Summary

There continue to be widespread challenges and confusion 

with COVID-19 vaccine rollout in the U.S., which undermines vaccine confidence 

and threatens vaccine acceptance. Consumers are confused about how COVID-19 

vaccines work and their relative effectiveness, while people with high-risk 

underlying and acute medical conditions are concerned about vaccine safety 

and their eligibility to receive a vaccine. Although vaccine supply has expanded 

to retail pharmacy settings, consumers continue to face structural barriers to 

access. The Centers for Disease Control and Prevention (CDC) should continue to 

coordinate with states and jurisdictions to increase transparency, respond to gaps 

in information, and confront misinformation with evidence-based messaging to 

increase vaccine confidence more broadly.

COVID-19 State of Vaccine 

Confidence Insights Report

Report 2 | March 1, 2021 | Date Range: January 31, 2021 – February 13, 2021

Contents

3 Consumers are confused about how COVID-19 vaccines 

work and their benefits.

3 People with underlying medical conditions, acute 

medical conditions, or allergies are unsure if current 

vaccines are safe for them.

4 Barriers to vaccine access remain, despite national 

expansion to retail pharmacy administration sites.

5 Emerging Topics

5 People are confused about their risk for COVID-19 

before vaccine series completion.

5 Recruitment of children for vaccine trials met with 

concern and fear.

5 Scams are emerging across the U.S., targeting 

consumers trying to be vaccinated.

5 Closed-network social media platforms gaining traction 

with anti-vaccine supporters.

6 Continuing Themes

7 Appendix

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
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COVID-19 State of Vaccine Confidence Insights Report | Report 2 | March 1, 2021

Aims and Methods

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

of Vaccine Confidence Insights Report emphasizes major themes influencing COVID-19 vaccine hesitancy and 

uptake, 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 U.S.

The information in this report is 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

 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

How has this theme/idea changed over time (since last report or over the course of multiple reports)?

increasing 

Information spreading rapidly

stable 

Information remaining constant at prior 

level

decreasing

Information is not gaining further 

traction and there has been no 

indication of additional activity
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COVID-19 State of Vaccine Confidence Insights Report | Report 2 | March 1, 2021

Major Themes

Consumers are confused about how COVID-19 vaccines work and their benefits.

Consumers are confused about how COVID-19 vaccines work,1

the impact of vaccination on asymptomatic spread,2 how many 

doses they need if they previously had COVID-19 illness,3

 and 

whether they will need to get vaccinated each year.4 Social 

media discussion and media coverage of vaccine effectiveness 

and efficacy are second only to conversations about accessing 

vaccination appointments, with 14% of the total conversations on COVID-19 vaccines online focused on vaccine effectiveness. 

Media coverage consistently includes statistics describing effectiveness of the available vaccines, with no information about 

how the public should interpret the statistics. Consumers need additional information to better manage their expectations for 

how COVID-19 vaccines work.5

Additionally, media coverage of new studies looking at VE of a single dose of mRNA vaccines is increasing. 6,7 As social media 

conversation about unpleasant common side effects after the second dose of mRNA vaccines also increases, this type of 

coverage may persuade consumers that they either do not need a second dose or that the benefits do not outweigh the risk of 

experiencing side effects.8

Short-term recommendations

 Clarify messaging about vaccine effectiveness and efficacy, including how it is determined, what it means, and how

consumers should interpret the vaccine effectiveness statistics in media headlines.

Partner with healthcare providers to better understand which questions patients have regarding vaccine effectiveness and 

expand tools to assist providers in ongoing patient education.

Long-term recommendation

Conduct research to better understand why consumers did not complete COVID-19 vaccine series and describe the wide array 

of barriers to completing COVID-19 vaccination.

People with underlying medical conditions, acute medical conditions, or 

allergies are unsure if current vaccines are safe for them.

Consumers are confused about whether people with underlying or high-risk 

medical conditions, such as cancer, or heart disease, or Down syndrome should or 

should not get a COVID-19 vaccine. Many believe that vaccination will cause illness 

and is unsafe, given their underlying condition. Compounding this misinformation, 

states and jurisdictions define “high-risk medical condition” differently, and 

generally lack clarity on where to find the lists of accepted underlying conditions 

for vaccination.9 This could affect the ability of those with underlying conditions to 

access the vaccine. High rates of media requests to CDC seeking to understand the 

underlying conditions eligible for vaccine prioritization and increased web queries 

on vaccination for those with a variety of conditions, underscore the public’s desire for credible information.

