CS000000-A | 06/21/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 10 | June 21, 2021 | Date Range: May 25, 2021 - June 7, 2021

Summary

Findings. Even as the number of unvaccinated people with intent to get a COVID-19 vaccine has shrunk, efforts to 

promote vaccination have remained the same or even increased. This is causing some who might not intend to get 

vaccinated to report feeling unfairly pressured to get vaccinated. At the same time, the removal of mask mandates 

for vaccinated individuals and other mitigation measures across the United States has reduced motivation for some 

unvaccinated people to get vaccinated. The United States’ decision to investigate the possibility that the virus that 

causes COVID-19 might have been created in a laboratory has caused some consumers to express distrust in domestic 

and foreign governments, the COVID-19 response, and COVID-19 vaccines. 

Ways to take action. Federal, state, and local partners should work together to disseminate messages about the 

effectiveness of COVID-19 vaccines, respond to gaps in information, and confront misinformation with science-based 

messaging. The goal of these efforts is to increase confidence in COVID-19 vaccines and expand vaccine uptake more 

broadly. Communication and outreach efforts should be evaluated and recalibrated to provide a more tailored, localized 

approach to reach the shrinking number of people with some intent to get a COVID-19 vaccine. Additional research 

and evaluation should be done to better understand the perceptions and opinions regarding COVID-19 vaccines and 

motivating factors for vaccination among those who want to be vaccinated but have not yet for various reasons.

Contents

2 Aims and Methods

3 Pressure created by abundant marketing campaigns 

and unprecedented incentives and vaccine 

requirements might be alienating consumers who are 

unsure about getting vaccinated.

4 While the ‘return to normal’ appears to be motivating 

some consumers to get vaccinated, it seems to be 

decreasing urgency for others. 

5 The origin story of the virus that causes COVID-19 is 

reducing confidence in COVID-19 vaccines for some. 

6 Continuing and Evolving Themes

7 Appendix

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 10 | June 21, 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. These are 

characterized by 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 improve vaccine confidence 

across the United States.

The information in this report is a snapshot in time based on the date range of the report and certain populations might be 

underrepresented. Images and quotes are illustrative examples and are not meant to be comprehensive of all content related 

to the highlighted themes. Included polls and literature reflect polls that were released or conducted data collection during the 

date range of this report.

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 10 | June 21, 2021

Major Themes

Pressure created by abundant marketing campaigns, unprecedented incentives, 

and vaccine requirements might alienate consumers who are unsure about 

getting vaccinated.

In an effort to reach the President’s goal to administer at 

least one dose of vaccine to 70% of adults by July 4, 2021, 

vaccination coverage and efforts by states and jurisdictions 

to increase vaccine confidence and uptake was widely 

covered by the news media.1,2 While some consumers 

expressed optimism of getting closer to the goal, others 

expressed skepticism and felt that the strategies being 

used are ineffective, intrusive, and discriminatory.3,4,5One 

poll found that 4 in 10 unvaccinated people felt ‘unfairly 

pressured,’ indicating that the government, news media, 

society, and loved ones all contributed to this feeling. The 

poll also found that the likelihood a person perceived ‘unfair 

pressure’ increased the more reluctant or hesitant they were 

to get vaccinated.6

As the number of unvaccinated people with an intent to 

get a COVID-19 vaccine shrinks, the volume and scale of 

communication and marketing campaigns have remained 

the same or even grown. Also, localized efforts to increase 

uptake through incentives, such as lotteries and free beer, 

and other innovative outreach methods, like offering free 

rides to vaccination sites and badges on dating apps, have 

also grown.7,8,9 Some consumers felt that these efforts should 

be seen as 'red flags,'10 and people who are unvaccinated should ignore the ‘bribes’ and decide to get vaccinated on their own 

when they are ready.11,12 These perceived attempts at ‘coercion’ have resulted in some consumers losing further trust in the U.S. 

vaccination system,13,14 which could decrease their motivation and intent to get vaccinated.15

Another source of perceived pressure is announcements from several entities on requirements to prove vaccination status for 

travel, school attendance, employment, and when receiving services. News media outlets covered the legality of employers 

requiring vaccination and companies announcing such requirements, as well as employees suing their employers over the 

requirements.16,17,18,19,20 Some vocal vaccine deniers attempted to sow further distrust in the U.S. vaccination system by equating 

proof-of-vaccination systems and mandates to ‘medical segregation.’21 Their efforts especially focused on education-based 

mandates in light of colleges and universities announcing reopening plans and the recent recommendation that adolescents 

12–15 years old be vaccinated.22,23,24,25,26

Proof-of-vaccination systems remain a polarizing topic for consumers and politicians. One survey found that just over half 

(56%) of people surveyed would support policies that would prevent those without proof of vaccination from traveling, 

while 1 in 10 (14%) would be upset if they were asked for proof of vaccination.27 Some political leaders introduced executive 

orders and legislation to prevent proof-of-vaccination systems and mandates, claiming that vaccination should be a personal 

choice.28,29,30,31,32,33

Ways to act:

 Further evaluate the perceptions and opinions of unvaccinated adults to better understand the reasons they might be 

delaying or refusing COVID-19 vaccination, what messengers and platforms they most trust, and what would motivate them 

to get vaccinated. Leverage such evaluation to develop tailored communication and social mobilization campaigns around 

vaccination.

