CS000000-A | 04/13/21

Summary

Findings. Vaccine supply is increasing nationally, and many states and jurisdictions 

have expanded, or plan to expand, vaccine eligibility to all people 16 years and older in the coming weeks. 

Consumers are optimistic that a return to normalcy is within reach due to the wider availability of vaccines. This 

optimism is undermined by growing online narratives that focus heavily on hypothetical or proposed vaccine 

mandates and proof-of-vaccination systems. Many consumers expressed concern about the legality and ethics 

of both requiring COVID-19 vaccination and tracking who is and isn’t vaccinated. Consumers also continue to 

express confusion around guidance for those who are fully vaccinated. Households with fully vaccinated adults 

but unvaccinated children are seeking clarity about which COVID-19 prevention measures should be continued 

until their children can be fully vaccinated. Many parents feel hopeful that children 12 years and older may be 

able to be vaccinated in the coming months after the successful clinical trials for Pfizer-BioNTech’s COVID-19 

Vaccine in children. However, experts are divided about whether prioritizing vaccinating children will help to 

bring the pandemic to an end. 

Ways to take action. Federal, state, and local partners should continue to work together to increase 

transparency, respond to gaps in information, and confront misinformation with evidence-based messaging. 

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

broadly. Efforts should be made to continue to amplify information about the safety and effectiveness of 

COVID-19 vaccines. Additionally, research should be supported to better understand the role that vaccine 

mandates, proof-of-vaccination systems, and incentives play on an individual’s motivation and intent to get 

vaccinated.

COVID-19 State of Vaccine 

Confidence Insights Report

Report 5 | April 12, 2021 | Date Range: March 15–29, 2021

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

Contents

2 Aims and Methods

3 Hypothetical and proposed COVID-19 vaccine 

mandates are polarizing consumers.

4 Consumers are confused about the role of 

vaccinating children on the path to population 

immunity.

5 Negative sentiment increasing among 

consumers over the concept of vaccine 

passports

6 Emerging Themes

8 Continuing and Evolving Themes

9 Appendix: Inputs and Sources

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence Team, Insights Unit
Page: 2

COVID-19 State of Vaccine Confidence Insights Report | Report 5 | April 12, 2021

Aims and Methods

By rapidly reviewing and analyzing numerous sources and inputs (see Appendix), the biweekly COVID-19 State 

of Vaccine Confidence Insights Report emphasizes major themes that influence COVID-19 vaccine hesitancy 

and uptake. This is categorized by their level and type of threat to vaccine confidence, degree of spread, and 

directionality. By examining how consumers think and feel, social processes, and the practical issues around 

vaccination, the Insights Report seeks to identify emerging issues of misinformation, disinformation, and places 

where intervention efforts can positively impact vaccine confidence across the United States.

The information in this report is only a snapshot, and certain populations may be underrepresented. Images 

and quotes are illustrative examples and are not meant to be comprehensive of all content related to the 

highlighted themes.

Theme Classification

How do you classify this theme/information?

High risk Moderate risk Low risk Positive sentiment

















May lead to vaccine 

refusals and decreased 

uptake

Wide reach, pervasive

Potential to trigger 

hesitancy to vaccinate

Moderate reach, modest 

dissemination

Concerning, but low risk 

to vaccine confidence

Limited reach, limited 

dissemination

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 5 | April 12, 2021

Major Themes

Hypothetical and proposed COVID-19 vaccine mandates are polarizing 

consumers.

With many states and jurisdictions expanding vaccine eligibility to 

people 16 years and older, media and consumers are discussing 

the possibility of schools, universities, and employers mandating 

vaccines. Rutgers University, the state university of New Jersey, 

was the first to announce that it is requiring students attending 

classes in person this fall to receive a COVID-19 vaccine, with other 

institutes of higher education following suit.1,2

 Although consumers 

met this mandate with mixed results, many noted that requiring 

vaccination is not new for institutions of higher education. 3,4

 In the 

corporate sector, 7 in 10 chief executive officers indicated they were 

open to requiring COVID-19 vaccination for their employees and are 

exploring incentives to increase vaccine uptake among employees.5

Many consumers noted they would feel more comfortable 

returning to the office if COVID-19 vaccination were required.6 However, consumers against vaccine mandates are leading 

conversations online focused on the legality and ethics of vaccine mandates for vaccines available through an emergency use 

authorization (EUA).7

Consumers who expressed concern about or who were against vaccine mandates claim that the COVID-19 vaccines are 

