CS000000-A | 12/1/23

Center for Disease Control and Prevention 

Immunization Services Division, 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).

CDC’s State of 

Vaccine Confidence 

Insights Report

Vaccine Hesitancy Among 

Pregnant People 

December 1, 2023
Page: 2

State of Vaccine Confidence Insights Report | December 1, 2023

Report Summary 

This State of Vaccine Confidence Insights Report emphasizes major themes influencing general 

vaccine confidence and uptake among individuals who are currently pregnant or planning to become 

pregnant, with a particular focus on COVID-19 vaccination.

Themes with the potential to impact vaccine confidence and demand:  

 Theme 1: Many pregnant people do not have adequate information about the benefits and risks 

of vaccination during pregnancy or are susceptible to circulating misinformation about receiving 

vaccines during pregnancy.

 Theme 2: Many pregnant people are concerned about vaccine safety and side effects.

 Theme 3: Several factors contribute to differences in vaccine uptake between Black, Hispanic, 

and White populations among pregnant people. 

Ways public health and partners can take action to improve vaccine confidence:

 Develop evidence-based, culturally appropriate materials about vaccination during pregnancy 

to address common concerns, debunk myths, and provide accurate information about vaccine 

safety and effectiveness. Use clear language, visuals, and relatable examples to effectively 

communicate accurate information.

 Collaborate with trusted community leaders, healthcare providers, and organizations that have 

influence and credibility within pregnant populations.

 Encourage pregnant people to become vaccine advocates within their own communities. 

Provide them with accurate information, resources, and tools to address vaccine-related 

misinformation and share their positive experiences with vaccination during pregnancy.

 Actively monitor social media platforms, online forums, and other digital spaces visited 

by pregnant people where vaccine-related misinformation may circulate. When possible 

and appropriate, swiftly respond with accurate information, providing correct context and 

addressing concerns raised.

 Highlight positive experiences and outcomes of pregnant people who have received vaccines 

during pregnancy. Share stories of healthy pregnancies and positive health outcomes for both 

the mother and baby.

 Disseminate easily understandable materials that explain the benefits and risks of vaccination 

during pregnancy. Use multiple communication channels, including community events, social 

media, and local media outlets.

 Reduce barriers to accessing vaccines by establishing vaccination clinics in easily accessible 

locations, such as community centers, places of worship, or workplaces. Offer flexible scheduling 

options and extended hours to accommodate pregnant people’ needs.

 Enhance healthcare provider education and training on vaccine benefits, risks and 

recommendations during pregnancy, cultural competency, and effective communication 

techniques. Equip providers with the skills and accurate information to address concerns and 

build trust with pregnant people from diverse backgrounds.

 Communicate how and why FDA-approved vaccine package inserts differ from ACIP and CDC 

vaccine recommendations. 

Resources: The following link contains graphics and assets partners can use to address themes in this 

report: https://centersfordiseasecontrol.sharefile.com/d-sd7cc301a41a3402ba8626c1c4ac73387
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State of Vaccine Confidence Insights Report | December 1, 2023

Table of Contents

4

Aims and Methods

5

Theme 1: Many pregnant people do not have 

adequate information about the benefits and 

risks of vaccination during pregnancy or are 

susceptible to circulating misinformation about 

receiving vaccines during pregnancy.

5

Perceptions, Concerns, and Threats to Vaccine 

Confidence

6

Common Questions and Queries from the Public

9

Ways Public Health and Partners Can Take Action 

to Improve Vaccine Confidence

9

Theme 2: Many pregnant people are concerned 

about vaccine safety and side effects.

9

Perceptions, Concerns, and Threats to Vaccine 

Confidence

11

Inaccurate Health Information Themes

11

Commonly Asked Questions and Queries from 

the Public

13

Ways Public Health and Partners Can Take Action 

to Improve Vaccine Confidence

14

Theme 3: Several factors contribute to differences 

in vaccine uptake between Black, Hispanic, and 

White populations among pregnant people.

14

Perceptions, Concerns, and Threats to Vaccine 

Confidence

14

Commonly Asked Questions and Queries from 

the Public

15

Ways Public Health and Partners Can Take Action 

to Improve Vaccine Confidence

16

References

20

Appendix: Inputs and Sources
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State of Vaccine Confidence Insights Report | December 1, 2023

Aims and Methods

By reviewing and analyzing numerous specific sources and inputs, this State of Vaccine Confidence 

Insights Report emphasizes major themes influencing vaccine confidence and uptake in people 

that are currently, or planning to become, pregnant. Data for this report was specifically gathered to 

examine how consumers think and feel, social processes, and the practical issues around vaccination 

during pregnancy. This Insights Report seeks to identify emerging issues related to the spread 

of inaccurate health information to help identify where intervention efforts can improve vaccine 

confidence in pregnant people. 

