CS000000-A | 05/10/21

Summary

Findings. Despite expanded eligibility for vaccination, vaccine supply has begun to exceed demand and 

vaccination rates are trending down in many states and jurisdictions across the country. States and jurisdictions 

are changing tactics to expand access and increase vaccine uptake; however, communities of color continue 

to face challenges accessing COVID-19 vaccines. Announcements by Pfizer-BioNTech and Moderna about the 

likely need for a booster shot caused some to express their belief this is a business decision rather than one 

that is in the best interest of public health. Lastly, parents are confused about the benefits of vaccination for 

children. Misinformation is increasing as the first Emergency Use Authorization (EUA) for COVID-19 vaccination 

of children aged 12–15 years nears. 

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

transparency around rationale for updated guidance, 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. More research should be conducted to better understand 

the role that incentives play in a person’s motivation and intent to get vaccinated. Regular updates should 

be provided on the benefits, safety, side effects, and effectiveness of COVID-19 vaccines for children and 

adolescents in addition to adults.

COVID-19 State of Vaccine 

Confidence Insights Report

Report 7 | May 10, 2021 | Date Range: April 13-26, 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

1 Summary

2 Aims and Methods

3 News coverage on the potential of booster 

doses is causing some consumers to believe 

vaccines are ineffective and are being 

promoted for financial gain

4 Consumer access to vaccines remains an issue 

for communities of color despite many states 

and jurisdictions reporting excess supply

6 Emerging Theme

7 Update: Lifting the J&J/Janssen Pause

8 Continuing and Evolving Themes

10 Appendix: Inputs and Sources

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence Team, Insights Unit
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COVID-19 State of Vaccine Confidence Insights Report | Report 7 | May 10, 2021

Aims and Methods

By rapidly reviewing and analyzing numerous sources and inputs (see 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.

Appendix),

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 7 | May 10, 2021

Major Themes

News coverage on the potential of booster doses is causing some consumers to 

believe vaccines are ineffective and are being promoted for financial gain.

Both Pfizer-BioNTech and Moderna stated that consumers who 

received both doses of their mRNA COVID-19 vaccine will most 

likely also require a booster shot within 12 months.1,2

 The idea that 

COVID-19 vaccines will not provide lifelong immunity and will 

operate more like annual flu vaccines is perceived as demoralizing 

news for vaccine hesitant consumers.3,4,5

 Some vocal vaccine 

deniers falsely interpreted this announcement as an admission 

that two vaccine doses “aren’t enough” and that Pfizer-BioNTech 

dosage “doesn’t work.”6

 Other deniers claimed this information 

is evidence that pharmaceutical companies are striving to increase profits — an opinion that gained traction and has been 

amplified on social media.7,8,9,10,a Further, a recent focus group of vaccine hesitant consumers largely considered the choice to 

recommend booster doses will be a “business decision” driven by money, rather than by public health.11 

Additionally, CDC offered its first public reporting of the number of breakthrough cases of COVID-19 among fully vaccinated 

adults,12,13 lending further evidence for some that COVID-19 vaccines may not be as effective as the industry and government 

suggest.14,15 As consumers contend with new information related to the potential need for booster doses of COVID-19 vaccine, 

breakthrough cases, and the length of immune protection, news media report that the endpoint of the pandemic remains 

uncertain.16,17 As stamina for enduring the pandemic continues to wane, it is critical for trusted messengers to amplify evidencebased data how a decision regarding booster doses will be made that resonates more clearly than information provided by 

influencers wielding misinformation.18

Ways to act:

 Share clear, complete, and accurate messages about the effectiveness of COVID-19 vaccines and the benefits of vaccination

to promote trust in vaccines, vaccinators, and the health vaccination system. Update talking points and messaging to better 

explain the latest data about booster doses, breakthrough cases, asymptomatic spread, and long-term immunity against 

COVID-19, including in formats designed to be easily shared online.

Proactively address and mitigate the spread and harm of misinformation via social media platforms, partners, and trusted 

messengers. Offer guidance to healthcare professionals who want to engage more effectively online and amplify voices of 

trusted messengers and vaccine advocates such as #ThisIsOurShot to engage directly with consumers.

a Social Listening Team. COVID-19 Interagency Social Listening Report. Washington, DC, Federal Emergency Management Agency; April 16, 2021.
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COVID-19 State of Vaccine Confidence Insights Report | Report 7 | May 10, 2021

Consumer access to vaccines remains an issue for communities of color despite 

many states and jurisdictions reporting excess supply.

