CS000000-A | 03/29/21

Summary

Findings. Following President Biden’s announcement that there will be enough vaccine for every adult by the 

end of May, many people express a renewed sense of hope and optimism. However, the idea that “hesitancy” is 

used as an excuse to explain low vaccination rates among communities of color, rather than confronting longheld equity and access issues, is being increasingly highlighted. As a result, structural issues are often being 

met with individual-level interventions and solutions. Misinformation on social media continues to undermine 

vaccine confidence; current tactics by tech companies to manage misinformation often do little to combat its 

spread or address consumer concerns. Recent data suggest that those who do not intend to get vaccinated 

are also less likely to adhere to safety and mitigation guidelines, further polarizing the fully vaccinated from 

unvaccinated groups. In addition to vaccination status, conversations about “vaccine passports” are contributing 

to divisions between these groups. New studies with COVID-19 survivors investigating their immune response 

to one dose of the current two-dose vaccines raised consumer confusion about whether partial vaccination 

offers protection against the virus that causes COVID-19.

Recommendations. Federal, state, and local partners should continue to work together to increase 

transparency, 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. Efforts should be made to engage and deploy trusted messengers who connect with under-vaccinated 

groups; investigate community-specific factors contributing to low vaccine uptake; and slow the spread of 

misinformation while promoting trustworthy sources.

COVID-19 State of Vaccine 

Confidence Insights Report

Report 4 | March 29, 2021 | Date Range: March 2 – 15, 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 Vaccine hesitancy concerns are disguising 

structural and practical barriers.

4 Current tactics for addressing misinformation 

online are insufficient.

5 People who are fully vaccinated are more 

likely to continue to adhere to COVID-19 safety 

guidance.

6 Emerging Themes

7 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
COVID-19 State of Vaccine Confidence Insights Report | Report 4 | March 29, 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

 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

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
COVID-19 State of Vaccine Confidence Insights Report | Report 4 | March 29, 2021

Major Themes

Vaccine hesitancy concerns are disguising structural and practical barriers.

Although COVID-19 vaccine supplies have increased and states have 

dramatically expanded eligibility criteria, data indicate that vaccination 

rates for Black people have not caught up to those of White people. In 

some states, White people are vaccinated at two to three times the rate 

of Black people.2

 Although early polling data reported that Black people 

were more likely to be vaccine-hesitant, it may be that one year later, 

vaccine access is a greater threat to vaccine uptake or at least a sizable 

additional threat.3,4 Increasingly, web traffic, social media, and news 

headlines emphasize that “hesitancy” is used as an excuse to justify 

low vaccination rates, as a way to avoid confronting long-standing 

health system-level equity and access issues. Vaccination sites are 

less common in Black communities and Black Americans face longer 

driving distances to vaccination sites than their White counterparts.5,6

People from White neighborhoods often claim an a larger share of 

vaccination appointments in Black and Hispanic neighborhoods; in 

addition, appointment access codes have been misused by people for 

whom they were not intended.7 Lack of internet access and technology 

also remain a threat to vaccination coverage. Nearly half of all people 

in the United States without home internet access are people of color, 

which is especially notable because the majority of appointmentbooking systems are online.8

 Because Black people are overrepresented 

in frontline and essential jobs, difficulty taking time off work is another 

compounding problem.9,10

Adults over 65 years, non-U.S.-born people, and people living in rural 

areas face similar challenges. Deep concerns around infrastructure 

inequalities and underinvestment have driven some communities to 

provide access in innovative ways, such as using Meals on Wheels11

to deliver vaccines to homebound older adults, and use of alternative 

facilities where people might feel comfortable and trust, such as public 

libraries, community centers, and faith-based organizations.12 Pop-up 

clinics and walk-in vaccination clinics that do not require appointments 

are also used to combat transportation and technology challenges.13,14

Short-term recommendations:

 Partner with states and jurisdictions to identify the many factors contributing to low vaccine uptake, including vaccine

confidence and structural and practical barriers, among others. Conduct a rapid community assessment to identify 

intervention strategies to increase uptake and identify community leaders and trusted messengers to reach communities.

Clearly explain the rationale underlying which vaccination sites were chosen and how people can access them. States and 

jurisdictions should partner with local, trusted messengers to better understand specific barriers and develop updated 

messages accordingly.

Long-term recommendation:

Invest in research to understand the long-term structural issues and equity concerns impacting underlying vaccination 

coverage and vaccine access.

