CS000000-A | 2/24/22

COVID-19 State of Vaccine 

Confidence Insights Report

Report 23 | February 24, 2022 | Date Range: January 11 – 31, 2022

Summary

Findings. The first major theme of this report is that consumers and news outlets discussed the superiority of infection-induced 

immunity over COVID-19 vaccine-induced immunity with many concluding that infection-induced immunity is superior to 

vaccine-induced immunity. The second major theme is that consumers questioned the effectiveness of COVID-19 vaccines as 

a surge in breakthrough cases is being reported. A third theme is that consumers continued to have concerns about adverse 

events and unknown side effects of COVID-19 vaccines. The fourth and fifth findings during this report period are regarding 

consumers’ concerns and opposition to pediatric COVID-19 vaccines and vaccine requirements. 

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. These efforts aim to 

increase confidence in COVID-19 vaccines and expand vaccine uptake more broadly. Partners should create and disseminate 

messages about the safety and effectiveness of the COVID-19 primary series and booster doses compared to acquiring SARSCoV-2 infection-induced immunity. 

SPECIAL UPDATE: The following link contains social media resources such as graphics, language, and social media 

calendars that our partners can use to address the issues raised in this report: 

https://centersfordiseasecontrol.sharefile.com/d-sb8e03759bfe742649b787e1b3997f76c

Contents

2 Aims and Methods

3 Major Themes

3 Consumers and news outlets discussed the perceived 

superiority of infection-induced immunity versus 

vaccine-induced immunity.

5 Consumers question the effectiveness of COVID-19 

vaccines as news outlets report a surge in Omicronrelated breakthrough cases.

6 Continuing/Evolving Theme

6 Consumers continue to have concerns about adverse 

events and unknown side-effects of COVID-19 

vaccines

8 Consumers express their concerns and opposition to 

pediatric vaccines 

9 Consumers voiced their opposition to any vaccine 

requirements

10 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).
Page: 2

COVID-19 State of Vaccine Confidence Insights Report | Report 23 | February 24, 2022

Aims and Methods

By rapidly reviewing and analyzing numerous sources and inputs (see Appendix), the 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. 

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 23 | February 24, 2022

Major Themesa

Consumers and news outlets discuss the perceived superiority of SARS-CoV-2 

infection-induced immunity versus COVID-19 vaccine-induced immunity

A recent MMWR1 and other studies,2,3,4 appeared to elevate the debate surrounding the importance of vaccine-induced 

immunity compared to infection-induced immunity. More than 175 news outlets wrote about the MMWR findings1

, specifically 

that by early October of 2021, people who had survived a previous infection had lower case rates than those who were 

vaccinated alone.b Online searches for “CDC natural immunity” increased by 400% during this reporting period.c Some social 

media users5,6,7,8,9,10 and a widely shared Wall Street Journal opinion piece11 stated that the MMWR1 was CDC’s admission that 

infection-induced immunity is superior to vaccine-induced immunity.d

Online discussions increased further when the National Collegiate 

Athletic Association (NCAA) allowed individuals who had documented 

COVID-19 within the past 90 days to meet their requirement of being 

fully vaccinated.12 Social media users expressed their opposition13,14,15 and 

support of this policy.16,17,18

Perceptions, Concerns, and Threats to Vaccine Confidence

 Social media users stated that the results of the recent MMWR is evidence that the CDC and government cannot be 

trusted.e,f,19,20

 There are increasing reports of people intentionally trying to get infected with SARS-CoV-2 by having social gatherings with 

people previously diagnosed with the disease.21,22,23

 A notable conversation missing from the social media landscape is that the COVID-19 vaccines are a safer option to acquiring 

protection as opposed to infection-induced immunity. 

 The belief that infection-induced immunity is superior to vaccine-induced immunity has the potential to impact vaccine 

confidence because people may believe that getting COVID-19 is a safer strategy to acquiring immunity than getting the 

vaccines. 

