CS000000-A | 1/26/22

COVID-19 State of Vaccine 

Confidence Insights Report

Report 21 | January 26, 2022 | Date Range: November 30 – December 20, 2021

Summary

Findings. The major theme for this report is that some consumers express distrust for the authorization of COVID-19 vaccines 

after CDC updated its recommendations with a preference for the Pfizer-BioNTech and Moderna vaccines over the Johnson 

& Johnson’s Janssen COVID-19 Vaccine. A second theme is that consumers and news outlets continue to have questions and 

concerns about the SARS-CoV-2 Omicron variant. Third, consumers and parents continue to discuss concerns surrounding 

COVID-19 vaccines for children. The final finding from this report is that consumers have questions and concerns about the 

safety and effectiveness of the COVID-19 booster dose, mixing vaccine brands and types, and the potential need for additional 

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 mis/disinformation with evidence-based messaging. These efforts 

aim to increase confidence in COVID-19 vaccines and expand vaccine uptake more broadly. Create, disseminate, and amplify 

messages, especially on social media, that explain why the Pfizer-BioNTech or Moderna COVID-19 vaccines are preferred over 

the J&J/Janssen COVID-19 vaccine in most cases, including what has changed since the Janssen COVID-19 vaccine pause lifted 

on April 23, 2021. 

Contents

2 Aims and Methods

3 Major Themes

3 Consumers express distrust for the authorization of 

COVID-19 vaccines after CDC endorsed a preference 

for the Pfizer-BioNTech and Moderna vaccines.

4 Continuing and Evolving Themes

3 Consumers and news outlets have questions and 

concerns about the SARS-CoV-2 Omicron variant.

3 Consumers and parents continue to discuss 

concerns surrounding COVID vaccines for children 

3 Consumers have questions and concerns about the 

safety and effectiveness of the COVID-19 booster 

doses, mixing vaccine brands and types, and the 

potential need for additional booster doses. 

4 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 21 | January 26, 2022

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. Themes 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 21 | January 26, 2022

Major Themea

Consumers express distrust for the authorization of COVID-19 vaccines after CDC 

endorsed a preference for the Pfizer-BioNTech and Moderna vaccines.

On December 16, 2021, the CDC adopted vaccination recommendations made by the Advisory Committee on Immunization 

Practices (ACIP) to prevent COVID-19, expressing a clinical preference for individuals to receive an mRNA COVID-19 vaccine over the 

Janssen COVID-19 vaccine.1

 Social media and online searches about Janssen COVID-19 vaccine and blood clots increased after the 

announcement.b

 This can potentially impact vaccine confidence and uptake as it may imply to people that already have concerns that 

the vaccination authorization system is flawed, and the COVID-19 vaccines are not safe.

Perceptions, Concerns, and Threats to Vaccine Confidence

 Some social media users stated that the change in guidance proves their 

safety concerns about the vaccines are valid.2,3,4

 Online, people claimed this change in guidance is evidence that the 

vaccination authorization system is too flawed to trust.5,6,7,8

 Individuals expressed concern about getting blood clots after receiving 

Janssen COVID-19 vaccine.9,10,11,12

 Some people believed this change is evidence that pharmaceutical companies 

have too much influence in the vaccine authorization process.13,14,15

Content Gaps and Information Voids

 Does this change in preference show that other COVID-19 vaccines might be dangerous? 

 The ACIP reaffirmed that the benefits of COVID-19 vaccination outweighed risks. However, mRNA COVID-19 vaccines are 

generally safer than Janssen COVID-19 vaccine and thus mRNA vaccines are preferred. COVID-19 vaccine severe adverse 

events are rare, but severe adverse events from mRNA vaccines are even more rare than from the Janssen vaccine.16 

 Do pharmaceutical companies have too much influence over government health policy? 

 No, the ACIP is an independent advisory committee.17

 Why were the data on blood clots not considered during the initial vaccine authorization process? 

 As new information became available regarding the Janssen COVID-19 vaccine side effect from blood clots, vaccine 

safety was reassessed and the clinical preference for mRNA vaccines was made. However, it was determined that for most 

populations, the benefits of the vaccine outweighed the risk of rare adverse events.18

 Why did the CDC not end the recommendation for using Janssen COVID-19 vaccine instead of preferring the other COVID-19 

vaccines on December 16, 2021? 

 ACIP’s unanimous recommendation followed a robust discussion of the latest evidence on vaccine effectiveness, the 

epidemiology of the pandemic, vaccine safety, and rare adverse events, and consideration of the U.S. vaccine supply. ACIP 

reaffirmed that receiving any COVID-19 vaccine that is authorized or approved for use in the United States is better than 

being unvaccinated.19

Misinformation Themes

 NIH has joint ownership of the Moderna vaccine and helped orchestrate the pandemic for profit.20,21

 Johnson & Johnson was bribing doctors and politicians to hide the risk of serious vaccine adverse events.22,23

Ways to Take Action

 Create, disseminate, and amplify messages, especially on social media, that explain why the Pfizer-BioNTech and Moderna COVID-19 

vaccines are preferred over the Janssen COVID-19 vaccine . Messages should include changes that have occurred since the Janssen 

COVID-19 vaccine pause lifted on April 23, 2021. 