Build case studies to explore the role of alternative vaccination systems, such as mobile vaccination units and other emerging 

innovations and practices, and their contribution to higher uptake and confidence in COVID-19 vaccines and the adult 

immunization system.

“The vaccine rates are low not because people 

don’t want the vaccine, but because those 

who want it can’t get it,” said Robert Fullilove, 

a professor of sociomedical sciences at the 

Columbia University Medical Center.1

Vaccination sites concentrated in 

majority-White communities (Atlanta, GA)

Source: https://www.npr.org/2021/02/05/962946721/across-the-southcovid-19-vaccine-sites-missing-from-black-and-hispanic-neighbor
COVID-19 State of Vaccine Confidence Insights Report | Report 4 | March 29, 2021

Current tactics for addressing misinformation online are insufficient.

Combating misinformation on social media platforms 

continues to be challenging, and tactics to manage 

misinformation vary across platforms. Some platforms are 

adding “strike” systems and attaching warning labels to 

messages,15 while others are turning off systems to flag 

anti-vaccine messages.16 However, many consumers have 

found ways to evade such measures by using syntax tricks, 

avoiding the word “vaccine” in their messages, and leveraging 

“wellness” influencers to share “soft” anti-vaccine messages.17

Current tactics to combat the spread of misinformation do 

little to provide people who have genuine concerns and 

information needs about COVID-19 vaccines with credible 

sources of information from reliable, evidence-based, and 

trustworthy sources.18

In the absence of a national strategy to combat misinformation and disinformation, advocacy organizations and jurisdictions are 

rising to the challenge. Organizations are leveraging existing health outreach programs and deploying their networks of trusted 

messengers to address misinformation offline. An example is the Health In-Reach and Research Initiative (HAIR), which is using 

a network of barbershops and beauty salons to debunk misinformation within the Black community in Maryland.19 As one of 

the most trusted sources of healthcare information, healthcare providers are using their status to address misinformation online 

and promote vaccination to their communities and social media followers. With grassroots campaigns like #ThisIsOurShot20 and 

#Vaccinate4Love,21 providers seek to amplify messages aimed at increasing confidence in COVID-19 vaccines, while quickly and 

credibly debunking vaccine misinformation and disinformation.

Short-term recommendation:

 Partner with trusted messengers to deploy hyper-targeted messages for various demographics and social groups about

vaccine confidence and address information gaps specific to their communities. Messages should be authentic, and 

accompanying content and assets should be carefully considered based on target audience, platform, and messenger. Offer 

ways for people to ask questions and get answers from trusted sources, especially healthcare providers.

Long-term recommendations:

Work with technology companies to slow the spread of misinformation while also amplifying and promoting credible, 

evidence-based information and trustworthy sources. Supported by research, use what is known about trusted sources of 

information to ensure audiences are receiving promotional content from sources they personally trust and already look to for 

credible advice and information.

Continue to partner with technology companies and researchers to better understand the interplay of digital media with 

vaccine confidence, including the consequences of exposure to misinformation, the pathways of misinformation and how it 

spreads within and across platforms, the role of influencers, and how misinformation impacts health-seeking behavior.

Develop a network and community of practice for subject matter experts, federal partners, advocacy organizations, 

institutions of higher education, and states and jurisdictions focused on addressing the COVID-19 infodemic and future health 

infodemics in the United States.
COVID-19 State of Vaccine Confidence Insights Report | Report 4 | March 29, 2021

People who are fully vaccinated are more likely to continue to adhere 

to COVID-19 safety guidance.

Following CDC’s release of recommendations for fully vaccinated 

people, online conversations increased about continued adherence to 

COVID-19 safety guidance. Some consumers expressed disapproval, 

saying they don’t need permission to return to normal and will gather 

with friends or family regardless of their vaccination status.22,23 This 

opposition was validated by recent polls, which found that people 

who report they will not get vaccinated were more likely to report 

never or rarely wearing masks in public and that their immune system 

is strong enough to manage COVID-19 if they were to get sick.i,24

Fully vaccinated people, on the other hand, were more likely to 

continue wearing masks and limit the size of gatherings.25 Additionally, 

people who report that they would get vaccinated expressed more 

fear of COVID-19 illness, compared to those who would likely not get 

vaccinated.i

Such division within the U.S. population is not new—polls continue 

to indicate that consumers who identify as conservatives are less 

likely to get vaccinated, with one poll indicating that the proportion 

of those who do not plan to be vaccinated remains steady despite 

overall intent to be vaccinated increasing nationally as the number 

of people wanting to “wait and see” descreases.26,27 Engaging trusted 

messengers, such as primary care providers and community leaders, 

to reach these consumers will be essential not only to increase vaccine 

confidence,28 but also to uphold COVID-19 mitigation and safety 

measures, especially as states are relaxing mitigation measures and 

mask mandates.29

Short-term recommendations:

 Continue to engage and deploy trusted messengers to promote messages about the benefits of COVID-19 vaccination.