The information in this report is only a snapshot, and specific 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 
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State of Vaccine Confidence Insights Report | December 1, 2023

Theme 1: Many pregnant people do not have 

adequate information about the benefits and risks 

of vaccination during pregnancy or are susceptible to 

circulating misinformation about receiving vaccines 

during pregnancy.

a

The authors acknowledge that not every person who can become pregnant identifies as a woman; as such, this 

report uses “pregnant people” throughout except when citing studies or polls that were explicitly conducted 

among people who self-reported as female. 

Many pregnant peoplea need more information about vaccination during pregnancy or are exposed 

to circulating misinformation regarding vaccine safety and effectiveness during pregnancy.1 Making 

informed decisions about vaccination during pregnancy is crucial to protect the health of both the 

pregnant individual and their baby. However, limited awareness, complex and conflicting information 

(discussed further in Theme 2), and exposure to misinformation can hinder their ability to make 

informed choices. Understanding the knowledge gaps and addressing misinformation are critical for 

promoting accurate information, enhancing vaccine literacy, and empowering pregnant people to 

make informed decisions about vaccination during pregnancy.

Perceptions, Concerns, and Threats to Vaccine Confidence

 One study measuring COVID-19 vaccine hesitancy during pregnancy found the most commonly 

reported reason for low vaccine confidence was low levels of self-reported knowledge.2

 A KFF COVID-19 Vaccine Monitor survey from November 2021 found about 40% of surveyed 

adults heard that pregnant women should not get the COVID-19 vaccine and thought this was 

true (17%) or weren’t sure (22%). Among women ages 18-44, 18% believed this to be true and 

29% were uncertain.3

 A KFF COVID-19 Vaccine Monitor survey from May 2022 found approximately 29% of women 

who are pregnant or planning to get pregnant believed at least one of three false statements 

about pregnancy and COVID-19 vaccines. Specifically, 24% of pregnant or women planning 

to be pregnant mistakenly believed that it is not advisable for pregnant women to receive a 

COVID-19 vaccine.4

 Many people currently or planning to be pregnant have believed widely circulating 

misinformation that COVID-19 vaccines cause infertility.5,6

 Social media has played a specific role in the spread of inaccurate vaccine-related information. 

Due to an initial lack of information regarding the safety of COVID-19 vaccination during 

pregnancy, misconceptions about negative COVID-19 vaccine side effects took hold in online 

communities of pregnant people.7

 Some common platforms pregnant people use for information and support have users that are 

vocal vaccine skeptics expressing concerns about the safety of vaccination during pregnancy or 

limited safety data about vaccination of pregnant people, especially COVID-19 vaccines.8
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State of Vaccine Confidence Insights Report | December 1, 2023

 Concerns about COVID-19 vaccines may 

have been amplified because initial 

COVID-19 vaccine trials did not include 

pregnant people. Limited safety data 

among pregnant people and their infants, 

along with differences in vaccine safety 

and effectiveness statements from CDC 

compared to FDA-approved vaccine 

package inserts, contributes to consumer 

confusion and the potential spread of inaccurate health information.9

 A systematic review and meta-analysis of factors influencing vaccine decision-making 

during pregnancy found that pregnant individuals with general knowledge about influenza 

vaccination were more than five times as likely to receive an influenza vaccine. This importance 

of influenza vaccine health literacy was similarly evident across several qualitative studies that 

identified gaps in knowledge and awareness of vaccine recommendations and benefits during 

pregnancy.10 In this study, however, a provider recommendation was the factor most strongly 

associated with influenza vaccination. 

 Low awareness and knowledge may affect vaccine demand for new vaccines, such as respiratory 

syncytial virus (RSV) vaccines. In May 2023, two RSV vaccines—GSK’s Arexvy (RSVPreF3) and 

Pfizer’s Abrysvo (RSVpreF)—received FDA approval for individuals aged 60 years and older. 

Pfizer’s Abrysvo vaccine also received FDA approval in August 2023 for use during pregnancy to 

protect infants against RSV and was subsequently recommended by ACIP and CDC in September 

2023. This marks a significant milestone as the first RSV vaccine for pregnant people to protect 

their newborn from severe RSV illness. (For more information about consumer perceptions of 

RSV vaccination during pregnancy, refer to Theme 2 of this report.)