“experimental” and that full approval by the Food and Drug Administration (FDA) is necessary before any vaccine can be 

mandated or required.8,9,10 Concerns about vaccine mandates are not just circulating among consumers. A recent survey found 

1 in 6 healthcare workers would leave their job if their employer required them to get vaccinated.11 However, new data indicate 

that COVID-19 vaccine mandates may increase motivation to get vaccinated for some of those who are currently unsure about 

getting vaccinated. While vaccine mandates have potential to 

incrementally increase vaccine uptake, they could alternatively 

harden opinions against vaccination by those who are 

undecided or wanting to “wait and see” before deciding to get 

vaccinated.a

Ways to take action:

 Continue to promote messages about the safety of COVID-19 

vaccines, highlighting the low rates of adverse events. Expand 

messaging on the Emergency Use Authorization (EUA) 

process, including as the timeline from EUA to FDA approval 

and how CDC and FDA analyze safety and effectiveness data 

before authorization and recommendation. Clarify that states 

and employers can mandate vaccination, but the federal 

government cannot.

 Engage with partners, such as institutions of higher education 

and the private sector, to better understand the concerns and 

information gaps among their constituents and develop tools 

and educational content as needs are determined.

 Support research to better understand the impact of vaccine 

mandates, ‘soft’ mandates (e.g., requiring full or extra personal 

protective equipment if not vaccinated), and other incentives 

on vaccine intention and motivation.

a Unpublished data. For methods and previous Omnibus data please see: Nguyen KH, Srivastav 

A, Razzaghi H, et al. COVID-19 Vaccination Intent, Perceptions, and Reasons for Not Vaccinating 

Among Groups Prioritized for Early Vaccination — United States, September and December 

2020. MMWR Morb Mortal Wkly Rep 2021;70:217–222. DOI: http://dx.doi.org/10.15585/mmwr.

mm7006e3

Which of the following would make you more likely to 

receive the COVID-19 vaccine ... if your workplace or 

school required it?

Source: Unpublished data. For methods and previous Omnibus 

data please see: Nguyen KH, Srivastav A, Razzaghi H, et al. COVID-19 

Vaccination Intent, Perceptions, and Reasons for Not Vaccinating Among 

Groups Prioritized for Early Vaccination — United States, September and 

December 2020. MMWR Morb Mortal Wkly Rep 2021;70:217–222. DOI: 

http://dx.doi.org/10.15585/mmwr.mm7006e3
Page: 4

COVID-19 State of Vaccine Confidence Insights Report | Report 5 | April 12, 2021

Consumers are confused about the role of vaccinating children on the path 

to population immunity.

Although fewer cases of COVID-19 have been reported in 

children (age 0–17 years) than in adults, recent data suggest 

the number and rate of cases in children has been steadily 

increasing and more children have died from COVID-19 than 

from the flu in an average year.13 Increases in childhood 

cases have given rise to varying opinions among both 

scientists and parents about how critical it is that children 

be immunized as schools seek to fully reopen.14 Additionally, 

although the guidance for fully vaccinated individuals has 

to which households with unvaccinated children should 

proceed with preventative and safety measures and/or return to pre-COVID-19 activities.

expanded, consumers expressed confusion about the extent 

15 Some experts feel vaccinating 

children is not a top priority due to lower transmission rates, whereas others believe vaccinating children is crucial to ending the 

pandemic. Some researchers say that given adults’ current hesitancy toward COVID-19 vaccination, population immunity might 

be impossible to achieve without vaccinating children. 16,17,18, 19

While many parents expressed optimism with the release of clinical trial 

data showing that Pfizer-BioNTech’s COVID-19 vaccine was safe and effective 

in adolescents as young as 12 years old,20 others expressed concern and 

discomfort, stating that children were being used as “test subjects.”b Other 

parents worry that COVID-19 vaccines may be required for attending school 

in the fall and that religious or other vaccination exemptions may not be 

granted.c

 These concerns could further alienate parents who are generally 

vaccine-hesitant. Recent polls show that parents who were vaccine hesitant 

are mostly unwilling to vaccinate both themselves and their children when 

COVID-19 vaccines are available to them.21

Ways to take actions:

 Expand guidance for fully vaccinated individuals to thoroughly explain the risks and safety precautions still needed for

activities between households with fully vaccinated adults and unvaccinated children. Develop and promote messages for 

fully vaccinated adults with unvaccinated children about activities they can safely participate in and who they can safely visit 

and spend time with. 