Specifically highlight the benefits of vaccination over natural immunity and how vaccination allows people to avoid the 

potential “long COVID” health effects of natural infection. 

Develop specific messages and tools for healthcare providers to use in discussing the benefits of vaccination and the 

importance of COVID-19 mitigation measures with patients who are uncertain about or leaning toward not getting 

vaccinated.

Long-term recommendations:

Bolster research to better understand vaccine motivations within diverse demographics and across a range of political 

leanings. Include rapid message testing, visual testing, and channel/platform questions to plan optimal online placement of 

messages to help agencies, partners, and trusted messengers achieve vaccine confidence and increase vaccine uptake.

i 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 

Over the past week, how often have you 

worn a mask when in public?

Source: 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
COVID-19 State of Vaccine Confidence Insights Report | Report 4 | March 29, 2021

Emerging Themes

Vaccine status and “vaccine passports” are contributing to division 

and polarization.

As practical issues with vaccination continue, especially for communities of 

color and other medically underserved populations, online conversations 

point to vaccination status and access to specific brands of vaccine as 

new ways to segment and divide the population.30 Discussions of “vaccine 

passports” or “green passes” in the media have further exacerbated concerns 

of “immune-privilege,” with some consumers pointing out the potential of 

these strategies to further marginalize communities that encounter structural 

and practical barriers to vaccination.31,32 The travel and hospitality industry 

is perceived as encouraging the concept of vaccine passports in an effort 

to reassure consumers, boost pandemic-depressed travel bookings, and 

curb global quarantine requirements.33 However, some feel that a passport would enable those who are fully vaccinated to do 

things that the unvaccinated cannot,34 contributing to increased polarization within the population. At the same time, others 

believe that vaccine passports and postvaccination guidance are infringing on their liberties and rights and are equivalent to 

government-issued mandates.35

Short-term recommendations:

 Continue to promote messages about current travel guidance; highlight that requiring proof of vaccination status is not

currently a part of any travel or safety recommendations.

Partner with states and jurisdictions and private industry to communicate clearly and often about interstate and international 

travel requirements.

Long-term recommendation:

Investigate the intersection of vaccination coverage and the spread of virus across multiple modes of travel to inform whether 

“vaccine passports” have utility for interrupting viral transmission on a global scale. Additionally, evaluate the spread of virus 

variants to better understand the extent to which variants might blunt the effect of vaccines—meaning even vaccinated 

people can get sick. Communicate findings to the public.

Newly released data create confusion about whether partial vaccination offers 

protection against the virus that causes COVID-19.

New studies investigating the immune response after a single dose of mRNA vaccines (Pfizer-BioNTech and Moderna) indicate 

that for those who have previously been infected with SARS-CoV-2, a single dose may provide adequate protection against the 

virus that causes COVID-19.36,37 At the same time, consumers report struggling to complete their two-dose series within the 

recommended time interval due to appointment administration issues, weather events, or general time constraints.ii,iii The public 

is confused about the extent to which the second mRNA vaccine dose is important for vaccine effectiveness or offers additional 

protection from virus variants, and how partial vaccination affects population immunity.

Short-term recommendations:

Deliver clear and transparent messages around the need for the second dose of mRNA vaccines and implications for vaccine 

efficacy; clearly communicate what is known and not known about partial vaccination.

Ensure that vaccine administration systems and in-clinic logistics support scheduling a second dose appointment easily and/

or automatically. Partner with vaccination providers to ensure that second dose appointments are scheduled during the 

patient waiting period or when first dose appointments are scheduled.

ii Social Listening Team. COVID-19 Interagency Social Listening Report. Washington, DC, Federal Emergency Management Agency; March 4, 2021.

iii Social Listening Team. COVID-19 Interagency Social Listening Report. Washington, DC, Federal Emergency Management Agency; February 10, 2021.
COVID-19 State of Vaccine Confidence Insights Report | Report 4 | March 29, 2021