 A June 2023 survey from the Annenberg Public Policy Center 2023 found only 7% of surveyed 

adults thought there was an FDA-approved vaccine against RSV and 73% were unsure whether 

there was one.11 Notably, 57% of respondents who were presented with a flowchart detailing 

FDA’s rigorous vaccine approval process were very or somewhat likely to recommend the 

RSV vaccine, if approved, to a pregnant family member or friend, compared with 40% of 

respondents in a control group who were not exposed to the flowchart.12

Common Questions and Queries from the Public 

 Which vaccines should people receive before pregnancy?

 Live virus vaccines, such as the MMR and chickenpox, should not be given to pregnant people, 

but should be given to them before or after pregnancy, if indicated. Other vaccinations to 

consider receiving prior to pregnancy include HPV, hepatitis B, and pneumococcal vaccines. 

The American College of Obstetricians and Gynecologists (ACOG) recommends that people of 

reproductive age should have their immunization status assessed annually to determine which 

vaccines they need, including Tdap, MMR, hepatitis B, and chickenpox. In addition, ACOG 

recommends that the need for other immunizations be assessed during a pre-pregnancy visit 

by reviewing health, lifestyle, and occupational risks of other infections and administering 

required doses as indicated. People considering getting pregnant should talk to their provider 

about which vaccines they need to be up to date before getting pregnant.
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State of Vaccine Confidence Insights Report | December 1, 2023

 Rubella. Rubella is a contagious disease that can cause a miscarriage or serious birth defects. 

The best protection against rubella is the MMR (measles-mumps-rubella) vaccine. People 

who are not up to date with the MMR vaccine should get it before getting pregnant. A 

pre-pregnancy blood test can assess immunity to rubella. Most people were vaccinated 

with the MMR vaccine as children but should confirm with their doctor or other healthcare 

professional.13 Because of the theoretical risk to the fetus when the mother receives a live virus 

vaccine, people should be counseled to avoid becoming pregnant for 28 days after receipt 

of MMR vaccine. People who are pregnant but not immune to rubella can receive the MMR 

vaccine after delivery.14

 Chickenpox. Because the effects of the varicella virus on the fetus are unknown, pregnant 

people should not be vaccinated. Nonpregnant people who are vaccinated should avoid 

becoming pregnant for 1 month after each injection.14

 Which vaccines should people receive during pregnancy?

 Whooping cough. Pregnant people can give their babies protection against whooping 

cough (pertussis) before their little ones are even born. To prevent whooping cough in 

infants, Tdap vaccine is recommended during the 27th through 36th week of each pregnancy, 

preferably during the earlier part of this time period.15 For more information, refer to ACOG’s 

recommendations and considerations for Tdap vaccination during pregnancy.

 Influenza. Pregnant people should get an influenza shot and not the nasal spray influenza 

vaccine.16 Influenza vaccine can be given during any trimester of pregnancy. September and 

October are generally good times to be vaccinated each year. Earlier vaccination (e.g., in July 

or August) can be considered for people who are in the third trimester of pregnancy during 

those months.17 For more information, refer to ACOG’s recommendations and considerations 

for influenza vaccination during pregnancy.

 COVID-19. COVID-19 vaccines can be given at any time, including before or during any 

trimester of pregnancy, as soon the person is eligible. Pregnant people are more likely to 

get severely ill with COVID-19 compared with non-pregnant people. Pregnant people can 

receive a COVID-19 vaccine. Getting a COVID-19 vaccine during pregnancy can prevent severe 

illness from COVID-19. Patients with questions about getting vaccinated can be referred to 

talk to their healthcare provider.18 For more information, refer to ACOG’s recommendations 

and considerations for COVID-19 vaccination during pregnancy and CDC COVID-19 vaccine 

recommendations.