Consumers are also concerned that known allergies and factors such as acute illness, recent surgery, or taking antibiotics or 

other medications might prevent them from getting vaccinated, with 1,200 inquiries per week on the topic to CDC-INFO. Many 

with autoimmune disorders or suppressed immune systems, including HIV, are concerned that their bodies will not develop a 

significant immune response to the vaccine and that they will not be protected against COVID-19, or that the vaccine will make 

them increasingly ill.10

Caller has lupus, and wants 

to know how the vaccine will 

affect her immune system? She 

also has other high-risk medical 

conditions.

- CDC-info caller, 2/8
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COVID-19 State of Vaccine Confidence Insights Report | Report 2 | March 1, 2021

Short-term recommendation

 Address the information gap around underlying conditions, acute medical conditions, allergies, medications, and vaccine

safety. Populate evidence-based, trusted websites with comprehensive and transparent information on what is known about 

health conditions and vaccine safety. Consider launching screeners or chat-bots to further fill these information gaps.

Long-term recommendations

Collaborate with states to ensure “high-risk medical conditions” are defined clearly and consistently and that the conditions 

included in the high-risk category are listed and easy to locate on state websites and other state-level communication 

materials about vaccination eligibility.

Partner with advocacy organizations and specialty healthcare organizations to reach out to people with disabilities and 

high-risk groups directly to ensure they are aware that they are eligible for vaccination and develop messaging to promote 

vaccination as appropriate.

Barriers to vaccine access remain, despite national expansion to retail 

pharmacy administration sites.

Although the Federal Retail Pharmacy Program sought to 

expand access to COVID-19 vaccines,11 consumers report that 

scheduling or appointment systems are difficult to navigate; 

many consumers cannot secure appointments or find nearby 

vaccination locations.12 Social media mentions and media 

interest in the pharmacy program increased over the reporting period, with reporters seeking to understand how pharmacies 

were selected and how vaccine doses were allocated. Questions are consistently raised about why large-scale vaccination sites 

are closed due to vaccine supply problems, but pharmacies continue to receive vaccine doses. Some news outlets are reporting 

that vaccine supply initially earmarked for hospitals is now being rerouted to mass vaccination clinics and pharmacies to 

increase vaccination coverage, which has led to appointment cancellations.13

Additionally, consumers’ concerns about eligibility and vaccine allocation are increasing as the media highlights reports of a 

doctor losing his job after giving away excess doses prior to expiration14 and vaccines being seized after doses were mistakenly 

administered to non-eligible teachers.15 Pharmacies also report different plans for how to use excess doses before they expire, 

with some pharmacies allocating them to their staff and others developing wait lists of prioritized individuals.16

Short-term recommendations

 Develop clear, transparent messaging about how the Federal Retail Pharmacy Program operates; outline the process by which

vaccines are allocated to pharmacies and other administration sites.

Work with states and jurisdictions to develop systems to assist consumers with limited internet access with scheduling 

appointments and identifying the locations of vaccine administration sites.

Collaborate with retail pharmacy partners and states/jurisdictions to develop clear communication plans for scheduling 

appointments through the Federal Retail Pharmacy Program

Long-term recommendation

Use geospatial mapping to identify where to increase vaccine supply allocations to ensure equitable access to high-burden 

populations.
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COVID-19 State of Vaccine Confidence Insights Report | Report 2 | March 1, 2021

Emerging Topics

People are confused about their risk for COVID-19 before vaccine series 

completion.















An uptick in media inquiries, web traffic, and social media listening platforms indicates uncertainty among consumers about 

what they should do if they are exposed to COVID-19 after the first dose of vaccine and whether they should proceed with 

getting their second vaccine dose.

Short-term recommendation

Create clear communication materials regarding what to do if you are exposed to COVID-19 during the vaccination series

Recruitment of children for vaccine trials met with concern and fear

Consumers are expressing deep concern about clinical trials for COVID-19 vaccines involving children. Social media posts 

have compared the trials in children to child abuse,17 noted that vaccination should be unnecessary for this group as their 

transmission of the virus is low,18 and expressed that even if a COVID-19 vaccine were approved, parents would not allow their 

children to be vaccinated.19

Short-term recommendation

Coordinate with FDA, state and local health departments, and professional organizations to develop messaging about how 

clinical trials in children work and why they are necessary.

