVID-19 booster doses. On November 19, 2021, CDC 

expanded the eligibility for COVID-19 booster doses to all adults.48 On December 9, 2021, CDC also recommended boosters 

for teens ages 16 - 17 years old.49 Information regarding this decision will be analyzed in the next State of Vaccine Confidence 

Report. Generally, consumers reacted positively to expanding eligibility for booster doses.50 However, some social media 

users continued to express their concerns and frustrations about needing to get booster doses.51,52,53,54 Vocal vaccine 

opponents used this opportunity to falsely claim that evidence supporting brand mixing was contradictory to current research 

and politically motivated.55 Online searches related to booster doses initially declined during this reporting period until the 

announcement of the discovery of the Omicron variant.f Many viewed the decision to introduce booster doses as a timely 

response to the emergence of the Omicron variant,56,57 while others lamented that the decision had taken too long.58

Consumers continued to display confusion regarding the safety and effectiveness of mixing the type and brand of the primary 

series COVID-19 vaccines and booster doses in addition to accessing vaccines from different manufacturers at a vaccination 

site.g,59,60,61 Web searches explicitly related to “mix and match boosters” spiked during this reporting period.h

 Some consumers 

described unpleasant side effects from their booster shot and attributed these to brand mixing.62 Other users expressed that 

they intended to receive only the same brand of booster dose as their primary series.63,64

f

Google Trends

g

CDC-INFO

h

Google Trends
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COVID-19 State of Vaccine Confidence Insights Report | Report 20 | December 20, 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, 

Altmetric 

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