 RSV. For the first time, an RSV vaccine is now available for pregnant people to protect 

their newborn from severe RSV illness, which is the leading cause of hospitalization for 

U.S. infants. In clinical trials, Pfizer’s new RSVpreF vaccine (Abrysvo) reduced the risk of 

RSV hospitalization for babies by 57 percent in the first six months after birth. To maximize 

protection for babies after birth, CDC recommends seasonal administration (meaning 

September through January in most of the continental U.S.) of one dose of RSV vaccine for 

pregnant people during weeks 32 through 36 of pregnancy.19 For more information, refer to 

ACOG’s recommendations and considerations for RSV vaccination during pregnancy.
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State of Vaccine Confidence Insights Report | December 1, 2023

 There are also monoclonal antibody products that can help protect babies and young 

children from severe disease from an RSV infection. Nirsevimab (Beyfortus) is recommended 

for all infants younger than 8 months of age born during RSV season or entering their first 

RSV season, but is not needed, except in rare circumstances, if the infant was born 14 or 

more days after the mother got RSV vaccine. Nirsevimab is also recommended for some 

children aged 8 through 19 months who are at increased risk for severe RSV disease and 

entering their second RSV season. Side effects after nirsevimab are uncommon and include 

temporary pain, redness, swelling, or rash. No serious allergic reactions occurred in the 

clinical trials.20 Note: in October 2023, CDC issued a health advisory notice to communicate 

interim recommendations due to the limited supply of nirsevimab for the 2023–2024 RSV 

season. 

 A different monoclonal antibody, palivizumab, is limited to children aged 24 months and 

younger with certain conditions that place them at high risk for severe RSV disease. It 

must be given once a month during RSV season. CDC further recommends that providers 

suspend using nirsevimab in palivizumab-eligible children aged 8–19 months for the 

2023–2024 RSV season. These children should receive palivizumab per American Academy 

of Pediatrics (AAP) recommendations.

 Some people may need other vaccines before, during, or after they become pregnant. For 

example, for pregnant people who work in a lab or travel to a country where they may be 

exposed to meningococcal disease, their doctor or healthcare professional may recommend 

meningococcal vaccination.

 Hepatitis A. For pregnant people who have a history of chronic liver disease, doctors or 

healthcare professionals may recommend the hepatitis A vaccine.

 Hepatitis B. If not already vaccinated with hepatitis B vaccine (HepB), pregnant people 

can be vaccinated with HepB in pregnancy, since all adults 19 through 59 years of age are 

recommended to receive HepB vaccination.14 Pregnant people should also be screened for 

hepatitis B infection. The first hepatitis B dose can be given on the same day that a blood 

sample is taken for screening for infection.

 Vaccines for travel. Pregnant people planning international travel should talk to their 

doctor or healthcare professional at least 4 to 6 weeks before their trip to discuss any 

special precautions or necessary vaccines. See Traveler’s Health for additional tips on how to 

prepare to travel safely.

 Which vaccines should I not get if I am pregnant?

 Some vaccines are not recommended during pregnancy, such as:

 Human papillomavirus (HPV) vaccine

 Measles, mumps, and rubella (MMR) vaccine

 Live influenza vaccine (nasal flu vaccine)

 Varicella (chickenpox) vaccine

 Certain travel vaccines: yellow fever, typhoid fever, and Japanese encephalitis. These travel 

vaccines should generally not be given during pregnancy, unless your healthcare provider 

determines that the benefits outweigh the risks.

 If you get any of these vaccines and then find out you are pregnant, talk to your doctor. Further 

doses of the vaccines, if needed, should be given after your pregnancy has ended.21
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State of Vaccine Confidence Insights Report | December 1, 2023

Ways Public Health and Partners Can Take Action to Improve Vaccine 

Confidence

 Develop evidence-based, culturally appropriate 

materials about vaccination during pregnancy 

to address common concerns, debunk myths, 

and provide accurate information about vaccine 

safety and effectiveness. Use clear language, 

visuals, and relatable examples to effectively 

communicate accurate information.

 Collaborate with trusted community leaders, 

healthcare providers, and organizations that 

have influence and credibility within pregnant 

populations.

 Utilize resources from ACOG to help inform 

providers about CDC vaccine recommendations endorsed by ACOG for pregnant people.

 Encourage pregnant people to become vaccine advocates within their own communities. 

Provide them with accurate information, resources, and tools to address vaccine-related 

inaccurate information and share their positive experiences with vaccination during pregnancy.

 Actively monitor social media platforms, online forums, and other digital spaces visited 

by pregnant people where vaccine-related misinformation may circulate. When possible 

and appropriate, swiftly respond with accurate information, providing correct context and 

addressing concerns raised.

 Offer training to healthcare providers to ensure they are equipped with accurate and up-to-date 

information on vaccine safety during pregnancy. Support them in effectively addressing patient 

concerns and debunking vaccine-related misinformation.

Theme 2: Many pregnant people are concerned 

about vaccine safety and side effects. 

