CS000000-A | 09/02/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 13 | September 2, 2021 | Date Range: July 13, 2021 – August 16, 2021

Summary

Findings. The Delta variant continues to drive concerns about the effectiveness of current COVID-19 vaccines. While consumers 

who are vaccinated expressed concern about their levels of protection, consumers who have refused vaccination and vocal vaccine 

deniers exploited these concerns to amplify claims that the benefits of vaccination are diminishing. Some consumers felt that 

their personal rights were being restricted after hearing reports of employers leveraging vaccination mandates or new vaccination 

requirements being implemented across the country for people going to events or restaurants. Online searches for information 

about how to acquire exemptions from such requirements and restrictions were on the rise, with medical freedom groups on social 

media amplifying information about how to navigate exemptions.

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. Partners should disseminate messages 

that leverage available safety and effectiveness data, especially in relation to misinformation and the Delta variant. They should 

also partner with trusted messengers and healthcare personnel to further amplify these messages. Partners should ensure they 

are providing ample access to vaccines and taking previously recommended steps to build vaccine confidence before enacting 

organizational requirements.

Booster Doses. News media coverage and social media conversations about the potential for booster doses was a dominant 

theme for this report period. Following the White House press briefing on August 18, 2021, announcing an mRNA COVID-19 vaccine 

booster dose program for adults 18 years and older, a rapid insights report was conducted. Many of the themes, content gaps, and 

mis- and disinformation identified during this reporting period are reflected in the rapid report. The report is available here.

Contents

2 Aims and Methods

4 Consumers expressed concern over the effectiveness of COVID-19 

vaccines in reducing the spread of the Delta variant.

5 Some consumers expressed concern that vaccine mandates by 

employers, the government, restaurants, and entertainment venues 

would limit their freedoms. 

5 Consumers are frustrated by guidance for fully vaccinated 

individuals.

6 Parents expressed concern, confusion, and frustration as children 

return to school

7 Continuing and Evolving Themes

9 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 13 | September 2, 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 13 | September 2, 2021

Major Themes

Consumers expressed concern over the effectiveness of COVID-19 vaccines in 

reducing the spread of the Delta variant.

While news media outlets increased their coverage 

of hospitals approaching or reaching capacity in their 

intensive care units (ICU) due to COVID-19 caused by 

the Delta variant,1,2,3,4 a majority of consumers who 

are unvaccinated (57%) believed the seriousness of 

coronavirus in the news was being “exaggerated” 

according to one recent survey. At the same time, 

the survey also found that almost one-quarter of 

vaccinated consumers (24%) felt that news media 

coverage of the seriousness of COVID-19 was being 

underestimated.5

Even as vaccine uptake increased across the country,6

consumers expressed concerns about the effectiveness 

of vaccines due to increasing reports of breakthrough 

cases and new research indicating that people who 

are vaccinated and sick with COVID-19 caused by the 

Delta variant are similarly contagious to someone who 

is unvaccinated.7,8,9 In light of this new data, some vocal vaccine deniers and unvaccinated consumers expressed frustration with 

being blamed for the spread of the Delta variant,10,11,12 as vaccinated consumers increasingly expressed their frustration with 

people who are unvaccinated and people who deny the severity of the COVID-19 pandemic.13,14,15,16 These new findings about 

people who are vaccinated being able to spread COVID-19 caused some consumers who are unvaccinated and vocal vaccine 

deniers to further amplify misinformation claims that vaccines are not effective.17,18,19 Additional misinformation also spread in 

an attempt to further discredit vaccines including claims that:

 Vaccines are the reason behind the emergence of variants.20,21,22

 The surge of COVID-19 caused by the Delta variant is being driven by people with undocumented status entering the 

United States.23,24,25

 People who are vaccinated are more at risk for getting sick than people who are unvaccinated, citing breakthrough cases as 

evidence.26,27,281

News coverage about Lambda variant and the potential for future variants to evade available vaccines also continued at low 

levels throughout the reporting period29,30,31,32 but have not yet appeared to be a cause for concern among consumers in the 

United States.

Ways to act:

 Disseminate messages about what vaccine effectiveness means, the benefits of vaccination, and that the best way to protect 

yourself from severe illness, hospitalization, and death from COVID-19 is by getting vaccinated.

 Amplify stories from healthcare personnel about the severity of illness caused by the Delta variant. Remind consumers that it 

is not too late to begin a primary series of vaccination. Also remind people about the benefits of vaccination.

 Identify partners and organizations in local regions that are experiencing high transmission. Ask them to participate in 

localized, focused outreach efforts to ensure consumers understand the benefits of vaccination, where to access vaccines, and 

who to talk to if they have questions or want to discuss vaccination further. 

Source: https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-july-2021/
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COVID-19 State of Vaccine Confidence Insights Report | Report 13 | September 2, 2021

Some consumers expressed concern that vaccine mandates by employers, the 

government, restaurants, and entertainment venues would limit their freedoms. 

