CS000000-A | 09/13/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 14 | September 13, 2021 | Date Range: August 17 – 30, 2021

Summary

Findings. The announcement of the Food and Drug Administration's first full approval of a COVID-19 vaccine, Pfizer-BioNTech 

vaccine/Comirnaty, drove conversations in the news and on social media about the future of vaccine mandates. Consumers 

remain divided over whether vaccine mandates should be implemented and if natural immunity should be considered. 

Conversations online about the use of ivermectin to treat and prevent COVID-19 entered public consciousness with many 

consumers looking for more information online about whether the medication would work and how to get it. Some consumers 

claimed that ivermectin was safer and more effective than available vaccines. Several consumers, both for and against 

ivermectin, also felt that ivermectin use and promotion by other consumers and vocal vaccine deniers was a manifestation of 

the lack of trust in the United States government in handling the COVID-19 pandemic. Lastly, consumer interest in vaccinating 

children under 12 years old increased as students prepared or returned to school in August. Parents expressed confusion about 

the risk of COVID-19 to their children and were divided about whether to vaccinate their child or adolescent.

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. Messages leveraging available 

safety and effectiveness data should be tailored for a variety of demographics and disseminated by partnering with trusted 

messengers and healthcare personnel to further amplify these messages. Research should be supported to better understand 

the impact of authorized or approved treatments of vaccination intent and the motivation and interest in vaccination among 

adolescents and children.

Contents

2 Aims and Methods

3 Consumers faced layered misinformation aimed at discrediting the 

safety and effectiveness of the newly approved Pfizer-BioNTech 

COVID-19 Vaccine/Comirnaty.

5 Some consumers believe ivermectin is safer and more effective than 

COVID-19 vaccines.

6 Some parents are desperate to vaccinate children under 12 years old, 

while others question the need.

7 Update: Announcement of Booster Dose Program of mRNA 

COVID-19 Vaccines for U.S. Adults

7 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 14 | September 13, 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 
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COVID-19 State of Vaccine Confidence Insights Report | Report 14 | September 13, 2021

Major Themes

Consumers faced layered misinformation aimed at discrediting the safety and 

effectiveness of the newly approved Pfizer-BioNTech COVID-19 Vaccine (Comirnaty). 

On August 23, 2021, the Food and Drug Administration (FDA) announced the first approval of a COVID-19 vaccine, PfizerBioNTech COVID-19 vaccine (Comirnaty). A recent survey1

 reported that 31% of people who are unvaccinated would be more 

likely to get a COVID-19 vaccine after FDA approval. Another poll found that FDA approval increased vaccine confidence in 80% 

of respondents.2 Some local news outlets and surveys reported no change in the number of people getting vaccinated after the 

announcement of the approval,3 while others are reporting an increase.4,5,6

Some social media users warned that FDA approval would lead to more vaccine mandates.7,8,9 Some organizations began to 

implement vaccine mandates after the announcement.10,11 According to multiple recent polls, consumers remain divided 

over whether an employer should impose vaccination requirements 

or whether they should charge higher insurance premiums for 

unvaccinated employees.12,13,14 Additionally, these polls found a 

large difference in responses by the vaccination status of the 

respondent. Some consumers continued to promote the idea that 

mandates are not warranted because the vaccines are ineffective.15,16,17

They also sought more information about vaccination requirements, 

mandates, and exemptions throughout the reporting period.a

Unions and other worker advocacy groups demanded the right to 

negotiate vaccine mandates through collective bargaining, while 

some have or plan to file lawsuits and labor complaints against 

state governments and schools to nullify employer vaccine 

mandates.18,19,20,21 Some employee advocacy groups and vocal 

vaccine deniers expressed concern that vaccine mandates would 

result in people getting fired or quitting their jobs.22,23 One survey 

of long-term care employees found that more than half of unvaccinated home workers plan to find a job with no vaccine 

requirement.24,25 Some consumers expressed interest in vaccine mandates, or the lack of such mandates, for government 

agencies and pharmaceutical companies.26,27,28,29,30,31,32,33 Several consumers inquired about the Centers for Disease Control (CDC) 

and Prevention employees’ vaccine mandates.b,c

Approval of the Pfizer-BioNTech vaccine also appeared to renew the discussion of natural immunity’s role in preventing death 

and severe COVID-19. Consumers actively sought out information on natural immunity and if natural immunity provides more 

protection than vaccine-mediated immunity.