 This theme could also have a negative impact on people’s trust in the government and CDC as some perceive that this new 

evidence proves the government and CDC were lying about the superiority of vaccine-induced immunity.

Content Gaps and Information Voids

 Is SARS-CoV-2 infection-induced immunity superior to vaccine-induced immunity?

 Getting sick with COVID-19 offers some protection from future illness with COVID-19, sometimes called “natural immunity.” 

The level of protection people get from having COVID-19 may vary depending on how mild or severe their illness was, the 

time since their infection, and their age. No currently available test can reliably determine if you are protected after SARSCoV-2 infection or for how long protection would last.24

 Why should people get vaccinated if they were previously infected with COVID-19?

 All COVID-19 vaccines currently available in the United States are effective at protecting against SARS-CoV-2 infection. 

Getting a COVID-19 vaccine gives most people some protection against COVID-19, even in people who have already been 

sick with the disease. Getting sick with COVID-19 can offer some protection from future illness, but the level of protection 

people get from having COVID-19 may vary depending on how mild or severe their illness was, the time since their 

infection, and their age.25

 Will CDC incorporate the role of infection-induced immunity into their vaccination and mitigation guidance?

 Currently, data are insufficient to determine the level of antibodies needed to indicate when an individual is protected from 

infection with the virus that causes COVID-19. There is neither an FDA-authorized/-approved test nor any other scientifically 

validated strategy that providers or the public can use to reliably determine whether a person is protected from infection.

a

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

b

Altmetric

c

Google Trends

d

Project VCTR

e

CDC-INFO

f

Rumble
Page: 4

COVID-19 State of Vaccine Confidence Insights Report | Report 23 | February 24, 2022

Misinformation Themes

 People with a previous COVID-19 infection are the safest people to be around.26,27

 CDC has changed their stance on infection-induced immunity.g,28,29

Ways to Take Action

 Create and disseminate messages, especially through trusted messengers, about the safety and effectiveness of the COVID-19 

primary series and booster doses compared to acquiring SARS-CoV-2 infection-induced immunity. 

 Create talking points and fact sheets for healthcare providers to aid in patient discussions regarding benefits of COVID-19 

vaccination versus infection-induced immunity.

 Disseminate messages that explain the limitations of using antibody titer results to determine protection from future infection 

with the virus that causes COVID-19.

g

CDC-INFO
Page: 5

COVID-19 State of Vaccine Confidence Insights Report | Report 23 | February 24, 2022

Consumers question the effectiveness of COVID-19 vaccines as news outlets 

report a surge in Omicron-related breakthrough cases 

As the Omicron variant surged in January, public health experts warned that local hospitals would be overwhelmed, leading 

many consumers to question the effectiveness of COVID-19 vaccines. During this reporting period, media coverage highlighted 

the spike in breakthrough cases.30,31,32 Some social media users decried the vaccine as a failure and urged public health 

officials to acknowledge this.33 Recently published studies showed that while the primary COVID-19 vaccine series had lower 

effectiveness against the Omicron variant, COVID-19 vaccines and boosters still protect against severe illness, hospitalization, 

and death.34 Increased doubt in vaccine effectiveness and decreased trust in public institutions can affect vaccine confidence 

and uptake. 

Perceptions, Concerns, and Threat to Vaccine Confidence 

 Some social media users believed that the number of breakthrough cases from COVID-19 proves vaccines are ineffective.35,36,37

 Consumers questioned why a vaccine is needed 

when vaccinated individuals can still get COVID-19 

and spread it to others.38,39,40,41,42

 Consumers expressed concern about the 

continued need for booster shots to protect against 

COVID-19.43,44,45

Content Gaps and Information Voids

 Do you still need a booster dose if you tested positive for COVID-19?

 COVID-19 vaccination causes a more predictable immune response than infection with the virus that causes COVID-19. 

Getting a COVID-19 vaccine gives most people a high level of protection against COVID-19 and can provide added 

protection for people who already had COVID-19.