Source: https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-may-2021/
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COVID-19 State of Vaccine Confidence Insights Report | Report 10 | June 21, 2021

Ways to act (cont.)

Evaluate and recalibrate current communication, marketing, and outreach efforts for COVID-19 vaccines and vaccination 

to identify new strategies for organic and paid media. This could include message testing, content frequency adjustments, 

new audience segmentations, and different channel selection and messengers that better reach remaining unvaccinated 

consumers. 

Develop and disseminate messages by leveraging data that show how widely accepted and safe vaccines have proven to be, 

with over 65% of U.S. adults getting at least one dose and safety monitoring continuing to confirm that the vaccines are safe 

and effective.

Partner with local influencers, trusted messengers, and public health experts to encourage dialogue around vaccination 

through hosting town halls or forums, digitally and in-person, as able. Use these events to foster a safe space for questions, 

concerns, and information gathering.

While the ‘return to normal’ appears to be motivating some consumers to get 

vaccinated, it seems to be decreasing urgency for others. 

Many states and jurisdictions have announced plans to remove mask 

mandates and other mitigation measures after reaching a vaccination 

coverage target,34,35,36 while some have already rolled back mitigation 

measures regardless of vaccination rates.37,38 News coverage abounded 

with examples of the country returning to pre pandemic life, such as the 

lifting of mask mandates for schools,39 countries announcing that they 

would once again be welcoming Americans for international travel,40 and 

even crowded festivals and movie theaters returning to full capacity.41,42

While some consumers expressed excitement to see vaccinations helping 

this return to normal,43,44 others expressed concern that without proofof vaccination systems and higher rates of vaccination coverage these 

decisions were premature.45,46 This was especially concerning for families 

with children who are not eligible to be vaccinated and people with 

compromised immune systems who commented that they felt as though 

public health guidance did not adequately protect them.47,48,49,50,51 These 

concerns could contribute to broader distrust in the U.S. vaccination 

system and public health response to COVID-19.

Many businesses and organizations are relying on an ‘honor system’ regarding vaccination status with mask and physical 

distancing requirements lifted for fully vaccinated people without requiring proof of vaccination,52,53which vaccine advocates 

claim is being ignored by those reluctant or refusing to be vaccinated.54,55 A recent poll supported these claims finding that the 

percentage of people wearing masks is declining, with less than 50% of people who do not plan to get vaccinated reporting 

wearing masks compared with 90% of people who are fully vaccinated.56 Another poll found that updated guidance for fully 

vaccinated individuals regarding mask wearing has little to no effect on the intent for those who have yet to get vaccinated 

to get a COVID-19 vaccine.57 This indicates that the further loosening of mitigation measures might not increase vaccine 

confidence or uptake for those wanting to ‘wait and see’ and those who would only get vaccinated if it is required.

Ways to act:

 Amplify true vaccination stories from community members, particularly of those who delayed vaccination, to highlight how 

they decided to get vaccinated, their experience, and what they are looking forward to once they are fully vaccinated.

 Continue to disseminate messages through health authorities, healthcare providers, and other trusted messengers about the 

importance of vaccination, how to find a vaccine near, and the importance of mitigation measures for those who are not fully 

vaccinated. Messages should include information about the role of vaccination in protecting themselves and their loved ones, 

especially those who are not able to be vaccinated.
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COVID-19 State of Vaccine Confidence Insights Report | Report 10 | June 21, 2021

Emerging Theme

The origin story of the virus that causes COVID-19 is reducing confidence in 

COVID-19 vaccines for some. 