a,b,c Vocal vaccine deniers and some consumers claimed natural immunity provides 

superior protection than the protection provided by COVID-19 vaccines.34,35,36,37,38,39,40,41 Several news outlets shared early data 

from a preprint study that presented evidence that natural immunity provides superior protection compared to the protection 

provided by vaccines, and some social media users used this to support the claim that natural immunity is better.d,42,43,44,45,46,47,48

a

Google Trends

b

CDC-INFO

c

SEMrush

d

Google Trends
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COVID-19 State of Vaccine Confidence Insights Report | Report 14 | September 13, 2021

Multiple misinformation themes emerged in wake of the approval of the PfizerBioNTech vaccine:

 Comirnaty, which is the vaccine’s tradename, is different from the Pfizer-BioNTech 

COVID-19 Vaccine administered under emergency use authorization (EUA).49,50,51

 FDA did not grant full approval, but, rather, just extended the EUA.52,53,54  

 Research eventually determined that many other previously FDA-approved 

medical products and pharmaceuticals have long-term side effects.55,56,57,58

 The approval of the Pfizer-BioNTech vaccine did not follow standard 

procedures.59,60,61,62,63

 The experimental study for the Pfizer-BioNTech vaccine will continue until 2023, so 

FDA’s full approval should not have happened.d,64,65,66

Some consumers also continued to express concern about the lack of long-term safety 

data despite FDA’s approval.67,68,69  

Ways to act: 

 Create messaging that communicates what is known about the vaccines with 

empathy, displays humility about the unknowns of the vaccine, and frames vaccines 

as part of a broader pandemic response.70

 Engage trusted community partners and develop innovative approaches to share 

messages.

 Disseminate messages that clarify that the Pfizer-BioNTech COVID-19 Vaccine and Comirnaty are the same.

 Continue to share information with the public about the effectiveness and safety of COVID-19 vaccines, including potential 

booster doses, in contrast to the dangers of acquiring natural immunity.

 Support research that investigates the differences between natural immunity and vaccine-mediated immunity in protecting 

people from COVID-19.
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COVID-19 State of Vaccine Confidence Insights Report | Report 14 | September 13, 2021

Some consumers believe ivermectin is safer and more effective than COVID-19 

vaccines.  

News coverage of healthcare providers prescribing ivermectin or consumers seeking it through veterinary supply stores for 

the prevention and treatment of COVID-19 increased in the last two weeks of August 2021.e,71,72,73 News outlets also amplified 

stories of vocal vaccine deniers who died of COVID-19 even though they promoted the use of ivermectin,74 increased calls to 

poison control centers for ivermectin misuse,75 and information about the types of adverse outcomes from improper ivermectin 

use.76 However, some consumers continued to promote the benefits of ivermectin in treating COVID-1977,78,79 despite this news 

and warnings from FDA80,81 and other health officials.82,83 With the digital environment cluttered with information promoting 

and discouraging the use of ivermectin to treat COVID-19, consumers searched for more information online.f Some news 

outlets attempted to answer some of the most common questions about what ivermectin is, why people claim it is a potential 

treatment, and how safe it is.84,85 However, available digital content from health authorities was limited.g 

Some consumers went as far as to claim ivermectin is safer 

and more effective than COVID-19 vaccines.86,87,88 Some 

cited that ivermectin is an FDA-approved medication,89,90,91

unlike current COVID-19 vaccines, which were only 

authorized until August 23, 2021, when FDA approved the 

Pfizer-BioNTech vaccine.92 Some consumers also claimed 

that ivermectin was responsible for reducing the severity 

and spread of the Delta variant in other countries93,94

with pointing to a misrepresentation of the World Health 

Organization’s (WHO) guidance for ivermectin use for 

COVID-19 treatment.95 Some politicians claimed the 

government was suppressing ivermectin use in order to 

promote vaccination,96 while some healthcare providers 

continued to prescribe ivermectin to treat patients with 

COVID-19. 97,98,99

Many consumers, both for and against ivermectin use, felt that the lack of trust in the U.S. government, FDA and CDC100,101,102,103

drove use of ivermectin. News outlets and some public health experts expressed their feelings that ivermectin, which is being 

studied as a treatment for COVID-19, has been “radicalized” by vocal vaccine deniers and people who refuse vaccines.104,105,106

