CS000000-A | 12/14/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 19 | December 14, 2021 | Date Range: October 26, 2021 – November 08, 2021

Summary

Findings. This report identifies several vaccine confidence themes during this reporting period. First, despite positive vaccine 

uptake trends, high-profile personalities continued to express negative vaccine sentiments which elevated these conversations. 

Second, consumers continue to worry about side effects of available COVID-19 vaccines. Third, there is continued frustration 

about CDC revising the definition of “vaccine” and “vaccination”. Fourth, consumers continue to show their support and 

opposition to the Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine for children ages 5 – 11 years 

old. Fifth, states and localities continue to take legislative action against implementing vaccine requirements. Sixth, social 

media users expressed their support for the suspension of the Occupational Safety and Health Administration (OSHA) COVID-19 

vaccine requirement. Finally, consumers continue to debate the role of infection-acquired immunity in preventing the spread of 

COVID-19.

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 goals of these 

efforts are to increase confidence in COVID-19 vaccines, generate demand, and expand vaccine uptake more broadly. Partner 

with professional sporting associations and teams to generate vaccine demand and promote uptake by disseminating 

messages from current and former players about why they got vaccinated, whether they had concerns about the vaccine, and 

what helped them overcome their concerns. Work with trusted messengers to disseminate messages that educate people on 

the importance of understanding scientific study limitations and how to interpret the results of peer-reviewed and preprint 

studies especially when the results appear to run counter to well-established scientific evidence. 

Contents

2 Aims and Methods

3 Major Themes

3 Trusted messengers continue to drive online conversations 

about vaccination

4 Consumers continue to worry about side effects and adverse 

events of available COVID-19 vaccines. 

5 Emerging Themes

4 Consumers express frustration about CDC updating the

definition of vaccine

4 Update: Consumers continue to show their support and 

opposition of the Emergency Use Authorization for the PfizerBioNTech COVID-19 Vaccine in children ages 5 – 11 years old.

6 Continuing and Evolving Themes

7 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 19 | December 14, 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 19 | December 14, 2021

Major Themes

Trusted messengers continue to drive online conversations that amplify vaccine 

concerns and misinformation 

Despite positive vaccine uptake trends and expanded eligibility of booster doses to all adults, high-profile personalities 

continued to elevate negative vaccine sentiments.a

 According to the latest Rasmussen Reports national telephone and online 

survey, 52% of participants support workers resisting vaccine requirements.1 While some consumers may resist vaccine 

requirements, data from individual companies indicates a majority (84% - 91%) of their employees are compliant.2

On November 3, 2021, Green Bay Packers 

quarterback, Aaron Rodgers, tested positive 

for COVID-19 despite telling reporters in 

August 2021 that he had ‘been immunized’.3

During an interview on November 5, 

2021, Aaron Rodgers claimed he had been 

immunized against COVID-19 through a homeopathic protocol. He then promoted several pieces of misinformation including 

unapproved treatments and preventatives as well as vaccine-related fertility concerns.4

 Many social media users discussed this 

matter and circulated the issues he raised,5,6,7,8,9,10 and this issue was widely covered by national news outlets, which spread the 

associated misinformation.11,12,13,14

Other news stories about celebrities refusing or getting the COVID-19 vaccine, along with Big Bird’s promotion of the COVID-19 

vaccines, also led to additional social media conversations about COVID-19 vaccines,15,16.17,18,19,20,21,22,23 accompanied by 

consumers’ increasing online searches about these stories.a President Biden’s Twitter account also added to the conversation 

when he expressed his support for Big Bird getting vaccinated.24

Ways to act: 

 Partner with professional sporting associations and teams to generate vaccine demand and promote uptake by disseminating 

messages from current and former players about why they got vaccinated, whether they had concerns about the vaccine, and 

what helped them overcome their concerns. 

 The NFL Vaccination Strategy is an example of this type of approach.

 Support and perform research that attempts to better understand vaccine confidence and perceptions of vaccine 

effectiveness, including trusted messengers and sources of information, among groups with low vaccine confidence. 

 Create and disseminate messages that promote vaccination and address common vaccine-related information voids when 

high profile figures, for or against vaccination, cause an increase in new stories and social media conversations. Timing 

message dissemination in this manner has the potential to also elevate messages that would build vaccine confidence. 

a

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

Consumers continue to worry about side effects and adverse events of available 

COVID-19 vaccines. 