Many pregnant people understand the necessity of vaccines but may have concerns about their safety 

and potential side effects.22 Because vaccines play a vital role in safeguarding pregnant people or 

their infants from vaccine-preventable diseases, addressing these concerns is crucial for promoting 

confidence and informed decision-making. Understanding specific worries regarding vaccine safety 

and side effects during pregnancy can help tailor communication and education efforts to address 

these concerns effectively.

Perceptions, Concerns, and Threats to Vaccine Confidence

 The research consistently shows that most pregnant women recognize the significance of 

vaccination in safeguarding both individuals and the community against infectious diseases.23

This sentiment is reflected in the high percentage of women expressing their intention to 

vaccinate their children. Nevertheless, the surveys conducted also revealed that a considerable 

number of women have reservations regarding vaccine safety. They expressed doubts about the 

quality and impartiality of information provided by healthcare professionals.23
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State of Vaccine Confidence Insights Report | December 1, 2023

 A review of influenza vaccine 

hesitancy during pregnancy 

characterizes concerns about 

vaccine safety as one of the most 

important factors influencing 

vaccine decision-making, further 

noting that safety concerns are commonly expressed not only by pregnant patients but 

healthcare providers as well.24

 In a recent review examining barriers and facilitators of COVID-19, influenza, and pertussis 

vaccination during pregnancy, concerns about vaccine safety were the most commonly cited 

obstacle to vaccination for all three diseases.25

 A circulating regulatory document from the United Kingdom drafted in December 2020 

purportedly shows that U.K. health officials recommend against receiving Pfizer’s COVID-19 

vaccine during pregnancy and while breastfeeding due to safety concerns. However, this is an 

outdated version of the document that was subsequently updated once safety data became 

available.26 Nonetheless, many social media users have shared this document claiming the Pfizer 

COVID-19 vaccine is unsafe for people who are pregnant or breastfeeding.27,28,29,b

 During the initial COVID-19 vaccine rollout in early 2021, pregnant people faced conflicting 

vaccine guidance from CDC (advising for vaccination) and WHO (advising against, except in 

high-risk individuals). Because pregnant people were not included in vaccine clinical trials, 

both physicians and pregnant people had to consider COVID-19 vaccination during pregnancy 

with little to no information on safety or effectiveness.30 Soon after, WHO changed their 

recommendations to align more closely with CDC’s guidance.31

 A KFF COVID-19 Vaccine Monitor from May 2022 showed 16% of women who are pregnant or 

plan to become pregnant say they’ve heard and believe COVID-19 vaccines can cause infertility. 

Additionally, 17% of women who are pregnant or planning to become pregnant say they have 

heard and believe it is unsafe for women who are breastfeeding to receive a COVID-19 vaccine.4

 Research from the Annenberg Public Policy Center from April 2023 shows a majority (53%) of 

women ages 18-49 are aware that the seasonal influenza vaccine is safe for pregnant women. 

However, 17% of women in this group hold the incorrect belief that it is not safe. A substantially 

higher proportion of women of childbearing age (17%) have doubts about the vaccine’s safety 

for pregnant women compared to women aged 50 and older (4%).32

 According to panel survey findings published by the Annenberg Public Policy Center in 

February 2023, 49% of adults in the U.S. do not know whether it is safe to receive an influenza 

shot during pregnancy, including 10% who believe it is unsafe and 39% who are unsure.33

 Pregnant people who had received a COVID-19 vaccine are using social media to share their 

experiences of miscarriages that they attribute to the vaccine.34,35,36

b

Social media posts referenced throughout this report can be found in this online document.
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State of Vaccine Confidence Insights Report | December 1, 2023

 Some social media users have concerns about 

FDA package inserts for certain vaccines that 

include language stating that the vaccines’ 

safety and effectiveness “have not been 

established in pregnant women” and feel it 

is unethical to recommend these vaccines to 

pregnant people without more clinical data.37,38

Literature indicates that differing information 

between CDC/ACIP statements of vaccine safety 

and FDA-approved vaccine package inserts can contribute to vaccine hesitancy and consumer 

confusion.39,40 In a 2019 survey of 321 ACOG members, providers “expressed the need for clearer 

and succinct wording, and emphasized the need for evidence-based vaccine package inserts 

that comply with ACOG and ACIP recommendations” to help reduce confusion and improve 

vaccine uptake during pregnancy.40

 GSK’s maternal RSV vaccine application for use during pregnancy was withdrawn and clinical 

trials halted because of preterm birth concerns, which could impact consumer risk perceptions 

of maternal RSV vaccination overall (only Pfizer’s RSV vaccine, Abrysvo, is approved for use 

in pregnant women).41,42 In Pfizer’s clinical trials, more preterm births were observed among 