Several also blamed social media companies for the continued spread of misinformation around ivermectin without adequate 

mitigation measures being implemented to reduce harm.107,108

Ways to act:

 Expand available content about approved, authorized, and recommended treatments for COVID-19. Clarify what ivermectin 

is, what it is currently approved to treat, and how we are learning more about its potential role in treating patients with 

COVID-19. Disseminate messages encouraging people concerned about getting COVID-19 or wanting to treat COVID-19 at 

home to discuss treatment options with their healthcare provider. Disseminate messages about the risk of taking medications 

that are not approved or authorized for human use.

 Amplify messages about the safety and effectiveness of COVID-19 vaccines in preventing severe illness, hospitalization, and 

death. Highlight the number of vaccines safely given in the United States and how the U.S. vaccination system continues to 

monitor the vaccines to ensure they are safe and effective.

 Encourage healthcare providers to talk with their patients about the benefits of COVID-19 vaccination, such as preventing 

the need for experimental treatment options and hospitalization. Provide healthcare providers with talking points about 

ivermectin. 

 Support research to better understand the impact that available, approved treatments have on motivation and intention for 

people to receive a primary series of COVID-19 vaccines. 

e

Meltwater

f GoogleTrends

g

SEMRush
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COVID-19 State of Vaccine Confidence Insights Report | Report 14 | September 13, 2021

Emerging Themes

Some parents are desperate to vaccinate children under 12 years old, while others 

question the need. 

Consumer interest about when vaccines will be authorized and recommended for children under 12 years old has grown steadily 

since May 2021, peaking in mid-August.h

 This peak of interest aligned with many children returning to school or preparing to 

return to school for the 2021-2022 academic year. With reports of pediatric COVID-19 cases increasing,109,110 including cases of 

pediatric hospitalizations and deaths,111,112,113,114 many parents expressed feeling anxious and nervous about the risk of their 

child getting COVID-19, especially since many schools are implementing little to no 

mitigation measures.115,116,117,118 This has driven many people to desire that COVID-19 

vaccines be authorized soon for children younger than 12 years old.119,120,121 However, 

health authorities have not provided clear information about when authorization 

and recommendation for children younger than 12 years old will come.122,123,124 Some 

politicians have called for updated timelines to be released,125 while some public health 

experts online have speculated when vaccines will be authorized and recommended.126

Some public health experts and healthcare providers are calling for authorization for 

children younger than 12 years old to be expedited, given the recent approval of the 

Pfizer-BioNTech vaccine.127,128,129,130 However, some parents said they have decided to 

not wait for authorization and have already gotten a COVID-19 vaccine for their child 

under 12 years old,i,131,132,133 despite warnings from health authorities and healthcare 

providers against “off label” administration of the Pfizer-BioNTech vaccine.134,135,136,137

There continues to be a divide in parental opinions about whether children and 

adolescents need to be vaccinated.138,139,140,141 Some parents do not believe that 

COVID-19 is a risk to children and that the risk for an adverse event from vaccination is higher.142,143,144 Some other parents and 

journalists have attempted to debunk this belief.145,146 Some consumers against vaccinating children argued that it would do little to 

control the spread of COVID-19.147 This has spurred debate about whether COVID-19 vaccines should be mandated in K-12 schools, 

as some community vaccination requirements for children 12 years and older have already been put into place.148 Some prominent 

public health figures and politicians have already backed mandating COVID-19 vaccines for schools,149,150,151 which was met with 

support by some parents.152,153,154While other consumers, parents, and politicians felt mandating a new vaccine was too soon and 

an infringement on their medical freedom,155,156 with some citing the lack of mandates for influenza vaccination as justification157 or 

calling for the consideration of natural immunity.158 Some groups are providing parents who refuse to vaccinate their children with 

information on how to seek an exemption.159

Ways to act:

 Clarify the risk for serious COVID-19 for children and adolescents and what is known about their role in spreading the virus, 

tailoring to different demographics and age groups as possible. Highlight the benefits of vaccination for adolescents 12 years 

and older, such as reduced illness severity and length of illness.