Share clear, complete, and accurate messages about COVID-19 vaccination in children to build trust in the vaccines and the 

health system prior to vaccine authorization and recommendation for children. Provide regular updates on what is known 

about the benefits, safety, side effects, and effectiveness of COVID-19 vaccines for children. 

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

COVID-19 vaccination for children with parents who are uncertain about, or leaning toward, not getting themselves or their 

children vaccinated.

Support research to better understand the opinions and concerns of vaccine-hesitant parents on COVID-19 vaccines and of 

school-age children’s perspectives to better inform future communication campaigns and outreach efforts.

b Social Listening Team. COVID-19 Interagency Social Listening Report. Washington, DC, Federal Emergency Management Agency; March 16, 2021.

c Social Listening Team. COVID-19 Interagency Social Listening Report. Washington, DC, Federal Emergency Management Agency; March 17, 2021.

“The sooner that we can get vaccines into

as many people as possible, regardless 

of their age, the sooner we will be able to 

really feel like we’re ending this pandemic

for good,” Angela Rasmussen, PhD, a 

virologist affiliated with Georgetown 

University in Washington.12
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COVID-19 State of Vaccine Confidence Insights Report | Report 5 | April 12, 2021

Negative sentiment increasing among consumers over the concept 

of vaccine passports.

New York State introduced the first “vaccine passport” as a digital app 

called the “Excelsior Pass,” allowing residents to prove they have been fully 

vaccinated or have recently tested negative, in an effort to quickly reopen 

businesses in the state.22,23 The goal of proof-of-vaccination systems, 

like the Excelsior Pass, is for fully vaccinated people to quickly and easily 

verify their vaccination status so they can bypass state mandates on 

large-group activities and travel.24,25 However, large segments of the 

population are vocally opposed to proof-of-vaccination systems, citing 

distrust of government systems, federal governmental overreach, medical 

surveillance, and segregation.26

There is some evidence that using a uniform proof-of-vaccination system 

throughout the United States could motivate vaccine-hesitant consumers 

to get vaccinated.27 However, some experts fear that vaccine passports 

could be a form of discrimination28 and could further exacerbate racial, 

ethnic, and income inequities already present with current vaccine 

distribution and administration strategies.29 As a result, there has been 

a rise in consumers looking to purchase counterfeit vaccination cards to undermine these systems and gain access to travel 

or other activities.30,31,32 A confusing or ineffective proof-of-vaccination system could undermine trust in health systems and 

government and further politicize the broader vaccination effort.33,34

Ways to take action:

 Support research to better understand how proof-of-vaccination systems may contribute to or undermine vaccine confidence

and the population’s willingness to get vaccinated. Gather information on people’s thoughts and feelings toward sharing 

private health information and message framing that may work best to explain the rationale for these types of systems. 

Limit the use of counterfeit vaccination cards by identifying emerging practices for managing proof-of-vaccination systems, 

including what consumers should do if they lose their vaccination card, and determine methods to validate someone’s 

vaccination status. To protect personal information, consider promoting messages about not sharing images of vaccination 

cards and instead encouraging consumers to share photos of their bandage or vaccination sticker.

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

confidence and structural and practical barriers. Conduct a rapid community assessment to identify intervention strategies to 

increase uptake and identify community leaders and trusted messengers to reach communities with low COVID-19 vaccine 

uptake. Proof-of-vaccination systems may provide individuals with greater access to public spaces, travel, and even job 

opportunities; therefore, it is important to ensure all consumers who want to get vaccinated, can get vaccinated. 
Page: 6

COVID-19 State of Vaccine Confidence Insights Report | Report 5 | April 12, 2021

Emerging Themes

Consumers are confused about the effectiveness and benefit of COVID-19 

vaccines with reports of breakthrough cases and increasing cases of illness.

Media coverage of the rising vaccine administration numbers is bringing 

hope to consumers that they will soon be able to return to their prepandemic lives. Simultaneous messages of “impending doom,”35 the threat 

of a new wave of COVID-19 cases,36 and increasing reports of breakthrough 

cases among fully vaccinated people push the desired timeline for 

return to normalcy out of reach.37 Online conversations about vaccine 

effectiveness remain prevalent. However, current discourse has shifted 

focus from how well COVID-19 vaccines prevent illness to confusion over 

whether COVID-19 vaccines can prevent asymptomatic transmission, 

which may diminish the perceived benefit of vaccination.38,39

Ways to take action:

 Continue to develop and disseminate messaging about COVID-19 vaccination benefits, vaccine effectiveness, and what is

known about the effects of vaccination on asymptomatic spread. Ensure messages contain information about what COVID-19 

vaccines were developed to do and how vaccines work more generally. Continue to promote benefits of COVID-19 vaccination 

alongside messages about guidance for fully vaccinated individuals. 