Abrysvo vaccine recipients than among placebo recipients, although the differences were not 

statistically significant. To reduce the potential risk of preterm birth and complications from 

RSV disease, FDA approved Pfizer’s maternal RSV vaccine for use during weeks 32 through 36 of 

pregnancy while additional studies are conducted.43 Some social media users are choosing to 

wait until long-term data is available before electing to receive the maternal RSV vaccine.44,45 

Inaccurate Health Information Themes

 Some social media users believe Tdap, 

influenza, and COVID-19 vaccines during 

pregnancy cause miscarriages.46,47,48,49

 The belief that the maternal RSV vaccines 

are experimental and lack evidence from 

long-term studies is circulating on social 

media.50,51,52

 Some consumers believe the COVID-19 vaccines will cause infertility.53,54,55

Commonly Asked Questions and Queries from the Public 

 Are vaccines safe during pregnancy?

 Specific vaccines are safe and recommended for pregnant people before, during, or after 

pregnancy to help keep them and their babies healthy. Vaccination of pregnant people with 

influenza and Tdap vaccines, for example, has been shown to prevent influenza and pertussis 

hospitalizations in infants. The antibodies pregnant people develop in response to these 

vaccines not only protect them, but also cross the placenta and help protect their babies from 

serious diseases early in life. Vaccinating during pregnancy also helps protect pregnant people 

from getting a serious disease and then giving it to their newborn.21 
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State of Vaccine Confidence Insights Report | December 1, 2023

 Can vaccines harm developing pregnancies?

 Risk to a developing fetus from vaccination of the mother during pregnancy is theoretical. No 

evidence exists of risk to the fetus from vaccinating pregnant people with inactivated virus or 

bacterial vaccines or toxoids. Live vaccines administered to pregnant people pose a theoretical 

risk to the fetus; therefore, live, attenuated virus and live bacterial vaccines generally are 

contraindicated during pregnancy.14 On this basis, certain vaccines, especially live vaccines, 

should not be given to pregnant people because they may theoretically be harmful to the 

pregnancy. Keep in mind that vaccine recommendations for pregnant people are developed 

with the highest safety concerns for both mothers and babies.21

 Is it safe to receive vaccines while breastfeeding?

 Yes. It is safe to receive routine vaccines right after giving birth, even while you are 

breastfeeding. However, yellow fever vaccine is not recommended for people who are 

breastfeeding unless travel to certain countries is unavoidable and a healthcare provider 

determines that the benefits of vaccination outweigh the risks. Talk with your provider if you 

are considering yellow fever vaccine.21

 Is the COVID-19 vaccine safe for pregnant people?

 COVID-19 vaccination is recommended for all people aged 6 months and older. This includes 

people who are pregnant, breastfeeding, trying to get pregnant now, or those who might 

become pregnant in the future. Data show that COVID-19 vaccination before and during 

pregnancy is safe, effective, and beneficial to both pregnant people and their babies.56 A 

summary of the scientific evidence can be found on CDC’s website: COVID-19 Vaccines 

While Pregnant or Breastfeeding For more information on COVID-19 vaccine safety during 

pregnancy, visit CDC’s Vaccine Safety Publications webpage. 

 What are the side effects of receiving a COVID-19 or influenza vaccine during pregnancy?

 Side effects after receiving a COVID-19 or influenza vaccine tend to be mild, temporary, 

and like those experienced after routine vaccinations. People who are pregnant have not 

reported different side effects from people who are not pregnant after vaccination with mRNA 

COVID-19 vaccines (Moderna and Pfizer-BioNTech vaccines).56 Common side effects include 

pain, redness, and/or swelling at the injection site, tiredness, headache, muscle pain, chills, 

fever, and nausea. If side effects occur, they usually begin soon after the shot is given and 

generally last for 1-2 days.17

 An influenza shot, like other injections, can occasionally cause fainting. Rarely, influenza 

shots can cause serious problems like severe allergic reactions. Anyone with a severe, lifethreatening allergy to any of the vaccine ingredients should not get the shot.17

 Fever during pregnancy, for any reason, has been associated with adverse pregnancy 

outcomes. Fever in pregnancy may be treated with acetaminophen as needed, in moderation 

and in consultation with a healthcare provider.56

 What are the possible side effects of the maternal RSV vaccine?