Consumers 16 years and older became eligible for COVID-19 

vaccinations in all states and jurisdictions on April 19, 2021.19

However, despite this expansion, an increasing number of 

news articles are reporting on the downward trend in the 

number of vaccine doses administered daily, with 41 states 

experiencing declines in vaccination and 11 of those states 

with declines of 25% or more.20,21,22,23

Regions in which vaccine coverage is low24 and cases of 

COVID-19 illness are increasing are also experiencing declines 

in vaccine uptake.25 In many states and jurisdictions, vaccine 

supply has begun to exceed demand for the first time. 

Numerous reports in news media emerged about how 

vaccination strategies are changing across the United 

States. Some jurisdictions are shifting from reservationonly vaccination sites to walk-in clinics,26 expanding access 

through employers,27 hosting pop up clinics,28 and increasing 

mobile clinic efforts.29 In addition to modifying vaccination 

outreach tactics, news media reported on incentive initiatives, 

like giving those who get vaccinated gift cards,30 vouchers to 

visit museums,31 and even extra vacation days,32,33 all in an 

effort to bolster vaccine demand. 

Source: https://medium.com/bloomberg/unused-vaccines-arepiling-up-across-u-s-as-some-regions-resist-9f75f64e7756

Source: Graph: 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
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COVID-19 State of Vaccine Confidence Insights Report | Report 7 | May 10, 2021

Conversations in the news media and on social media about vaccine supply also escalated during this period, with reports 

surfacing that states and jurisdictions are turning away shipments of vaccine.34,35 However, data indicate that among 

unvaccinated adults, about 40% are reluctant, 40% are moveable, and only 20% will definitely get a vaccine.36 Projections from 

a recent poll indicate that if current “vaccine enthusiasm” remains the same, every willing adult would be vaccinated by midMay.37 These polling data and slowing vaccine administration rates indicate the potential difficulty public health will face to 

meet President Biden’s newest goal of reaching 70% of adults receiving least one dose of vaccine by July 4, 2021. More efforts 

will be needed to generate demand to continue steady or increase vaccine administration rates. 38

Ways to act:

 Measure national, state, and local progress toward coverage goals and update consumers regularly. Clear and transparent

coverage goals stand to build trust in the healthcare system, encourage accountability, improve measurement of confidence 

and demand-building efforts, and promote equitable distribution and uptake of COVID-19 vaccines.

Partner with local and ethnic media outlets to highlight the successes of vaccination efforts at local levels. Large declines in 

vaccinations rates in some jurisdictions were a result of high vaccine coverage among eligible population rather than a sign 

of decreasing vaccine confidence.39 Partner with media outlets to further amplify messages about the benefits of COVID-19 

vaccination and consumer vaccination stories. 

Support research to better understand the enduring barriers communities of color and medically underserved communities 

face to access COVID-19 vaccination. Identify states and jurisdictions with innovative practices for reaching these populations 

for COVID-19 vaccination and amplify these initiatives.
Page: 6

COVID-19 State of Vaccine Confidence Insights Report | Report 7 | May 10, 2021

Emerging Theme

Parents are confused about the benefits of COVID-19 vaccination for children.

The possibility of the Pfizer-BioNTech COVID-19 vaccine 

being authorized and recommended for children 12 to 

15 years old has spurred widespread media coverage 

and social media conversations. Parents are confused 

about the benefits of COVID-19 vaccination for children 

and if potential hazards of vaccination outweigh the risks 

of getting COVID-19, even as reports of spikes in child 

COVID-19 hospitalizations in Michigan grow.40

Although children’s risk of dying from the virus remains 

low in the United States, the latest report from the 

American Academy of Pediatrics and the Children's Hospital 

Association indicates that children younger than 19 now 

account for 20.6% of all new COVID-19 cases added this 

April, up from 2.6% in April of 2020.41,42,43 Researchers note 

that because children and adolescents were less likely to 

be infected with COVID-19 last year, they are less likely to 

have antibodies to protect them from the virus and are also 

generally too young to get vaccinated.44,45

At the same time, momentum in much of the country 

is shifting toward returning to normal, and parents are 

weighing the risks they are comfortable taking related to 

their children during the next school year.46 CDC-INFO has 

seen an increase in inquiries from parents about whether 

their children may need vaccine “passports” to travel, 

participate in extracurricular activities, or attend school, whether they need to be present to consent to vaccination of their 

children, and what the timeline is for child and adolescent vaccine authorization and availability. 