Since the EUA of the Pfizer-BioNTech COVID-19 vaccine in December 2020, 

previous COVID-19 State of Vaccine Confidence Insights Reports found 

that individuals expressing hesitation towards the COVID-19 vaccine, or 

wanting to ‘wait and see’ before getting vaccinated, have often cited the 

possibility of adverse events and serious long-term side effects as their 

motivation behind delaying vaccination.b

In the period from November 6 to November 8, 2021, 

searches including the terms “efficacy” and “safety” 

increased rapidly.c Consumers continue to worry about cardiac-related side 

effects.d,25,26,27 Many continue to turn to public health officials to clarify, 

explain, and confirm the benefits of vaccination despite recorded 

adverse events.c

Some social media users are concerned and convinced that COVID-19 

vaccines do not prevent transmission between either unvaccinated or 

vaccinated individuals.28,29,30 Therefore, consumers are questioning the 

need for vaccination if it will not stop the spread of COVID-19 in the United 

States. Questions regarding the possibility and probability of transmission 

despite vaccination remain common. Public inquiries to CDC-INFO reflect 

questions about whether vaccinated individuals have the potential to 

spread fewer viral particles than unvaccinated individuals and if the 

vaccines prevent infection or stop transmission. 

Additionally, through CDC-INFO, some people were requesting sources, statistics, and studies from the CDC and other 

government agencies that discuss transmission after receiving the vaccine.d In response to these content gaps, misinterpreted 

or misrepresented journal manuscripts and circulating misinformation are guiding consumer opinion, potentially further sowing 

doubt and confusion regarding COVID-19 transmission.31,32,33 It is important to address this gap in information and put forward 

additional, trustworthy, and clear messaging about the risk of transmission after vaccination. You can find examples of resources 

and graphics at this CDC website.

In response to a perceived rise in breakthrough infections, some social media users are using this to strengthen their opposition 

to COVID-19 vaccines.34,35,36 On social media, vocal vaccine deniers are stating that if vaccines decrease in effectiveness over 

time, then vaccination is useless and unnecessary.37,38,39 Moreover, social media users are using breakthrough infections resulting 

from the Delta variant to spread the broader claim that vaccines are ineffective.40,41,42 Some are making this claim following a 

widely circulating study that concludes people with breakthrough infections are just as likely as unvaccinated individuals to 

spread COVID-19 to household contacts.43,44,45  

Ways to act: 

 Work with healthcare providers, community groups promoting vaccination, and pharmacists to clarify the number of 

breakthrough infections, hospitalizations, and deaths among vaccinated and unvaccinated populations. Additionally, create 

and publish easy-to-understand graphics and figures showing these numbers. 

 Create and publish easy-to-understand content and graphics reflecting the risk of transmission after vaccination to counter 

misinformation on this topic. You can find examples of resources and graphics at this CDC website. 

 Enlist trusted messengers to communicate scientific findings of side effects and adverse events to vaccine hesitant individuals 

with a focus on uncommon dissemination channels and innovative messaging. 

 Work with trusted messengers to disseminate messages that educate people on the importance of understanding scientific 

study limitations and how to interpret the results of peer-reviewed and preprint studies especially when the results appear to 

run counter to well-established scientific evidence. 

b

COVID-19 State of Vaccine Confidence Insights Reports

c

Google Trends

d

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 19 | December 14, 2021

Emerging Themes

Consumers express frustration about CDC revising the definition of vaccine

Some consumers have expressed concern following CDC’s updated definitions for ”vaccine” and ”vaccination”.46  Prior to 

September 1, 2021, CDC definitions of ”vaccine” and ”vaccination” were as follows: “Vaccine: A product that stimulates a person’s 

immune system to produce immunity to a specific disease, protecting the person from that disease. Vaccines are usually 

administered through needle injections but can also be administered by mouth or sprayed into the nose. Vaccination: The act 

of introducing a vaccine into the body to produce immunity to a specific disease.”47 On September 1, 2021, CDC revised their 

definitions: “Vaccine: A preparation that is used to stimulate the body’s immune response against diseases. Vaccines are usually 

administered through needle injections, but some can be administered by mouth or sprayed into the nose. Vaccination: The act 

of introducing a vaccine into the body to produce protection from a specific disease.”48

Although this change happened on September 1, 2021, an e-mail 

correspondence obtained recently via a Freedom of Information Act 

(FOIA) request was shared widely online.49 Some online consumers 

suggested that the updating of the definition of ”vaccines” was a 

result of breakthrough infections, noting that “true” vaccines should 

prevent disease, and this new definition indicates that the COVID-19 

vaccines are too ineffective to have qualified as vaccines under the 

prior definition.50,51 Some instead believe that mRNA COVID-19 vaccines 

do not qualify as vaccines, and changing the definition eliminates 

this discrepancy.52,53,54 However, the aforementioned explanations for 

updating the definitions are misleading and have since been debunked 

as continual revision of scientific content is normal, universal, and 

acceptable.55

Ways to act: 

 Create messages that explain CDC’s rationale behind the necessary and improved “vaccines” definition. 

