CS000000-A | 06/07/21

Summary

Findings. Consumers are concerned about vaccine effectiveness due to reported COVID-19 vaccine 

breakthrough cases and are worried about CDC’s change in monitoring vaccine breakthrough cases. Polls and 

survey data suggest that some consumers who want to wait and see before vaccination might not trust CDC 

to provide scientifically reliable information. Consumers also don’t know if COVID-19 vaccines are effective — 

which undermines confidence in COVID-19 vaccines and the vaccination system. Misinformation is circulating 

online that people who previously had COVID-19 had severe side effects after vaccination and that natural 

immunity is the most effective way to protect oneself from COVID-19. Lastly, while much of the population 

returns to pre-pandemic life, consumers with compromised immune systems feel unprotected and vulnerable 

in the absence of safeguards like universal physical distancing and mask-wearing and feel uncertain how 

effective vaccines are for them. 

Ways to take action. Federal, state, and local partners may wish to work together to disseminate messages 

about the effectiveness of COVID-19 vaccines, respond to gaps in information, and confront misinformation 

with science-based messaging. The goal of these efforts is to increase confidence in COVID-19 vaccines and 

expand vaccine uptake more broadly. Communication and outreach efforts should be expanded to address 

concerns and questions about vaccine breakthrough cases, natural immunity, and vaccine effectiveness for 

those with compromised immune systems.

COVID-19 State of Vaccine 

Confidence Insights Report

Report 9 | June 7, 2021 | Date Range: May 11-24, 2021

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).

Contents

2 Aims and Methods

3 Major Themes

3 Consumer concerns about vaccine effectiveness 

and breakthrough case reporting are fostering 

mistrust in COVID-19 vaccines and the U.S. 

vaccination system

4 Some consumers believe that natural immunity is 

as protective as COVID-19 vaccines against illness

5 Emerging Theme

6 Continuing and Evolving Themes

8 Appendix: Inputs and Sources

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence Team, Insights Unit
Page: 2

COVID-19 State of Vaccine Confidence Insights Report | Report 9 | June 7, 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 that influence COVID-19 vaccine hesitancy and uptake. This is categorized 

by their level and type of threat to vaccine confidence, degree of spread, and directionality. 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 positively impact 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 be comprehensive of 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 vaccinate

 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 9 | June 7, 2021

Major Themes

Consumer concerns about vaccine effectiveness and breakthrough case reporting 

are fostering mistrust in COVID-19 vaccines and the U.S. vaccination system.

Consumers expressed concern on social media about COVID-19 vaccine breakthrough cases and vaccine effectiveness as media 

coverage highlighted breakthrough cases among high-profile people who were fully vaccinated1,2

 and many people began to 

relax masking behaviors.3,4,5,6,a

 At the same time, on social media and in news coverage, vocal vaccine deniers and some scientists 

noted apprehension regarding CDC’s reporting change from monitoring all vaccine breakthrough cases among fully vaccinated 

people to investigating only those breakthrough cases resulting in hospitalization or death.7,8,9,10 Vocal vaccine deniers viewed 

the updated monitoring decision with suspicion and claimed that the intent of the updated policy is to exaggerate vaccine 

effectiveness by deflating case counts.11,12,13

A recent poll found that over half of consumers wanting to ‘wait and see’ before getting deciding to get vaccinated do not 

trust CDC to provide accurate, scientifically reliable information.14,15 Additionally, according to recent survey data, 32% of those 

who are hesitant about getting vaccinated don’t know if COVID-19 vaccination will work.b

 Consumer perceptions of vaccine 

ineffectiveness and lack of trust in public health agencies may undermine confidence in the broader vaccination system and 

endanger vaccine uptake among this potentially reachable unvaccinated group.16

Ways to act:

 Model and communicate estimated numbers of COVID-19 illness, medical visits, hospitalizations, and deaths prevented by 

COVID-19 vaccination in the United States.17,18 Such estimates will provide consumers a better understanding about how 

vaccination can reduce the burden of COVID-19 and can build trust in COVID-19 vaccines. 

 Disseminate messages about the effectiveness of COVID-19 vaccines with updated effectiveness data since vaccine rollout 

began. Continue to provide updates about the effectiveness of current vaccines against common variants in the United States. 

Support trusted messengers to disseminate messages to people who may currently be distrustful of CDC and other health 

authorities. 

 Amplify new evidence that vaccination likely results in less severe illness for those who are vaccinated and get infected with 

the virus that causes COVID-19, becoming a breakthrough case19,20 Leverage data suggesting that COVID-19 vaccines offer 

protection against most variants of the virus that causes COVID-19 currently circulating in the United States.21,22

a Social Listening Team. COVID-19 Interagency Social Listening Report. Washington, DC, Federal Emergency Management Agency; May 14, 2021

b Unpublished data. For methods and previous Omnibus data please see: Nguyen KH, Srivastav A, Razzaghi H, et al.