Continuing and Evolving Themes

Themes below have been noted in Reports 1, 2, and 3 and continue to undermine vaccine confidence. For additional context 

and previous recommendations on these themes see Insights Report 1 (February 12, 2021)iv, Insights Report 2 (March 1, 2021),v

and Insights Report 3 (March 15, 2021).vi

 Adverse events and side effects. Conversations about vaccine safety

increased during this report period, with top headlines focused on 

the pause in the use of AstraZeneca COVID-19 vaccine abroad due 

to concerns about reported blood clots,38 newly reported deaths 

following vaccination,39,40 and concerns about mRNA vaccines causing 

tumor growth.41 While none of these adverse events are directly 

linked to vaccination, and despite the number of people who have 

been vaccinated with mostly common side effects, vocal vaccine 

deniers continue to leverage these stories to stoke fears that the 

vaccines are unsafe. New recommendations:

Continue to promote messages about the safety and benefits of 

COVID-19 vaccination, the rigors of FDA authorization, and longestablished safety systems used to monitor adverse events and 

negative side effects.

Be prepared for questions about how the U.S. vaccine monitoring 

systems compare to those of other countries—specifically, how 

causality is assessed and how recommendations are made—which 

may be prompted by potentially discordant conclusions reached or 

recommendations made by other health systems in assessing vaccine safety signals.

Vaccine brand preference. Consumers continue to seek out specific brands of COVID-19 vaccine and are cancelling 

vaccination appointments to wait for the brand or dosing schedule they prefer, with increased demand for Johnson 

& Johnson’s Janssen COVID-19 vaccine.42 Current systems, including VaccineFinder, allow consumers to search for 

vaccination appointments by brand, despite CDC messaging focused on getting the first vaccine offered and available. New 

recommendations:

Review current vaccine administration systems to better align vaccine brand availability with CDC messages stating no 

preference between the three authorized vaccines.43,44

Continue to promote messages that all three vaccines are safe and effective. Create messages and develop guidance for 

consumers emphasizing that whichever vaccine you are offered is the one you should accept and receive.

Prioritization and eligibility. As states expand eligibility criteria, some consumers report feeling guilt about their ability 

to get vaccinated because of inequities that exist45 or because they feel like their personal comorbidity is being broadcast 

and stigmatized.46

Pregnancy and fertility. New studies have found COVID-19 antibodies in breastmilk after vaccination, which may increase 

confidence in vaccines for new parents hoping to protect their babies.47 However, a report found that surrogacy agencies are 

receiving calls from clients requesting that surrogates be unvaccinated.48

Vaccine administration errors. Reports of 

vaccine administration errors in the news 

media, such as incorrect dosages49 and vaccines 

administered with empty syringes,50 could lead 

to reduced confidence in COVID-19 vaccines. 

New recommendations:

 Promote vaccination trainings and tools for current and proposed future vaccinators to ensure proper vaccine storage, 

handling, and administration.

 Continue to highlight vaccination coverage numbers and low numbers of safety and administration issues.

iv Insights Unit, Vaccinate with Confidence Team. State of vaccine confidence report: Report 1. Atlanta, GA: Vaccine Task Force, Centers for Disease Control and Prevention; 2021.

v Insights Unit, Vaccinate with Confidence Team. State of vaccine confidence report: Report 2. Atlanta, GA: Vaccine Task Force, Centers for Disease Control and Prevention; 2021.

vi Insights Unit, Vaccinate with Confidence Team. State of vaccine confidence report: Report 3. Atlanta, GA: Vaccine Task Force, Centers for Disease Control and Prevention; 2021.
COVID-19 State of Vaccine Confidence Insights Report | Report 4 | March 29, 2021

Appendix: Inputs and Sources

Type Input Cadence Sources Tactics for Utilization

Mixed 

Methods

Communication Surveillance 

Report

Daily, weekdays Google news

 Meltwater

CrowdTangle

Native platform searches

 Share of voice topic analysis to identify 

themes

 Emerging topics 

Tanaq Social Listening +Media 

Monitoring Report

Weekly  Meltwater

 Muck Rack

 Sprout Social

 First Draft

 Stronger

Native platform searches

 Trending topics

Demographic and geographic 

conversation monitoring

Meltwater Daily  Facebook, Twitter, Instagram

 Blogs

News media

Online forums

 Share of voice topic analysis

 Emerging theme topics

Identify high reach/velocity topics

Social 

Media 

Listening

OADC Channel COVID-19 Post 

metrics

Weekly  Sprout Social

Native OADC account analytics

Analyze # of posts, topics 

 Success of messages, # of impressions, 

reach, # of engagements

OADC Channel Comment 

Analysis

Daily, weekdays Native platform searches  Sentiment analysis

Identify message gaps/voids

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

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