 Engage with scientific associations to disseminate messages about the accuracy of the updated definition of “vaccines”.
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COVID-19 State of Vaccine Confidence Insights Report | Report 19 | December 14, 2021

Update: Consumers continue to show their support and opposition of the Emergency Use 

Authorization for the Pfizer-BioNTech COVID-19 Vaccine in children ages 5 – 11 years old. 

Following the EUA of COVID-19 vaccines for children ages 5 – 11 years, some consumers, especially parents, continue 

to question the necessity and safety of COVID-19 vaccination in children.56,57,58 Many continue to cite low case 

numbers and deaths, along with the possibility of harmful side effects and adverse events to negate the urgency 

of pediatric vaccination.59,60,61,62,63 Despite this, many parents are excited and relieved at the prospect of vaccinating 

their children between the ages of 5 – 11 years.64,65,66,67Vocal vaccine opponents continue to claim that childhood 

vaccine requirements limit personal liberty and limit parental choices.68  

Interest in pediatric vaccination increased during this reporting 

period. Searches for terms “5-11” and “vaccine mandate” 

spiked around the date of the FDA EUA for pediatric vaccination 

and publication of CDC guidance.e

 In addition, Google trends 

also showed consumers increasingly searched for vaccination 

sites and clinics near them following the EUA and CDC 

recommendation.d Following the EUA, some states, cities, and 

school districts are experiencing alternating support as well as 

backlash from parents and politicians as they consider adding the 

COVID-19 vaccine to their immunization requirements.69,70,71,72,73,74,75

Despite growing interest in childhood COVID-19 vaccination, a recent 

Kaiser Family Foundation (KFF) (n=219) poll found that parents are 

uneasy about childhood vaccination for a wide range of reasons:76

76% of parents are very or somewhat concerned about unknown long-term effects, while 71% are concerned their child might 

experience serious side effects. The same poll showed parents are hesitant to vaccinate their children due to fear of potential 

impacts on the child’s fertility, and concerns about access to vaccination sites and quality of the site. Additionally, parents are 

concerned about needing to take time off should their child experience side effects following vaccination.77

Ways to act: 

 Refer to previous Rapid Report – Announcement of Pediatric COVID-19 Vaccines for Children ages 5-11 years old

 Using plain language and trusted messengers, disseminate findings from these two recent MMWR reports

 COVID-19 Vaccine Safety in Adolescents Aged 12–17 Years — United States, December 14, 2020–July 16, 2021

 Trends in COVID-19 Cases, Emergency Department Visits, and Hospital Admissions Among Children and Adolescents Aged 

0–17 Years — United States, August 2020–August 2021

e

Google Trends
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COVID-19 State of Vaccine Confidence Insights Report | Report 19 | December 14, 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.

States and localities continue to take legislative action against vaccine requirements. Some states have banned all vaccine 

requirements, which prohibits a private business to compel or take an adverse action against a person in order to compel them 

to provide proof of vaccination.78,79 Additionally, other states are providing an option for exemptions or will permit employers to 

allow workers to opt out of vaccine requirements.80,81

New ways to act:

 Engage with local trusted messengers from the geographical regions where legislation was passed or proposed that would 

ban vaccine requirements and emphasize the importance of vaccination

 Partner with state and local public health authorities to provide periodic, clear messaging to the public on the current status 

of vaccine requirements

Consumers expressed their support for the suspension of the Occupational Safety and Health Administration (OSHA) 

COVID-19 vaccine requirement. The Occupational Safety and Health Administration (OSHA) is suspending enforcement of 

the Biden administration’s COVID-19 vaccine requirement for large private businesses after a federal appeals court upheld a 

stay on it last week.82 Some social media users expressed their support for this ruling.83,84,85 However, the White House urged 

businesses to continue implementing the guidance for COVID-19 vaccines and testing.86

Consumers continue to debate the role infection-acquired immunity has in preventing the spread of COVID-19. As 

reported in previous COVID-19 State of Vaccine Confidence Insights Reports, social media users continue to discuss the 

effectiveness of infection-acquired immunity compared to vaccine-acquired immunity.f,87,88,89 News outlets and social media 

users are sharing a recent study90 that they claim to support this belief.91,92,93

f

COVID-19 State of Vaccine Confidence Insights Reports
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COVID-19 State of Vaccine Confidence Insights Report | Report 19 | December 14, 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 (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