 Create, disseminate, and amplify messages that directly address those who have already received the Janssen COVID-19 vaccine. 

Messages should address uncertainty and provide information on what they should do next. 

 Continue to amplify messages and work with trusted messengers to promote that primary series and booster shot from mRNA 

COVID-19 vaccine doses are the best method of protection against severe COVID-19 infections, hospitalizations, and deaths. 

 Amplify messages about the safety of mRNA COVID-19 vaccines, highlighting the low number of adverse events following a high 

number of administered vaccines and vigilant safety monitoring.

 Amplify messages that promote vaccination benefits for all eligible people and show vaccination effectiveness in reducing 

hospitalizations and deaths.

a

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

b

Google Trends
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COVID-19 State of Vaccine Confidence Insights Report | Report 21 | January 26, 2022

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 and news outlets have 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 SARS-CoV-2 Omicron Variant 

Rapid Report. Online conversations surrounding the SARS-CoV-2 Omicron variant increased by 424% during the reporting 

period November 30 – December 20, 2021.c

Perceptions, Concerns, and Threats to Vaccine Confidence 

 News outlets and social media users debated the symptoms associated with the Omicron variant and stressed the importance 

of vaccination for those not yet vaccinated.d,24,25

 Online conversations and public sentiments around the Omicron variant included feelings of pandemic fatigue, hopelessness, 

and resignation,26,27,28,29,30 distrust in public institutions and pharmaceutical companies,d,31,32 and assertions that COVID-19 

vaccines are ineffective or cause harm.d,33,34

Content Gaps and Information Voids 

 Are the vaccines effective against the Omicron variant given the frequency of breakthrough cases?e,d,35,36,37

 Current vaccines are expected to protect against severe illness, hospitalization, and death due to infection with the Omicron 

variant.38

 Will people have to get a booster to prevent the Omicron infection?e,39 

 Everyone 12 years and older are recommended to get a booster dose.40

Misinformation Themes

 The emergence of new variants will lead to an endless production of variant-specific boosters and financial gain for 

pharmaceutical companies.41,42,43,44

 Recent travel bans and mitigation strategies were an “overreaction” from world leaders because the Omicron does not pose a 

significant threat.45,46,47

 Only those who are vaccinated have been infected with the Omicron variant.48,49,50

Ways to Take Action

 Amplify messages that promote vaccination benefits for all eligible people and show vaccination effectiveness in reducing 

hospitalizations and deaths. 

 Disseminate current data on the Omicron variant and the continued need for vaccination with primary series if unvaccinated, 

and booster dose.

 Promote trust in public institutions by providing clear and defined recommendations for risk mitigation. 

c

Meltwater

d

Google Trends

e

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 21 | January 26, 2022

Consumers and parents continue to discuss concerns surrounding COVID-19 

vaccines for children. 

The Food and Drug Administration (FDA) authorized the Pfizer-BioNTech COVID-19 vaccine for emergency use in children ages 

5—11 years on October 29, 2021.51 With this EUA consumers, specifically parents, continue to question the need and safety of 

COVID-19 vaccinations in children. A perceived higher risk of adverse events relative to benefits of vaccination or lack of concern 

about the severity of COVID-19 can impact vaccine confidence as justification for not having children vaccinated. 

Perceptions, Concerns, and Threat to Vaccine Confidence

 Consumers expressed apprehension about the safety, effectiveness and possible 

side effects of the COVID-19 vaccine in children, including but not limited to 

heart issues (myocarditis), death, and unknown long-term side effects. f,52,53,54

 Consumers expressed the belief that children do not need to be vaccinated 

due to having milder symptoms, stronger immunity, and fewer deaths. 55,56,57

Content Gaps and Information Voids 

 Why is the COVID-19 vaccine necessary for children younger than 18 years if they only experience mild symptoms? 

 Children infected with SARS-CoV-2, the virus that causes COVID-19, can develop serious complications. COVID-19 illness 

results in loss of in-person learning and impacts other opportunities for children to learn and socialize, and children can 

spread the illness to others, including those who are immunocompromised or who could otherwise have severe illness.58

 What are the booster vaccine guidelines for children younger than 12 years? 

 Booster doses not approved for children ages 5—11 years. Booster doses are recommended for all children 12 years and older. 

 Children ages 5—11 years who are immunocompromised are recommended to receive an additional dose at least 28 days 

after the second dose to complete the primary series.59

 After receiving a COVID-19 primary vaccine series, when do I get my booster dose? 

 After completing a primary series with an mRNA vaccine, a booster is recommended at least 5 months later. After the Janssen 

COVID-19 vaccine single dose, a booster is recommended at least 2 months later.60

 Why is there a lack of data on the long-term effects of COVID-19 vaccines on children? 