46

 Why should you get a COVID-19 vaccine if you can still get a SARS-CoV-2 infection and spread it to others?

 Fully vaccinated people with a vaccine breakthrough infection are less likely to develop serious illness than those who are 

unvaccinated and get COVID-19. Even when fully vaccinated 

people develop symptoms, they tend to be less severe than in 

unvaccinated people.47

Misinformation Themes 

 COVID-19 vaccines are causing a surge in the number of COVID-19 

infections and deaths.48,49,50

 COVID-19 vaccines are ineffective, and should not be called 

vaccines.

51,52,53

 Government officials are aware that vaccines are ineffective but are 

intentionally withholding information.54,55

Ways to Take Action

 Continue to disseminate and amplify messages that demonstrate why vaccines are still an important tool to protect against 

severe COVID-19 infection, hospitalization, or death. 

 Create and disseminate messages that educate the public about breakthrough cases and how they are expected due to the 

high transmissibility of the Omicron variant.
Page: 6

COVID-19 State of Vaccine Confidence Insights Report | Report 23 | February 24, 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 continue to have concerns about adverse events and unknown side 

effects of COVID-19 vaccines.

Online accounts of menstrual irregularities, preterm births, and myocarditis following COVID-19 vaccinations have contributed 

to consumers’ concerns about vaccine safety and adverse side effects.56 Several news outlets and social media users57,58,59,60,61

discussed findings from recently published scientific studies showing COVID-19 vaccination neither caused menstrual or fertility 

irregularities62,63,64,65,66nor increased risk of preterm birth.67,68,69,70 During this reporting period, online conversations of “COVID 

vaccine long term side effects” increased by more than 650%.h In addition, online discussions of myocarditis and other vaccine 

side effects increased during this reporting period.71,72,73,74

Social media users and news stories discussed a recently released podcast by Joe Rogan. During an interview with the podcast 

guest, Dr. Robert Malone, Dr. Malone expressed his belief in several pieces of misinformation related to COVID-19 vaccine safety 

and side effects which likely increased the spread of these beliefs on social media and in new stories.75,76,77,78,79 

Perceptions, Concerns, and Threats to Vaccine Confidence

 Some consumers believe the government and CDC are suppressing or 

ignoring VAERS data.80,81,82

 Some social media users cited personal experiences and unverified statistics 

as evidence of a high number of reproductive system disorders83,84,85 and 

myocarditis,86,87,88,89,90 following COVID-19 vaccinations. 

 Some consumers expressed the belief that an individual can get “Vaccine 

Acquired Immune Deficiency Syndrome” or “immune erosion” from COVID-19 

vaccinations.91,92,93,94,95

Content Gaps and Information Voids

 What are the side effects of COVID-19 vaccinations?

 Common side effects include pain, redness, swelling, tiredness, headache, muscle pain, fever. Severe allergic reactions and 

adverse effects that could cause a long-term health problem are extremely rare.96,97

 What are the effects of COVID-19 vaccines on fertility?

 There is currently no evidence that any vaccines, including COVID-19 vaccines, effect fertility in women or men.98,99 

However, a recent study found that women who received COVID-19 vaccines had a less than one-day increase in the length 

of their menstrual cycles around the time of their doses.100

 What are the effects of COVID-19 vaccines on pregnancy?

 There is currently no evidence that COVID-19 vaccines increase risk of preterm birth, low birth weight, or stillbirth.101,102

SARS-CoV-2 infection during pregnancy may increase the risk of severe illnesses, hospitalizations and deaths in mothers and 

newborns.103,104 A recent MMWR found that completion of a 2-dose mRNA COVID-19 vaccination series during pregnancy 

might help prevent COVID-19 hospitalization among infants aged <6 months.105

 What is the risk of myocarditis after mRNA COVID-19 vaccination?