Consumers on social media increasingly claimed that COVID-19 vaccine mandates would violate their right to make their 

own decisions about their medical care and their bodies.33,34 Some social media users discussed how vaccine mandates would 

impede people’s freedom more generally.35,36,37Others even adopted the pro-choice slogan, “my body, my choice,” to express 

these concerns and amplify their message.38,39,40 Individuals continue to state that being asked about their vaccination status 

violates their rights under HIPPA, despite this being untrue.41,42 Social media users are confused about the purpose of the 

vaccine mandate and the effectiveness of the vaccine due to reports of breakthrough infections.43,44,45 Consumers have also 

increasingly searched online for information about specific vaccine mandates, such as vaccine mandates at healthcare providers 

and within the military.a,b

Political figures also amplified and politicized vaccine mandate concerns by 

using the repeal or enactment of vaccine mandates in critiques of political 

rivals46,47,48 and as a part of inter-party criticism.49,50 Some of the political 

figures used the topic of vaccine mandates to amplify misinformation such as 

“COVID-19 is not a deadly disease,”51 or “the vaccines cannot be trusted because 

they are an experimental treatment.”52 Polarization across party lines has also 

been seen among consumers according to recent polls,53,54,55 which indicated 

that one’s party greatly influences their stance on vaccine mandates. When 

asked about vaccine mandates more broadly, another poll found that 75% of 

Democrats believe the federal government should recommend employers 

implement a vaccine mandate, while 67% of Republicans say the federal government should not do this.57

At the same time, online searches of medical exemptions, religious objections, fake vaccine cards, and COVID-19 vaccine 

exemption forms were on the rise.c Vaccine exemption forms and statement templates are being shared on websites advocating 

for medical freedom.58 In addition to the websites, social media groups advocating against mandates educated their followers 

on the vaccine exemptions and employee rights regarding vaccine mandates. They also advocated to use this information to 

slow vaccine uptake.59,60,61 

Finally, people are also reporting losing their vaccination cardsd,62,63,64,65 and they are looking for directions on how to get a 

new one or prove their vaccination status without the vaccination card. Some social media users said they needed to prove 

vaccination status to enter certain locations66,67,68 while others said they needed it because they are going to get their second 

dose and want proof of their first dose.69,70

Ways to act: 

 Disseminate messages such as the following: “if enough people get vaccinated, we can return closer to pre-pandemic life.” 

Couple these messages with information about the effectiveness and long-term safety of the COVID-19 vaccine and other 

vaccines. 

 Disseminate messages that amplify the health and financial consequences of not getting vaccinated, such as increased risk 

of negative health outcomes from COVID-19, increased health insurance premiums, and requirements for frequent COVID-19 

testing from employers.

 Engage with partners that are not publicly associated with a political party. Ask them to share messages about the 

effectiveness and safety of vaccines and the benefits of vaccination. This is especially important as schools re-open, 

employees return to work, and many facilities return to pre-pandemic capacity.

 Engage partners and influencers to create and amplify messages about the role of vaccination coverage in providing 

population-level protection and reducing the spread of COVID-19 broadly, especially when following other mitigation 

measures.

 Ensure that partners are providing ample access to vaccines and taking previously recommended steps71 to build vaccine 

confidence and offering convenient workplace vaccination. Ensure that considerations such as paid sick leave and supervisor 

education regarding requirements are part of any roll-out plans for vaccine requirements.

 Provide guidance to individuals about what to do if they lose their vaccination card.

a

Google Trends

b

SEMrush

c

Google Trends

d

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 13 | September 2, 2021

Emerging Themes

Parents expressed concern, confusion, and frustration as children return to school. 

With K-12 schools and institutions of higher education either already in session or about to open, the safety and 

well-being of students, faculty, and staff—as well as of their families and communities—once again is the subject 

of debate. This debate threatens to harden the views of consumers who are unvaccinated and erode vaccine 

confidence generally.72,73,74 While some parents continue to favor reopening K-12 schools in person and at capacity, parental 

views regarding appropriate mitigation strategies and mask or vaccine mandates track with political affiliation and 

vaccination status.75,76,77Anxious parents of young children are impatient that COVID-19 vaccines are not yet authorized 

for children younger than 12 years old. They are also slightly more likely to favor school mask requirements than those whose 

children are eligible to be vaccinated.78,79

Vocal vaccine deniers continued to amplify misinformation on social media about supposed dangers that masking and 

vaccination pose for children. This is fueling conflict between COVID-19 skeptics and parents and school administrators who 

support masks, vaccination, and other mitigation strategies.80,81,82,83,84,85 Clashes over masks in schools suggest that vaccination 

mandates, especially for younger children, will be difficult to implement, especially given that some politicians, faith leaders, and 

school administrators are already coaching skeptical parents on how to circumvent mask and vaccine requirements.86,87

Ways to act: 

 Develop and disseminate messages about the risk of COVID-19 for children. Highlight the increasing case numbers among 

children and the increasing number of children hospitalized with severe COVID-19. Remind consumers about the role that 

children play in spreading the virus. 

 Continue to amplify messages that vaccination for children 12 years and older is the best way to protect them from illness, 

clarifying that the risk for severe COVID-19 or complication caused by illness is higher than the risk of an adverse event from 

vaccination.