 In the clinical trials, the side effects most often reported by pregnant people who received 

the maternal RSV vaccine (Abrysvo) were pain at the injection site, headache, muscle pain, 

and nausea. Although not common, a dangerous high blood pressure condition called preeclampsia occurred in 1.8% of pregnant people who received the maternal RSV vaccine 

compared to 1.4% of pregnant people who received a placebo, but this difference was not 

statistically significant.
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State of Vaccine Confidence Insights Report | December 1, 2023

 In the clinical trials, more preterm births were observed among maternal RSV vaccine 

recipients than among placebo recipients, although the differences were not statistically 

significant. It is not clear if this is a true safety problem related to the RSV vaccine or if this 

occurred for reasons unrelated to vaccination. To reduce the potential risk of preterm birth 

and complications from RSV disease, FDA approved the maternal RSV vaccine Abrysvo for 

use during weeks 32 through 36 of pregnancy while additional studies are conducted. FDA 

is requiring the manufacturer to do additional studies that will look more closely at the 

potential risk of preterm births and pregnancy-related high blood pressure issues in mothers, 

including pre-eclampsia. Additionally, CDC will monitor the safety of maternal RSV vaccination 

using multiple vaccine safety systems.

43,57

 What are vaccine package inserts, and how do they differ from CDC’s recommendations for 

vaccination during pregnancy?

 A vaccine package insert is a legal document provided by the vaccine manufacturer and 

approved by the FDA that contains information about a vaccine, including its administration 

guidelines, dosage, storage, and all potential side effects. Package inserts are not intended to 

assess the likelihood of an adverse reaction and generally tend to include all adverse events 

that were temporally associated with a vaccine during clinical trials, whereas CDC’s vaccine 

information statements tend to emphasize those believed to be causally linked to the vaccine. 

Package inserts are not typically updated to convey current clinical guidelines or scientific 

safety data but instead reflect the data from clinical trials, which usually exclude pregnant 

people from early phases of testing as a precautionary measure. Public health authorities 

such as CDC do not rely solely on clinical data when making recommendations for vaccines 

during pregnancy and consider a broader scope of evidence (including observational studies 

and post-licensure data), expert opinion, and consideration of the potential risks and benefits 

for both the pregnant individual and the developing fetus. To learn more about package 

inserts, visit the Voices for Vaccines website or refer to Meissner et al.’s 2018 Pediatrics article on 

Understanding FDA-Approved Labeling and CDC Recommendations for Use of Vaccines.

Ways Public Health and Partners Can Take Action to Improve Vaccine 

Confidence

 Provide opportunities for pregnant people to have open and honest conversations with 

healthcare providers. Allow ample time for discussions, addressing specific concerns and 

tailoring information to individual needs.

 Highlight positive experiences and outcomes of pregnant people who have received vaccines 

during pregnancy. Share stories of healthy pregnancies and positive health outcomes for both 

the mother and baby.

 Continue to monitor vaccine safety and effectiveness during pregnancy in real-world settings to 

provide ongoing reassurance and inform public health policies.

 Communicate how and why FDA-approved vaccine package inserts differ from ACIP and CDC 

vaccine recommendations. 
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State of Vaccine Confidence Insights Report | December 1, 2023

Theme 3: Several factors contribute to differences in 

vaccine uptake between Black, Hispanic, and White 

populations among pregnant people.

Vaccine uptake among pregnant people varies across different racial and ethnic groups, with 

disparities observed between Black, Hispanic, and White communities.58 These differences in 

vaccination rates can have significant implications for the health and well-being of both pregnant 

people and their infants. Understanding the factors that contribute to these discrepancies is crucial 

for developing tailored interventions and strategies to promote equitable vaccine access and uptake. 

Various factors contribute to the differences in vaccine uptake among pregnant racial and ethnic 

minority populations. 

Perceptions, Concerns, and Threats to Vaccine Confidence

 Disparities in vaccination rates persist in racial and ethnic minority populations, especially 

among Black and Hispanic consumers.59,60 A study measuring influenza, Tdap, and COVID-19 

vaccination coverage among pregnant women in 2022 found that influenza and Tdap 

vaccination coverage for both Black and Hispanic women has remained stagnant for three 

seasons, and in the 2021-22 season, decreased for White women.61

 Several studies have found that certain factors contribute to lower vaccination rates in Black and 

Hispanic adults, including negative attitudes and beliefs towards vaccines, limited knowledge 

of and access to vaccines, and a lack of trust in healthcare providers and vaccines.59,62,63