 The known risks of COVID-19 illness and its related, possibly severe complications, such as long-term health problems, 

hospitalization, and even death, far outweigh the potential risks of having a rare adverse reaction to vaccination, including 

the possible risk of myocarditis or pericarditis.106

 Most patients with myocarditis or pericarditis who received care responded well to medicine and rest and felt better quickly. 

Patients can usually return to their normal daily activities after their symptoms improve.107

 Infection with the virus that causes COVID-19 increases the likelihood of myocarditis.108

h

Meltwater
Page: 7

COVID-19 State of Vaccine Confidence Insights Report | Report 23 | February 24, 2022

Misinformation Themes

 Batches of the Moderna COVID-19 vaccine are causing deaths, but the government and news outlets are not reporting on it.109

 COVID-19 vaccines are causing an unprecedented number of deaths.110,111

 Risks of adverse side effects and deaths from COVID-19 vaccines outweigh the benefits of vaccine effectiveness against 

hospitalizations and deaths.112

Ways to Take Action

 Encourage healthcare providers to engage in conversations that address vaccine safety concerns by discussing potential side 

effects, vaccine benefits, and low rate of adverse events using an empathy-based approach.

 Tailor and disseminate messages relating to reproductive health through trusted messengers on the following vaccine-related 

topics:113

 No safety concerns have been identified for people who received an mRNA COVID-19 vaccine late in pregnancy or for their 

infants. 

 There is no increased risk of miscarriage after receiving the COVID-19 vaccines.

 CDC, FDA, and vaccine manufacturers continue to monitor the safety of COVID-19 vaccinations during pregnancy. 

 Increase messages highlighting the potential severity of illnesses associated with infection with the virus that causes 

COVID-19 (e.g., myocarditis, adverse pregnancy outcomes, deaths etc.). 
Page: 8

COVID-19 State of Vaccine Confidence Insights Report | Report 23 | February 24, 2022

Consumers express concerns and opposition to COVID-19 vaccines for children.

Some parents continue to oppose COVID-19 vaccination for children of all ages.114,115,116 Interest in vaccines for children younger 

than five years increased as evidenced by searches for “Covid vaccine for kids under five” almost doubling since the previous 

reporting period.i As COVID-19 cases and hospitalizations among children increase,117,118,119 vocal vaccine opponents continue to 

state that the risk of long-term side effects from the vaccine outweigh the perceived risk of mild COVID-19 symptoms.j According to 

a recent poll, only 37% of parents considered it essential to vaccinate their children before “return to normal.”120

Perceptions, Concerns, and Threats to Vaccine Confidence 

 Some social media users are concerned that the pandemic will not end if children are not vaccinatedk or because the COVID-19 

vaccines are ineffective.121,122

 Vaccine uptake among eligible children is uneven and relatively low as pediatric hospitalizations continue to rise.k,123,124,125 This 

concerns many medical and public health professionals.

 Some parents report refraining from vaccinating their children due to concerns of unknown and long-term side effects, 

perceptions that children are a low-risk population, and lack of trust in public officials.126,127,128,129,130,131 

 Some social media users are claiming that other countries not approving COVID-19 vaccines demonstrates that children should 

not get the vaccine in the United States.132,133,134,135

Content Gaps and Information Voids

 When will a COVID-19 vaccine for children ages 4 and younger be available? 

 Currently, children ages 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 ages 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.136,137 The FDA postponed the Vaccines and Related Biological Products Advisory Committee (VRBPAC) meeting 

originally scheduled for February 15, 2021, to give the agency time to consider additional data, allowing for a transparent 

public discussion as part of their usual scientific and regulatory processes for COVID-19 vaccines.138 FDA will provide an 

update on timing for the advisory committee meeting once additional data is received on a third dose in this age group 

from the company’s ongoing clinical trial and have an opportunity to complete an updated evaluation.

 Where can parents find COVID-19 tests for children ages 4 and younger? 

 Parents can visit their state, tribal, local, or territorial health department’s website to look for the latest local information on 

testing.139

 Parents can visit their healthcare provider to get a self-collection kit or self-test.