Expand research to better understand the perceived benefits of COVID-19 vaccination, what consumers think about 

breakthrough cases, and how these cases might impact their intention to get vaccinated for COVID-19.

Generation Z adults are less interested in COVID-19 vaccines due to 

low risk perception.

Recent polls show that not only are some 

Generation Z adults (under 25 years old) 

disinterested in getting a COVID-19 vaccine,40

but they are also the least aware of guidance for 

fully vaccinated individuals. This might imply that 

Generation Z adults are unaware of the benefits 

of vaccination, thus contributing to the lack of 

enthusiasm toward a COVID-19 vaccine. Additionally, adults in Generation Z make up the highest percentage of people wanting 

to “wait and see” before deciding to get vaccinated. The level of vaccine confidence among this generation has remained stable 

over time, unlike other generations that have seen increased vaccine confidence since initial COVID-19 vaccine distribution 

began.d

Ways to take action:

 Develop a communication strategy that appeals to social responsibility while also promoting vaccination as the best action 

to return to normal, recognizing the impact that COVID-19 has had on their social and academic experience. Additionally, 

frame messages with a positive sentiment, focusing on what vaccination will allow individuals to do safely rather than what 

individuals still cannot do.

Work with states and jurisdictions to partner with Generation Z-led or Generation Z-focused organizations to identify and 

engage influencers to promote vaccination and continued adherence to COVID-19 preventive measures. 

Perform message testing to better understand the types of messages, graphic assets, channel placement, and types of 

messengers needed to increase motivation and intent to be vaccinated.

d Harris Insights & Analytics LLC, A Stagwell Company. (2021). The Next Greatest Generation: The Harris Poll CDC Youth Survey. 
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COVID-19 State of Vaccine Confidence Insights Report | Report 5 | April 12, 2021

Anecdotal evidence suggests consumers experiencing “long COVID” may benefit 

from COVID-19 vaccination.

A recent study found that about 3 

in 10 COVID-19 patients reported 

experiencing persistent symptoms 

for as long as 9 months after illness, 

referred to as “long COVID” or “longhaul COVID.”41 Personal testimonies 

have emerged about vaccination 

improving symptoms of long COVID, 

including a poll of a Facebook group 

for COVID-19 survivors that found 

about 1 in 3 people with long COVID 

reported improved to complete 

resolution of symptoms after 

vaccination.42 However, more research 

is needed to determine how or why 

some long COVID-19 patients see 

marked improvements after vaccination.43

Ways to take action:

 Identify partners and organizations that work with long COVID patients to collect testimonies about vaccination and the

challenges they faced or currently face from COVID-19 symptoms and negative outcomes.

Conduct research to better understand the impact and potential benefit of vaccination for long COVID patients and, if there 

is a demonstrated benefit, explore how it may affect willingness to get vaccinated among people who have been previously 

infected with the virus.
Page: 8

COVID-19 State of Vaccine Confidence Insights Report | Report 5 | April 12, 2021

Continuing and Evolving Themes

Themes below have been noted in previous reports and continue to undermine vaccine confidence. For additional context and 

previous recommendations on these themes see previous Insights Reports.e,f,g,h

 Access/logistics. Barriers to access, ranging from

vaccination site location to cumbersome appointment 

systems, continue to exist for communities of color, 

older adults, people with disabilities, and non-U.S.-

born consumers in scheduling both first and second 

dose appointments.44,45,46 Additionally, there were a 

growing number of reports of consumers who are undocumented being turned away from vaccination.47,48 Conversations 

surrounding vaccination planning for homebound older adult populations, people with disabilities, and people experiencing 

homelessness are also beginning to increase.49,50

Adverse events/side effects. The media 

and vocal vaccine deniers continue to 

amplify reports of adverse events and 

deaths following vaccination, despite an 

absence of known cause.51,52 Consumers 

continue to turn to social media in addition 

to their healthcare providers, v-safe, and 

CDC-INFO to report their side effects, both common and severe.53,54

Brand preferences. Consumers expressed concern over AstraZeneca’s COVID-19 Vaccine. These concerns were driven by 

reports of outdated data to determine COVID-19 vaccine effectiveness for their United States clinical trial55 and a disputed 

connection to blood clots.56,57,58Consumers reported that the news about AstraZeneca’s COVID-19 Vaccine made them 

concerned about all COVID-19 vaccines, which could lead them to delay.59New ways to take action:

 Develop and deploy messaging about how the U.S. vaccination system ensures all vaccines are safe, specifically about how 

causality between vaccination and adverse events is determined. Continue to promote messages that all authorized and 

recommended COVID-19 vaccines are safe and effective.