 Partner with school administrators and support them to promote messages about the benefits of vaccination or connect 

them to other trusted messengers. Also, help them promote mitigation measures for children, parents, school staff, and the 

broader community. Remind them to connect unvaccinated staff and families to vaccination information and events. 
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COVID-19 State of Vaccine Confidence Insights Report | Report 13 | September 2, 2021

Consumers expressed frustration and confusion about updated guidance for fully 

vaccinated individuals. 

CDC’s update to the Interim Public Health Recommendations for Fully Vaccinated People generated  confusion and exasperation 

among many consumers.88,89,90 Initial confusion about the updated guidance—particularly around when and where indoor 

masking for vaccinated individuals would 

be required—drove social media users to 

express frustration both with the updated 

guidance and with unvaccinated consumers. 

Many people saw consumers who are 

unvaccinated as responsible for the Delta surge 

and associated return of restrictions.91,92,93

The reimposition of mitigation strategies that 

equally affected people who are vaccinated 

and unvaccinated was amplified on both news 

media and social media.94,95,96,97 This, in turn, spawned opinion pieces chiding the frustrated for their pettiness and warning that 

openly shaming people who are unvaccinated could depress vaccine acceptance by driving some in the “moveable middle” into 

outright vaccine refusal.98,99,100

Renewed political and social clashes over mitigation measures could have further undermined vaccine confidence. Mask 

skeptics and vocal vaccine deniers seized upon the uncertainties that inform CDC’s updated guidance to disparage vaccines, 

sow doubt about the efficacy of vaccination, and create suspicion about the motives of public and private entities advocating 

vaccination.101,102,103

Ways to act: 

 Disseminate messages that provide clarity around guidance for people who are fully vaccinated. Remind people that both 

being vaccinated and wearing masks in public places can help protect people who are too young to be vaccinated, unable to 

be vaccinated, or at high risk for serious illness.

 Continue to amplify messages that asymptomatic or mild breakthrough cases of COVID-19 are expected and are a normal 

occurrence with many vaccines, such as influenza vaccination. Reassure consumers that even high numbers of breakthrough 

infections align with projected vaccine effectiveness and that breakthrough cases are likely much less severe than they would 

have been had the person not been vaccinated. 
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COVID-19 State of Vaccine Confidence Insights Report | Report 13 | September 2, 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.

Fertility and reproductive health concerns. Consumers continued to 

express concern that the COVID-19 vaccine will harm their reproductive 

health and fertility.e,104,105,106,107 The concerns persisted despite the American 

College of Obstetrics and Gynecology and the Society for Maternal-Fetal 

Medicine recommending that pregnant and breastfeeding persons be 

vaccinated.108 Multiple news outlets continued debunking misinformation 

that vaccines cause infertility or negative reproductive outcomes.109,110

Despite this, concerns persisted. 

Natural immunity. Some consumers and political leaders continued to 

express frustration that recommendations for vaccinations and guidance 

for people who are fully vaccinated didn’t include information about natural immunity.111,112,113,114 Vocal vaccine deniers also 

promoted unsubstantiated claims that natural immunity provides superior protection compared to vaccines,115,116 despite the 

new data CDC shared indicating that vaccination may provide more protection.117

New ways to act:

 Disseminate messages about risk of reinfection and the benefits of vaccination specifically for those who have previously 

had COVID-19.

 Partner with healthcare providers to proactively have conversations with previously infected patients about the benefits of 

vaccination.

Ivermectin. Despite a variety of health authorities, public figures, and news 

outlets debunking,119,120,121 some social media users, politicians, celebrities, 

and websites continue to spread the false claim that Ivermectin is a safe 

and effective treatment for COVID-19 and claim that its benefits are being 

suppressed.122,123,124,125 These claims persist despite news articles reporting 

an increase in calls to Poison Control Centers related to Ivermectin.126

New ways to act:

 Continue to amplify messages about the role of vaccination and 

proven treatments together being necessary to manage the COVID-19 

pandemic.

 Disseminate messages about what is known about the safety and side 

effects of Ivermectin. Remind people to discuss any medication with a doctor before taking it to protect against potential 

adverse reactions. Additionally, amplify available information about authorized and approved treatments that have been 

proven effective in treating COVID-19. 

Polyethylene glycol. Vocal vaccine deniers highlighted vaccine ingredient polyethylene glycol claiming that this ingredient 

was linked to anaphylactic shock127,128,129 and could be leveraged to avoid vaccination or gain an official exemption.130,131,132

Consumers increasingly searched online and called CDC-INFO to learn more about polyethylene glycol and the potential for an 

allergic reaction.f,g

New ways to act:

 Continue to amplify messages about the safety of the ingredients of COVID-19 vaccines. Highlight where one can access 

information about vaccine ingredients. If possible, specifically address concerns about polyethylene glycol.

 Continue to disseminate messages about the safety of COVID-19 vaccination, highlighting that allergic reactions are rare 

and that people who are concerned should talk to their healthcare provider.

e

CDC-Info

f

CDC-INFO

g

 GoogleTrends
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COVID-19 State of Vaccine Confidence Insights Report | Report 13 | September 2, 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 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