140

 Should children receive a booster dose?l

 Everyone ages 12 years and older should get a COVID-19 booster dose. Currently, a booster dose is not recommended for 

children ages 11 years and younger.141

 How was the vaccine developed for children and what are the associated adverse events?m

 Before recommending COVID-19 vaccination for children, scientists conducted clinical trials with thousands of children and 

found no serious safety concerns. Learn more about the process of developing, authorizing, and approving COVID-19 vaccines.

Misinformation themes 

 Children do not need the COVID-19 vaccine because deaths, hospitalizations, and infections are low.142,143,144,145

 The flu is worse than COVID-19 in children because the risk of severe side effects from COVID-19 is very low for children.m,146,147

 COVID-19 vaccines for children are a part of an experiment by large pharmaceutical companies.148,149,150

Ways to Take Action

 Encourage public health experts, community leaders, and pediatricians to promote pediatric vaccinations to parents. 

 Develop plain language information about the steps involved in vaccine development and adverse events for media distribution. 

 Provide public health professionals, doctors, schools, and daycare centers with COVID-19 mortality and morbidity information to 

clarify COVID-19 risk in children. 

i

Google Trends

j

Tanaq Social Listening Report

k

CDC Community Surveillance Report

l

CDC-INFO

mTanaq Social Listening Report
Page: 9

COVID-19 State of Vaccine Confidence Insights Report | Report 23 | February 24, 2022

Consumers voiced their opposition to any vaccine requirements

On January 13, 2022, the United States Supreme Court voted to block the Occupational Safety and Health Administration (OSHA) 

vaccine requirement for businesses with more than 100 employees.151 Citing this decision, a federal judge in Texas blocked the 

executive order requiring COVID-19 vaccines for federal employees.152 Despite the ruling, 30% of polled companies plan to require 

employee vaccination.153 The Supreme Court voted to uphold the requirement for recipients of Medicare and Medicaid funding 

to ensure their staff is vaccinated against COVID-19 unless exempt for medical or religious reasons.154 Recent consumer polling 

indicates a slight majority of respondents support workplace requirements.155

Perceptions, Concerns, or Threats to Vaccine Confidence

 Many consumers expressed their support on social media for the 

Supreme Court’s decision to block the OSHA requirement for businesses 

with more than 100 employees156,157 while others participated in protests 

against the requirements.158,159,160,161

 Some polling indicated that levels of trust in employers’ COVID-19-

specific communication exceeded levels of trust in CDC.162

 Blocking OSHA’s COVID-19 vaccination requirement may decrease 

vaccine confidence by contributing to a perception that vaccines are 

unnecessary, ineffective, or illegal.

Content Gaps and Information Voids

 Why was the vaccine requirement blocked?

 The Supreme Court’s decision to block the OSHA vaccine requirement 

rule was based on a perceived inability to enforce the vaccination 

requirement163 and the need for congressional approval for broader 

vaccination requirements.164

 Can companies still require vaccination? 

 Given the categorization of COVID-19 as a ‘direct threat’ by the Equal 

Employment Opportunity Commission, companies can require 

employees to be vaccinated or tested for COVID-19 regularly.165,166 CDC 

has a webpage listing public health vaccination laws and resources 

regarding state vaccination requirements.167

Misinformation Themes

 Vaccine requirements are illegal168 and not effective.169,170

 The high transmissibility of the Omicron variant means vaccine requirements are unnecessary.171,172,173

 Vaccination requirements are the first step to enact population control.174

Ways to Take Action

 Support employers that have existing vaccine requirements by providing or helping them craft messages about the importance 

of vaccination for their employees or offer onsite vaccinations. 

 Support employers that do not have existing vaccine requirements by helping them implement COVID-19 preparedness, 

response, and control plans.175
Page: 10

COVID-19 State of Vaccine Confidence Insights Report | Report 23 | February 24, 2022

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 (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