Conservative populations. A new “Stop the Vaccine” movement has emerged, warning consumers that as vaccination rates 

decrease, “more aggressive force” from the government will be used to vaccinate people who are not yet vaccinated.60Persons 

who view conservative media and engage with conservative social media sites continue to be exposed to messages stating 

that “immunity through infection” is the optimal way to gain protection,61 despite a declaration from a group of researchers 

stating the danger of using this tactic to reach population immunity.62

Mis- and dis-information. With tech companies 

expanding their efforts to remove or flag potentially 

misleading content, vocal vaccine deniers are finding 

new tactics to spread misinformation. A recent study 

found that article headlines that connected death 

and vaccination were among the most engaged with 

and are more difficult for tech companies to identify 

and flag appropriately.63,64 Additionally, consumers are increasingly concerned that tech companies are unable to remove 

misinformation in languages other than English at the same rate as English language posts.65New ways to take action:

 Engage media and journalists in dialogue about how news articles are being weaponized and misrepresented to decrease 

vaccine confidence. Strategize tactics for reducing misrepresentation of articles on social media, such as ensuring additional 

context is built into auto-generated images on article links.

 Partner with tech companies to expand and enhance methods for removing and flagging misinformation or vaccine-related 

content in non-English posts. Ensure that social media flags go to appropriate content hubs in the same language as the 

original post.

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

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

g Insights Unit, Vaccinate with Confidence Team. State of vaccine confidence report: Report 3. Atlanta, GA: Vaccine Task Force, Centers for Disease Control and Prevention; 2021.

h Insights Unit, Vaccinate with Confidence Team. State of vaccine confidence report: Report 4. Atlanta, GA: Vaccine Task Force, Centers for Disease Control and Prevention; 2021.
Page: 9

COVID-19 State of Vaccine Confidence Insights Report | Report 5 | April 12, 2021

Appendix: Inputs and Sources

Type Input Cadence Sources Tactics for Utilization

Mixed 

Methods

Communication Surveillance 

Report

Daily, 

weekdays

Google news

 Meltwater

CrowdTangle

Native platform searches

 Share of voice topic analysis to identify 

themes

 Emerging topics 

Tanaq Social Listening +Media 

Monitoring Report

Weekly  Meltwater

 Muck Rack

 Sprout Social

 First Draft

 Stronger

Native platform searches

 Trending topics

Demographic and geographic conversation 

monitoring

Meltwater Daily  Facebook, Twitter, Instagram

 Blogs

News media

Online forums

 Share of voice topic analysis

 Emerging theme topics

Identify high reach/velocity topics

Social 

Media 

Listening

OADC Channel COVID-19 Post 

metrics

Weekly  Sprout Social

Native OADC account analytics

Analyze # of posts, topics 

 Success of messages, # of impressions, 

reach, # engagements

OADC Channel Comment 

Analysis

Daily, 

weekdays

Native platform searches  Sentiment analysis

Identify message gaps/voids

CrowdTangle content insights 

report

Biweekly  Facebook  Top pages (voices), groups

General trends/sentiment analysis

News analysis through posts

FEMA Social Listening Report Daily Hootsuite

 Brandwatch

CrowdTangle

 Meltwater

 Trends/sentiment analysis

National and global news analysis

Direct 

Reports

CDC-INFO Metrics Weekly, 

Mondays

CDC-INFO inquiry line list

 Prepared response (PR) usage 

report

Cross-compare PR usage with inquiry 

theme analysis

 Sentiment analysis

Identify information gaps/voids

VTF Media Requests Weekly, 

Mondays

 Media request line list  Leading indicator for news coverage

Identify information gaps/voids

Web Metrics Weekly, 

Wednesdays

 Top pages

Google search queries

 Top FAQs

 Referring domains

Identify information gaps/voids,

Identify keywords/search terms, changes in 

web traffic

Research

Poll Review Weekly, 

Mondays

Harris Poll, PEW research, Gallup 

Poll, KFF 

New data related to vaccine 

hesitancy

Identify socio-behavior indicators related 

to motivation and intention to vaccinate 

Literature Review Weekly, 

Mondays

 PubMed, LitCovid, ProQuest Central 

New data related to vaccine 

hesitancy

Identify current vaccination intention

Identify barriers to vaccination