Other reports note that many families, especially those in Hispanic or Latino persons disproportionally affected by COVID-19, 

fear physical school reopening due to perceived COVID-19 transmission risks.47,48 Regardless of whether schools mandate 

vaccination, it will be important to ensure equitable vaccine access to help ensure children have vaccination opportunities. 

Pfizer-BioNTech’s vaccine is the only one thus far to seek emergency use authorization (EUA) for children aged 12 to 15, and it 

currently faces the greatest distribution difficulties in rural areas because of its unique storage and handling requirements.49,50

Finally, an unverified claim that a 12-year-old enrolled in a vaccine trial has been hospitalized as a result of receiving the 

vaccine has spread widely among anti-vaccine groups, and continues to circulate.51,52,53 Misinformation surrounding child and 

adolescent vaccination will likely increase as vaccines become authorized and recommended for these age groups. 

Ways to act:

 Communicate transparently about the process for authorizing, recommending, monitoring the safety of, and administering

COVID-19 vaccines to children. Provide regular updates on the benefits, safety, side effects, and effectiveness of COVID-19 

vaccines for children and adolescents and clearly communicate both what is known and unknown about the vaccine’s use 

in children. Also, continue to disseminate messages about what is and is not known about the risk of getting COVID-19 for 

children and adolescents.

Support research to better understand parents’ and adolescents’ feelings and intent toward COVID-19 vaccination, content 

gaps, and motivators. Use findings to develop resources for healthcare professionals, school administrators, and other trusted 

messengers to promote confidence in COVID-19 vaccines for children and adolescents.

Source: https://downloads.aap.org/AAP/PDF/AAP and CHA - 

Children and COVID-19 State Data Report 4.15.21 FINAL.pdf
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COVID-19 State of Vaccine Confidence Insights Report | Report 7 | May 10, 2021

Update: Lifting the J&J/Janssen Pause

A rapid insights report was published on April 21, 2021, 

in response to the Recommendation to Pause Johnson 

& Johnson’s Janssen COVID-19 Vaccine on April 13, 

2021, with data from April 13.b

 Below is an update from 

the rapid insights report with data through April 26, 

2021.

On April 23, the Food and Drug Administration (FDA) 

and CDC lifted the recommended pause on the use 

of J&J/Janssen COVID-19 vaccine, giving states and 

jurisdictions support to continue administering it.54,55

Since the J&J/Janssen COVID-19 Vaccine is a singledose option that only requires standard refrigeration, 

it can be delivered in settings where others 

cannot – making it ideal for rural and low-resource 

communities.56 News media reported that the pause 

obstructed essential vaccination efforts, such as 

outreach to homebound seniors and people who are 

experiencing homelessness.57,58,59 According to state 

and local news media, the pause’s most immediate 

cost was exacted on those with the fewest vaccine 

options.60,61,62,63

According to polls, as of April 21, consumers reported 

reduced confidence in the safety of the J&J/Janssen 

vaccine and less than one-third of unvaccinated 

adults considered the J&J/Janssen vaccine to be 

safe.64 However, such sentiments do not seem to 

have affected confidence in the two-dose mRNA 

vaccines; at least half of unvaccinated adults consider 

these vaccines safe, a proportion that has remained 

relatively stable over time.65,66 Polls also found that 

72% of consumers reported having read or heard a lot 

about the recent J&J/Janssen vaccine pause, and 59% said 

it is reasonable for people to not want to get vaccinated in 

general following the pause.67 Social media conversations 

about the J&J/Janssen vaccine spiked after the pause was 

announced, but then returned to baseline levels. Although 

vocal vaccine deniers leveraged the pause to promote 

broad distrust in vaccines, these narratives appeared to 

have mostly remained within the anti-vaccine community; 

however, some influencers speculate that the safety of the 

J&J/Janssen vaccine is uncertain, a contention that gained 

wide traction and amplification.68

Source: https://www.washingtonpost.com/health/poll-johnson-johnsonvaccine/2021/04/26/a1085b26-a3ad-11eb-a774-7b47ceb36ee8_story.html

b Insights Unit, Vaccinate with Confidence Team. Rapid COVID-19 State of Vaccine Confidence Insights Report: Recommendation to Pause Use of Johnson & Johnson’s Janssen COVID-19 Vaccine. 