COVID-19 Vaccination Intent, Perceptions, and Reasons for Not Vaccinating Among Groups Prioritized for Early Vaccination — United States, September and December 2020. MMWR Morb 

Mortal Wkly Rep 2021;70:217–222. DOI:http://dx.doi.org/10.15585/mmwr.mm7006e3 

Source: https://www.ipsos.com/en-us/news-polls/cliffs-take-great-unmasking
Page: 4

COVID-19 State of Vaccine Confidence Insights Report | Report 9 | June 7, 2021

Some consumers believe that natural immunity is as protective as COVID-19 

vaccination against illness.

A high profile figure’s announcement that he will not get a COVID-19 vaccine because he was previously sick with COVID-1923,24

sparked a resurgence in conversations in news media and among consumers online regarding the role natural immunity plays 

in achieving population immunity and an individual’s protection from COVID-19. CDC along with some news outlets and public 

health experts continued to promote vaccination as the safest way to build protection against COVID-19.24,25,26,27 However, vocal 

vaccine deniers amplified misinformation that vaccine-induced immunity is less effective than natural immunity in protecting 

against COVID-19.28,29,30,31 At the same time, other news outlets claimed people who were previously infected were at increased 

risk for experiencing severe side effects if they did get vaccinated.32,33,34

Some news outlets and consumers online called for CDC and other 

health authorities to recognize natural immunity alongside vaccineinduced immunity as equally protective against COVID-19.35,36,37,38

Consumers online also highlighted the lack of guidance or clear direction 

so far from CDC about the role of natural immunity.39,40,41 The lack of 

acknowledgement of the contribution of natural immunity has led some 

consumers to declare that they now “identify as vaccinated.”42,43,44 Some 

of these consumers are using profile frames on Facebook to share their 

status as “naturally vaccinated” or “identifying as vaccinated” with others, 

which Facebook is working to remove.45 A related ‘challenge’ emerged 

on Tik Tok with unvaccinated consumers identifying themselves as 

future ‘lone survivors’ after all those who are vaccinated die as a result 

of vaccination.46 The lack of acknowledgment by health authorities of 

natural immunity has even led some consumers to claim that they are 

being discriminated against because their natural immunity status is not 

being recognized.47,48

Ways to act:

 Conduct research to better understand the role that natural immunity 

plays in population immunity and the length and quality of protection 

that natural immunity might provide. Leverage this work to expand 

guidance as necessary in relation to vaccination and mitigation efforts.

 Amplify messages about the benefits of vaccination for those consumers previously infected with COVID-19. Specifically 

address the misinformation that people who previously had COVID-19 are at increased risk for severe side effects and what is 

known regarding the length and effectiveness of natural immunity to COVID-19.

 Equip healthcare providers and other trusted messengers with talking points for discussing vaccination with patients who 

previously had COVID-19. Expand resources to better support these crucial conversations between providers and their 

patients.

 Expand research to better understand the vaccine intentions and compliance with mitigation behaviors of consumers who 

were previously infected with COVID-19. Expand monitoring of vaccination coverage among people with previous COVID-19 

infection.
Page: 5

COVID-19 State of Vaccine Confidence Insights Report | Report 9 | June 7, 2021

Emerging Theme

Consumers with compromised immune systems feel unprotected and worry that 

COVID-19 vaccines are not effective for them.

Since CDC’s recommendation that fully vaccinated 

people can resume normal activities without 

masking or physical distancing did not specifically 

address those with compromised immune 

systems,49,50 questions remain for those who are 

immunocompromised or immunosuppressed 

about how to reenter prepandemic life.51

Consumers with compromised immune systems 

were largely excluded from COVID-19 vaccine 

clinical trials and it is currently unknown how 

much protection these groups receive from 

vaccination.52 New research suggests that COVID-19 

vaccines might not work their best, or at all, against 

COVID-19 illness for these groups. In two studies, 

between one-half and three-quarters of organ 

transplant recipients did not mount an immune 

response after COVID-19 vaccination.53,54,55,56

In response to this new research and the CDC decision to lift masking and distancing recommendations for those who are fully 

vaccinated, many consumers with compromised immune systems expressed fear, isolation, and frustration on social media and 

in opinion articles.57,58,59 While much of the U.S. population increasingly returns to their regular routine, those with compromised 

immune systems feel unprotected and vulnerable in the absence of safeguards like universal social distancing and maskwearing and feel uncertain how effective vaccines are for them.60,61,62

Ways to act:

 Expand content on vaccine effectiveness and the benefits of vaccination for persons who are immunocompromised or 

immunosuppressed. Amplify messages about the protection conferred from COVID-19 vaccination, and any potential side 

effects of vaccination for these groups. Additionally, provide further guidance to households that contain a person or people 

with compromised immune systems on how to best protect their family member.