In late May 2021, President Biden ordered intelligence agencies to further 

investigate the origins of the virus that causes COVID-19.58,59 Early in the 

pandemic, claims that the virus might have been in a laboratory were widely 

fact-checked and labeled to be false, but this new investigation is re-examining 

early theories that the virus likely originated from animals. One poll indicated 

that most consumers (58%) believe that the virus that causes COVID-19 was 

made in a laboratory and some consumers (25%) believe it was released on 

purpose.60 Additionally, online searches for the origin of COVID-19 have almost 

doubled since the beginning of 2021, with only one of the top ten results being 

a health authority.61

News coverage on the re-investigation of the origins of the virus that causes 

COVID-19 quickly escalated from major news outlets61,62,63 and outlets known for 

their involvement in instigating and spreading mis- and disinformation.64,65 This 

coverage appeared to validate skepticism and distrust for vocal vaccine deniers 

and some consumers.66,67,68,69 This perceived validation led some social media 

companies to stop flagging and removing content related to the origins of the virus.70 This also led some consumers to call for 

other content flagged or removed on the basis of misinformation to be reinstated.71 Reinstating content might undermine the 

progress and efforts made to reduce the spread of COVID-19 and vaccine mis- and disinformation on social media platforms. At 

the same time, a widely-circulated story claimed that a scientist from the laboratory that some believe the virus emerged from 

filed a patent for a COVID-19 vaccine before the pandemic was declared.72,73 Some consumers indicated this story furthered their 

distrust in COVID-19 vaccines and the motivations of the federal government in promoting vaccination.74,75,76

Ways to Act:

Evaluate perceptions and opinions of consumers who have not yet been vaccinated to better understand how the origin of 

the virus that causes COVID-19 might affect their motivation and intent to get vaccinated.

Amplify messages through trusted messengers about the benefits of COVID-19 vaccines, regardless of the origin of the virus, 

and available facts and statistics on vaccine impact.
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COVID-19 State of Vaccine Confidence Insights Report | Report 10 | June 21, 2021

Continuing and Evolving Themes

Themes below have been noted in previous reports and continue to undermine vaccine confidence for people who remain 

unvaccinated. The information highlighted below focuses on what is new or different from previous reports. For additional 

context and previous recommendations on these themes see previousInsights Reports.

Vaccine effectiveness. Studies looking at the effectiveness of currently available COVID-19 vaccines against the most 

common variants of the virus that causes COVID-19 caught news attention. One highlighted the importance of completing 

a vaccination series, if a vaccination requires two doses,77 while another noted how the Delta variant in particular led to an 

increase in hospitalizations in the United Kingdom.78,79 Based on social media comments and inquires to CDC-INFO, consumers 

are expressing confusion about the effectiveness of their vaccination, when they would require a booster dose, and whether 

they should mix two brands of vaccine to enhance their protection.

New ways to act:

Enhance message dissemination about the role COVID-19 vaccines play in reducing the spread and development of virus 

variants.

Continue to amplify messages about the effectiveness of COVID-19 vaccines against common variants and the benefits of 

vaccination, particularly reducing the length and severity of illness if people get sick. 

Adverse events. Adolescents experiencing myocarditis following vaccination 

was a focus in the news cycle and in social media conversation about COVID-19 

vaccines.80,81,82,83 Vocal vaccine deniers intensified concerns about the potential of 

adverse events by spreading misinterpreted VAERS data, claiming that in addition to 

the myocarditis cases there are large numbers of adverse events occurring following 

COVID-19 vaccination.84,85,86

Misinformation. Concerns about foreign actors influencing vaccine confidence arose 

with reports of a foreign advertising agency targeting influencers to sow distrust in the 

Pfizer-BioNTech COVID-19 Vaccine.87,88 Minor misinformation topics during this reporting 

period included claims that:

Vaccination is leading to the development of virus variants.89

The Moderna COVID-19 Vaccine contains a cancer-causing ingredient that could also 

damage fertility or a fetus.90

Vaccination will cause mass deaths circulated based on comments by a former 

pharmaceutical executive and a Nobel prize winner who was misquoted.91,92

Natural immunity. Experts from two major health authorities in the 

United States spoke out advising consumers that previously infected 

people should ignore CDC’s guidance to get vaccinated,93 as there is little 

to no benefit for them.94,95 Social media misinformation that vaccination 

‘destroys’ the superior antibodies of people who were previously 

infected also circulated, causing some to say that is why convalescent 

plasma is not being accepted by blood banks.96 CDC-INFO received 

several inquiries asking for clarity on antibody testing and what levels of 

infection-induced antibodies are needed for one to be protected. 

Medical Bills. Consumers continue to report to CDC-INFO that they are receiving medical bills for their COVID-19 vaccination, 

causing confusion as vaccination is supposed to be free. As reports of people receiving medical bills continue, it has 

discouraged some unvaccinated consumers from getting vaccinated.97 At the same time, some consumers expressed concern 

about medical bills if they were to experience an adverse event that required medical care or hospitalization98 and some 

consumers have already contacted CDC-INFO to inquire about how to be reimbursed. 
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COVID-19 State of Vaccine Confidence Insights Report | Report 10 | June 21, 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 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 

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

FEMA Social Listening Report Daily Hootsuite

 Brandwatch

CrowdTangle

 Meltwater

 Trends/sentiment analysis

National and global news analysis

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