 Amplify messages about the safety of vaccines for children 12 years and older, highlighting the low number of adverse events 

following the high number of vaccinations. Clarify that safety information and clinical trial data for children younger than 12 

years old are not available and that these children should not be vaccinated at this time.

 Disseminate messages about the process for authorizing and recommending COVID-19 vaccines for children younger than 

12 years old. Also, clarify how COVID-19 vaccines other than the Pfizer-BioNTech vaccine are being studied for children and 

adolescents under 18 years old.

 Encourage healthcare providers, particularly pediatricians, to proactively have conversations with parents of children under 12 

years old. Expand talking points for healthcare providers to specifically address needs, concerns, and questions from parents of 

younger children.

 Partner with school administrators to amplify messages about where and how to vaccinate eligible children over 12 years old and 

to promote the benefits of vaccination for students, staff, and the broader community. 

 Support research to better understand children and adolescents’ perceptions and opinions of COVID-19 vaccines and their 

motivation for getting vaccinated if they can on their own or with parental consent.

h

GoogleTrends

i

CDC-IFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 14 | September 13, 2021

Update: Announcement of Booster Dose Program of mRNA COVID-19 Vaccines for U.S. Adults

In the week following the announcement of an mRNA COVID-19 vaccine booster dose program, news reports continued 

to highlight the political aspects of the announcement,160 evolving confusion from consumers and experts,161,162,163,164 and 

concerns about global vaccine equity.165,166 Consumers online and in polls were most interested in clarifying the mechanics of 

the booster dose program and they expressed desire for COVID-19 vaccines to be authorized and prioritized for all school-aged 

children.j,167,168,169,170,171,172,173

News coverage of the Delta variant appears to be fueling consumer demand for booster doses as consumers who are 

fully vaccinated perceive an increase in their risk for COVID-19.174,175 Some expressed the desire to receive, as a booster, a 

different brand from the vaccine they received for their primary series. Specifically, both consumers and healthcare providers 

began inquiring about administering the Moderna COVID-19 Vaccine as boosters to people who received other COVID-19 

vaccines.178,179 However, on September 5, 2021, some public health experts speculated that the Moderna COVID-19 Vaccine 

might not be approved in time for the promised roll out of the booster dose program during the week of September 20.180,181,182

People who received Johnson & Johnson’s Janssen COVID-19 Vaccine continued to express concerns about the vaccine’s 

effectiveness, when or whether booster doses would be authorized or recommended for them, and whether they could seek 

one or more doses of an mRNA COVID-19 vaccine.183,184,185

Vocal vaccine deniers and consumers who deny COVID-19 continued to use the announcement of the booster dose program to 

undermine vaccine confidence with familiar misinformation tropes, such as:

 Booster doses are being promoted for financial gain of pharmaceutical companies.186

 COVID-19 vaccines are not effective and will require multiple booster doses.187,188

 There is no benefit to booster doses of COVID-19 vaccines and safety data is not available.189

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.

Misinformation. False claims circulated at low levels about COVID-19 vaccines causing Antibody Dependent Enhancement 

(ADE) and worsening infections in vaccinated consumers.190,191,192,193,194,195,196,197 Vocal vaccine deniers claimed vaccination 

facilitates infection, might be inciting lethal cytokine storms,198 and can lead to breakthrough infections.199

New ways to act:

 Partner with healthcare providers and other trusted messengers to amplify messages de-bunking claims that consumers 

who are vaccinated are more at risk for COVID-19. 

Variants of the virus that causes COVID-19. The C.1.2 variant in particular attracted brief, intense attention with some claiming 

that this variant was more easily spread and has the ability to evade current vaccines.200,201,202,203

New ways to act:

 Amplify messages about how variants are being monitored and studied to understand how they impact the effectiveness of 

COVID-19 vaccines.

Side Effects. Concerns about potential near- and long-term effects of vaccination continue to be exploited by people who deny 

COVID-19 and vocal vaccine deniers. They have been amplifying misinformation about the purported impact of vaccination on 

adolescents and young adults, including impaired fertility and death or lasting heart damage.204,205,206,207,208,209,210,211,212,213

j

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 14 | September 13, 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-behavioral 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