 Serious side effects that could cause long-term health problems are extremely unlikely following COVID-19 vaccinations. Rare 

cases of myocarditis have been reported after vaccination, but most cases are mild and recover. Vaccine safety monitoring is 

ongoing for all vaccines, including COVID-19 vaccines.61

 When will vaccines be authorized or approved for children 4 years and younger? 

 Currently, children 4 years and younger are not eligible for a COVID-19 vaccine in the United States; however, clinical trials are 

underway. The best way currently to protect children 4 years and younger is to vaccinate everyone ages 5 years and older who 

are around them and to follow other CDC guidance for preventing COVID-19 transmission, including masking.62,63

Misinformation Themes

 Children do not need the COVID-19 vaccine because they are at low risk of death.64,65,66

 Deaths are more likely to occur from the COVID-19 vaccine than from contracting the SARS-CoV-2.67,68,69

 Pediatric vaccination is an experiment on children who are not at risk for COVID-19.70,71

Ways to Take Action

 Encourage parents, caregivers, and pediatric healthcare providers to engage in conversations that address vaccine safety 

concerns by discussing potential side effects, vaccine benefits, and low rate of adverse events. 

 Develop and disseminate messages and talking points for pediatric healthcare providers to assist them in their conversations 

with parents and caregivers.

 Create messages that discuss the risk and benefits of the COVID-19 vaccine and disseminate them through various media outlets 

to support the risk reduction potential associated with COVID-19 vaccinations.

 Increase messages highlighting how the risk for severe COVID-19 illness and hospitalizations offset the possibility of an adverse 

event from the vaccine. 

 Promote the benefits of children being vaccinated by amplifying the safety and efficacy of the COVID-19 vaccine. 

f

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 21 | January 26, 2022

Consumers have questions and concerns about the safety and effectiveness of the 

COVID-19 booster doses, mixing vaccine brands and types, and the potential need 

for additional booster doses.

On December 9, 2021, the CDC recommended that people ages 16—17 years be considered for COVID-19 vaccine booster 

dose vaccination, following authorization to this age group by the Food and Drug Administration (FDA).72 On January 3, 

2022, the CDC recommended boosters for all children ages 12—17 years.73 The CDC updated its guidelines to reflect a shorter 

time interval from 6 to 5 months for those waiting to receive the booster dose of the Pfizer-BioNTech and Moderna COVID-19 

vaccines. The CDC also recommended that children ages 5—11 who are immunocompromised receive an additional dose 28 

days after their 2nd COVID-19 vaccine dose.74 

Inconsistent and confusing messaging surrounding eligibility and waiting period for the booster doses and additional doses for 

immunocompromised persons may adversely affect vaccine confidence.75

Perceptions, Concerns, and Threats to Vaccine Confidence

 Citing the recent surge in the Omicron variant cases, some universities and the NFL required staff, students, players and 

coaches to get the COVID-19 vaccine booster doses.76,77,78

 Health experts called for a revision of the definition for “fully vaccinated” to include a booster dose.79,80However, the CDC has 

updated language for up-to-date on vaccinations to take into account the recommendations for booster doses.

Content Gaps and Information Voids:

 Will children need a COVID-19 vaccine booster? 

 At this time, CDC recommends that all people ages 12 years and older should receive a booster dose of COVID-19 vaccine.81

 Will there be a 4th COVID-19 booster dose? 

 At this time, CDC recommends that all people ages 12 years and older should receive a single booster dose of COVID-19 

vaccine.82

 If I am experiencing cold symptoms, can I get the booster dose? 

 Health experts say that it is safe to still get a booster dose. However, people should continue to follow isolation and 

quarantine measures to avoid exposing healthcare workers to COVID-19 if you might be infected with SARS-CoV-2.83

 Can I get the COVID-19 vaccine and booster during pregnancy? 

 It is safe to receive vaccinations before/during/after pregnancy, including while breastfeeding.

84

 Can I get a booster dose that is different from my initial COVID-19 vaccine series especially as it relates to COVID-19 vaccines 

received in other countries that are not FDA approved or authorized? 

 Yes. Regardless of the primary dose(s), the Pfizer-BioNTech or Moderna vaccines are preferred for booster doses as well as for 

primary series in most circumstances.85

Misinformation Themes

 The government is enforcing vaccine and booster dose requirements to enrich pharmaceutical companies.86

 Zinc helps to enhance the immune system against COVID-19 infection.87

 The vaccine mandate is part of a bigger plan to take away people’s freedom and liberty.88

Ways to Take Action

 Disseminate clear messages about the official guidance for COVID-19 booster dose recommendations and time intervals.

 Ensure COVID-19 booster vaccine official guidance is easily accessible on websites. 

 Continue to build trust in COVID-19 vaccine safety/effectiveness, healthcare providers, healthcare system and public/

governmental institutions

 Provide trainings and educational interventions to healthcare workers to increase knowledge, expertise, and confidence to 

disseminate messages that are tailored to communities’ culture.
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COVID-19 State of Vaccine Confidence Insights Report | Report 21 | January 26, 2022

Appendix 1: 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