Atlanta, GA: Vaccine Task Force, Centers for Disease Control and Prevention; 2021.
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COVID-19 State of Vaccine Confidence Insights Report | Report 7 | May 10, 2021

Continuing and Evolving Themes

Themes below have been noted in previous reports and continue to undermine vaccine confidence. The information 

highlighted below focuses on what is new or different from previous reports. For additional context and previous 

recommendations on these themes see previous Insights Reports.

c,d,e,f,g,h

 Reproductive health side effects. Consumer concerns about the

impact of vaccination on menstrual cycles are continuing to spread 

on social media.69 Misinformation has begun to spread that effects on 

menstrual cycles is being seen not just among those who are vaccinated, 

but those who are around others who are vaccinated, feeding into a 

long-standing anti-vaccination trope of “viral shedding.”70,71 These claims 

even triggered one private school to set a policy that would prevent 

vaccinated teachers from interacting with students.72

New ways to act: 

Continue to amplify messages about how COVID-19 vaccines work, 

de-bunking the myth of viral shedding. 

Conservative consumers. Polls continue to identify politically 

conservative consumers as the most likely to not intend to get a 

COVID-19 vaccine.73,74 Additionally, vaccine administration data analyzed by media organizations indicate that counties with 

a higher percentage of conservative residents have lower vaccination rates compared to liberal counties.75 Current efforts to 

reach these communities through social mobilization efforts are also having trouble recruiting people and organizations from 

these conservative communities.76

New ways to act:

Support research to better understand the organizations and trusted messengers to improve outreach to conservative 

communities.

Review current COVID-19 Community Corps membership and identify gaps in membership. Work with federal partners, 

states and jurisdictions, and partner organizations to organize recruitment efforts for new organizations and individuals 

from regions and demographics that are underrepresented.

Administration errors. Media coverage has highlighted a few instances of vaccine administration errors in various regions 

across the country. Reports spanned from consumers being mistakenly given saline,77 inmates at a prison given overdoses,78

and improper vaccine storage.79 Reports such as these can reduce consumer confidence in vaccinators. 

New ways to act:

 Continue to amplify messages for vaccinators about proper storage and handling and administration training tools.

c 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.

d 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.

e 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.

f 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.

g Insights Unit, Vaccinate with Confidence Team. State of vaccine confidence report: Report 5. 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 6. Atlanta, GA: Vaccine Task Force, Centers for Disease Control and Prevention; 2021.
Page: 9

COVID-19 State of Vaccine Confidence Insights Report | Report 7 | May 10, 2021

Continuing and Evolving Themes (cont.)

 Side effects. During this reporting period, 14% of calls to CDC-INFO

on COVID-19 vaccines were about side effects for all three authorized 

vaccines. Misinformation spread on social media during this period 

based on a recent study80 that claimed mRNA COVID-19 vaccines are 

causing herpes or shingles.81 However, the misinformation was quickly 

fact-checked.82,83

Military refusals. Media coverage about low vaccination rates among 

military personnel continues,84,85 with additional conversations on 

social media circulating that highlight personal stories as to why they 

chose not to be vaccinated.86 Current policy does not allow vaccines 

authorized under an EUA to be mandated, but some lawmakers are 

taking action to try and change this.87

Essential workers. Recent polls report that 20% of essential workers still do not plan to get vaccinated and oppose workplace 

mandates.88 Reports and conversations online are circulating with concerns related to some healthcare facilities beginning to 

require vaccination for employment, with many saying it is not legal until a vaccine receives full approval.89,90,91 Push-back and 

petitions have emerged.92
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COVID-19 State of Vaccine Confidence Insights Report | Report 7 | May 10, 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