 Partner with healthcare providers who care for patients who are immunocompromised or immunosuppressed. Work with 

these trusted messengers to amplify the benefits of vaccination and to ensure that the most recent data about COVID-19 

illness and vaccination in persons with compromised immune systems is shared with patients and their families. 

 Support evaluation efforts to better understand how immunocompromised and immunosuppressed groups consider the 

behavioral and social drivers of COVID-19 vaccination. Understanding how consumers with compromised immune systems 

think and feel about vaccination can inform strategies to increase vaccine confidence and vaccine uptake in this critical 

population.
Page: 6

COVID-19 State of Vaccine Confidence Insights Report | Report 9 | June 7, 2021

Continuing and Evolving Themes

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.

 Misinformation. The ‘magnet challenge’ arose on social media platforms during the report period and encouraged vaccinated 

people to put a magnet to their vaccination site as “proof” that the shots injected a microchip or metal into their bodies.63,64

While this claim was quickly debunked by fact checkers,65,66,67 it continues to circulate. Additional circulating misinformation 

includes:

 Claims that the Connecticut Department of Public Health confirmed that the Moderna COVID-19 Vaccine contained a 

deadly toxin within the lipid coat of the mRNA component.68

 Claims that vaccine development processes skipped animal trials as it was found to cause death to animals.69,70

New Ways to Act

 Continue to disseminate messages about the ingredients in COVID-19 vaccines, what makes them safe, and how they work 

inside the body.

 Continue to amplify messages about how COVID-19 vaccines were evaluated and continue to be monitored for safety and 

effectiveness. 

 Incentives. Recent poll data indicated that CDC’s updated guidance allowing fully vaccinated people to discontinue wearing 

masks had little to no effect on vaccination plans for people wanting to wait and see, for people who would only get 

vaccinated if required, and people who did not plan to get vaccinated.71 However, another poll found that financial incentives 

would encourage people who remain unvaccinated to get vaccinated and could have the ability to increase vaccine uptake.72

The Ohio Department of Public Health saw an increase in vaccination rates following the announcement of their ‘Vax-a-Million’ 

lottery.73

 Adverse event reporting. New guidance from the Occupational Safety and Health Administration (OSHA) stipulated 

that employers would be liable for any adverse reactions experienced by employees as a result of COVID-19 vaccines if 

vaccination was employer mandated.74 Many vocal vaccine deniers and leading conservative voices applauded the decision 

on social media, and perpetuated the claim that vaccines are “experimental.” 75,76 Later, OSHA reversed the rule and announced 

a new guideline indicating that adverse vaccine reactions are exempt from employer reporting requirements, sowing further 

distrust and suspicion.77,78 Such a reversal reinforces mistrust in government for those already prone to mistrusting such 

systems. 

Source: https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-may-2021/
Page: 7

COVID-19 State of Vaccine Confidence Insights Report | Report 9 | June 7, 2021

Continuing and Evolving Themes (cont.)

 Proof of vaccination. As a result of CDC’s updated guidance for people who are fully vaccinated, consumers and employers 

expressed confusion in response to news articles and on social media about whether businesses can ask for proof of COVID-19 

vaccination and whether they need proof to require it to protect clients and patrons.79,80,81 Many consumers believed that 

the Health Insurance Portability and Accountability Act (HIPPA) protected consumers from having to share identifying 

health information — but this law only applies to entities like insurance providers and healthcare providers sharing that 

information.82,83

 Long COVID. A new study in preprint reported that among 

participants suffering from long COVID, 56% experienced an overall 

improvement in their symptoms after receiving mRNA COVID-19 

vaccination.84,85,86 Although the reasons for the improvement are 

still unclear and authors note that it is unknown how long such 

relief will last, many on social media signaled hope in response to 

study findings.87

"There’s not one long-COVID treatment 

that’s going to fix everyone – but the fact 

that one treatment does fix something 

means that there’s bound to be other 

treatments out there that will fix others." 

-Dr. David Strain, study author and 

lecturer at the University of Exeter 

Source: https://www.theguardian.com/society/2021/may/18/

long-covid-symptoms-ease-after-vaccination-survey-finds
Page: 8

COVID-19 State of Vaccine Confidence Insights Report | Report 9 | June 7, 2021

Appendix: Inputs and Sources

Type Input Cadence Sources Tactics for Utilization

Social 

Media 

Listening 

& Media 

Monitoring

Communication Surveillance 

Report

Daily, 

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 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, 

weekdays

Native platform searches  Sentiment analysis

Identify message gaps/voids

Direct 

Reports

CDC-INFO Metrics Weekly, 

Mondays

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, 

Mondays

 Media request line list  Leading indicator for news coverage

Identify information gaps/voids

Web Metrics Weekly, 

Wednesdays

 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, 

Mondays

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, 

Mondays

 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

FEMA Social Listening Report Daily Hootsuite

 Brandwatch

CrowdTangle

 Meltwater

 Trends/sentiment analysis

National and global news analysis

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