Long-term recommendation

Conduct research to better understand parents’ fears and hesitancies, specifically related to COVID-19 vaccines for children.

Scams are emerging across the U.S., targeting consumers trying to be 

vaccinated.

Reports of fake vaccine being sold,20 people receiving calls to schedule them for fake vaccination appointments,21 and 

individuals targeting seniors on Craigslist and Facebook seeking to pose as “caregivers” for them in order to get vaccinated 

before they are eligible.22

Short-term recommendation

Encourage states and jurisdictions to develop messaging informing consumers how to verify that their vaccination 

appointment is legitimate and what scheduling appointments should look like, including what information the consumer will 

need to show the vaccine provider to receive the vaccine.

Closed-network social media platforms gaining traction with anti-vaccine 

supporters.

Vocal vaccine deniers and conspiracy theorists who previously used mainstream social media have been switching to closednetwork social media apps.23 Misinformation about COVID-19 vaccines has begun to circulate on this platform before moving 

to mainstream social media platforms with posts receiving tens of thousands of user views before they can be removed.24

Short-term recommendations

Partner with trusted messengers to communicate accurate, evidence-based information on closed messaging platforms and 

boost messages related to vaccine benefits and safety.

Continue to monitor activity in these closed messaging groups, and partner with companies in fact-checking efforts to 

support rebuttal or removal of harmful mis/disinformation.
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COVID-19 State of Vaccine Confidence Insights Report | Report 2 | March 1, 2021

Continuing Themes

 Themes below have been noted in Report 1 and continue to undermine vaccine confidence. For additional context and 

previous recommendations on these themes see Insights Report 1 (February 12, 2021).

 Vaccine Adverse Event Reporting System (VAERS) and adverse events. Misinformation about VAERS continues, along with

fear about adverse vaccine effects. Although recently published VAERS data showed very low levels of severe adverse events,25

media and the public continue to amplify deaths following vaccination and other potential reactions.

Nonsteroidal anti-inflammatory drugs (NSAIDS). A recent study found that NSAIDS “reduced both the antibody and 

pro-inflammatory cytokine response to SARS-CoV-2 infection,” which may indicate NSAIDS impact the body’s response 

to vaccination.26 Confusion about the effect of NSAIDS on vaccine effectiveness is expanding to other over-the-counter 

medications, like acetaminophen, pseudoephedrine, and naproxen. New recommendations:

Clarify what is known about the impact of NSAIDS and other medications on vaccine effectiveness.

Expand messaging about what types of medications can be taken after vaccination.

Provide healthcare providers and other trusted messengers with additional information on helping patients to manage 

common side effects.

Pregnancy and vaccination. Anti-vaccine supporters continue to target pregnant women with dis- and misinformation, 

distorting information around miscarriage risks. Many women are turning to pregnancy forums for discussion. Additional 

recommendation:

Partner with websites and organizations that host pregnancy discussion boards to identify information gaps and address 

them.

Prioritization. Sentiment has grown that willingness to reopen schools is in contradiction with teachers’ general lack 

of vaccine eligibility. Social media discussions and media coverage related to teacher eligibility accounted for 17% of 

all eligibility or prioritization conversations with 111,000 mentions. Only 24 states currently list teachers as eligible for 

vaccination.

Side effects. Consumers are expressing concern about general side effects, long-term side effects, severe allergic reactions, 

and feeling ill after receiving the vaccine.

Lack of equity. There is a lack of perceived equity in the vaccine prioritization process, and consumers continue to be 

frustrated about varied eligibility criteria and shifting guidelines.

Post-vaccination care. Confusion about post-vaccination mitigation measures is continuing, including CDC’s new quarantine 

guidance for those who are fully vaccinated. New recommendations:

Clarify consumer-facing messages about post-vaccination quarantine guidelines.

Integrate post-vaccination mitigation messaging into vaccine-related communication products and messaging.
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COVID-19 State of Vaccine Confidence Insights Report | Report 2 | March 1, 2021

Appendix

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, Mondays  Hootsuite

 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, Wednesdays  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, Mondays  Facebook  Top pages (voices), groups

 General trends/sentiment 

analysis

 News analysis through posts

FEMA Social 

Listening Report

Weekdays, daily  Various  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