Historical instances of medical injustices and ongoing experiences of mistreatment and racial 

discrimination contribute to a lack of trust in the healthcare system.62,64 Additionally, Black and 

Hispanic women are also less likely to trust information provided by healthcare providers and 

public health authorities.63 

 A February 2022 study of 435 

pregnant women found an average 

COVID-19 vaccine hesitancy rate of 46 

percent. The highest level of vaccine 

hesitancy, 52 percent, was among 

non-Hispanic Black pregnant people.65

 The COVID-19 pandemic may have contributed to low vaccine uptake in minority pregnant 

populations due to disrupted prenatal care, therefore providing fewer opportunities for 

healthcare workers to discuss the benefits of vaccination.66,67

Commonly Asked Questions and Queries from the Public 

 What are some factors that create challenges to vaccination access and acceptance among racial 

and ethnic minority groups?

 There are many social, geographic, political, economic, and environmental factors that create 

challenges to vaccination access and acceptance, and that often affect racial and ethnic 

minority groups. Some of these factors include:

 Education, income, and wealth gaps

 Job access and working conditions

 Racism and other forms of discrimination
Page: 15

State of Vaccine Confidence Insights Report | December 1, 2023

 Gaps in healthcare access

 Transportation and neighborhood conditions

 Lack of trust as a result of past medical racism and experimentation68

 Why should pregnant people belonging to racial and ethnic minority groups trust CDC or other 

federal agencies?

 CDC is leading vaccine equity efforts with national, state, tribal, territorial, local, and 

community partners to ensure that Black/African American, Hispanic/Latino, tribal, refugee, 

and immigrant populations have fair and just access to COVID-19 vaccination. To support 

vaccine equity, CDC continues to communicate with and listen to all communities affected by 

COVID-19. CDC is working to build trust, increase collaboration, and create tools and resources 

to respond to the concerns and feedback from all communities affected by COVID-19, 

especially those disproportionately impacted. These activities, along with messages supported 

by science, can help to increase COVID-19 vaccine acceptance and make it easier to get 

vaccinated.68

Ways Public Health and Partners Can Take Action to Improve Vaccine 

Confidence

 Direct partners to CDC’s Working Together to Reduce Black Maternal Mortality site to help 

stakeholders identify strategies to reduce black maternal mortality, including vaccination.

 Disseminate easily understandable materials that explain the benefits and risks of vaccination 

during pregnancy. Use multiple communication channels, including community events, social 

media, and local media outlets.

 Partner with community leaders, healthcare providers, faith-based organizations, community 

centers, and other influential stakeholders to disseminate vaccine information and address 

concerns within the community.

 Reduce barriers to accessing vaccines by establishing vaccination clinics in easily accessible 

locations, such as community centers, places of worship, or workplaces. Offer flexible scheduling 

options and extended hours to accommodate pregnant people’s needs.

 Enhance healthcare provider education and training on vaccine benefits, risks, and 

recommendations during pregnancy, cultural competency, and effective communication 

techniques. Equip providers with the skills and accurate information to address concerns and 

build trust with pregnant people from diverse backgrounds.

 Continuously monitor vaccination coverage and uptake rates among pregnant racial and 

ethnic populations to identify trends and areas for improvement. Conduct research studies to 

better understand the specific factors influencing vaccine hesitancy and uptake within these 

populations.
Page: 16

State of Vaccine Confidence Insights Report | December 1, 2023

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State of Vaccine Confidence Insights Report | December 1, 2023

Appendix: Inputs and Sources

Social Media Listening & Media Monitoring Data Sources

Input Cadence Sources Tactics for Utilization

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 (Office of 

the Associate Director 

of Communication) 

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 Report Data Sources

Input Cadence Sources Tactics for Utilization

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
Page: 22

State of Vaccine Confidence Insights Report | December 1, 2023

Research and Literature Data Sources

Input Cadence Sources Tactics for Utilization

Poll Review Weekly Harris Poll, PEW 

research, Gallup Poll, 

KFF, Annenberg Public 

Policy Center 

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 Report Data Sources

Input Cadence Sources Tactics for Utilization

Tanaq Social 

Listening +Media 

Monitoring Report

Weekly Meltwater

Sprout Social

First Draft

Native platform 

searches

Trending topics

Demographic and geographic 

conversation monitoring

Washington St. 

Louis iHeard

Weekly Proprietary methods Survey results

Emerging threats and data deficits

Vaccine narratives

Project VCTR Weekly Proprietary methods National and regional trends 

in negative attitudes toward 

vaccination

Conversations around Legislation