CS000000-A | 8/21/23

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence & Demand Team, Insights Unit

The findings and conclusions in this report are those 

of the author(s) and do not necessarily represent 

the official position of the Centers for Disease 

Control and Prevention (CDC).

CDC’s State of 

Vaccine Confidence 

Insights Report

Quarter 1 Report 

August 21, 2023

Date Range: January 1 – March 31, 2023

SPECIAL UPDATE: CDC partners can now report vaccine-related 

rumors directly to CDC. To report a rumor, go to wwwn.cdc.gov/dcs/

ContactUs/Form. Start the subject line with “Rumors:” and in the 

question box, give as much information about the rumor as you can, 

including a description of the rumor, where you heard it, and how 

many times you have heard it.
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State of Vaccine Confidence Insights Report | August 21, 2023

Summary

a

Themes for this report come from an integrated and thematic analysis of the data from the sources listed in the appendix.

Major, continuing, and emerging themes identified from social media, news, and other sources that may impact 

vaccine confidence:a

 Vaccine availability and interest may be negatively impacted amid the end of the COVID-19 Public Health 

Emergency (PHE), political and legal reactions to COVID-19 vaccination, and widespread inaccurate health 

information.

 Consumers and social media users were concerned about COVID-19 vaccine side effects following Damar 

Hamlin’s collapse during a football game even though his cardiac arrest was caused by a blow to the chest 

(commotio cordis).  

 Consumers continue to experience pandemic fatigue.

 Consumers and social media users continue to have questions and concerns about COVID-19 vaccination in 

children.

 Consumers and social media users continue to question the effectiveness, availability, and scheduling of the 

updated COVID-19 vaccine. 

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

 Disseminate resources (such as the NRC-RIM toolkit or HHS fact sheet) for individuals explaining how 

the COVID-19 PHE ending will impact their coverage and access to preventative and curative COVID-19 

measures. 

 Work with healthcare workers, community leaders, and trusted messengers to dispel any circulating misand disinformation related to COVID-19 vaccination. 

 Provide easy-to-read clinical findings showing the safety of all U.S approved vaccines. These findings may 

include vaccine safety relative to reproductive health and possible rare adverse events.

 Promote positive vaccine experiences, safety and the rarity of adverse events from the updated COVID-19 

vaccine.

 Continue to amplify messages about how COVID-19 vaccines function.

 Collaborate with trusted messengers to explain the benefits of the updated COVID-19 vaccines while 

addressing questions, concerns, and inaccurate health information discouraging vaccine uptake.

 Continue to research the effectiveness of the updated COVID-19 vaccine in humans and publish data as 

soon as it is available. 

 Continue to support research into the safety and effectiveness of COVID-19 vaccines. 

 Continue to support provider COVID-19 vaccine recommendations for pediatric patients.

 Continue to create communications products emphasizing the importance of COVID-19 vaccines in all 

children.

For findings and ways to act from our other reports, see previous Insights Reports. 

Resources: The following link contains social media resources such as graphics, language, and social media 

calendars that our partners can use to help educate their constituents and build vaccine confidence by addressing 

the themes in this report: https://centersfordiseasecontrol.sharefile.com/d-s214508599eef49878e258b4f8e0759f5
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State of Vaccine Confidence Insights Report | August 21, 2023

Table of Contents

4

Aims and Methods

5

Vaccine availability and interest may be negatively impacted amid 

the end to the COVID-19 Public Health Emergency, political and legal 

reactions to COVID-19 vaccination, and widespread inaccurate health 

information

8

Consumers and social media users are concerned about COVID-19 

vaccine side effects following Damar Hamlin’s collapse during a football 

game

11

Consumers continue to experience pandemic fatigue

12

Consumers and social media users continue to have questions and 

concerns about COVID-19 vaccination in children

13

Consumers have questions and concerns about the FDA’s proposed plan 

for annual COVID-19 booster doses

13

Other Continuing and Evolving Themes

15

References

19

Appendix: Inputs and Sources
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State of Vaccine Confidence Insights Report | August 21, 2023

Aims and Methods

By reviewing and analyzing numerous sources and inputs (see Appendix), the State of Vaccine 

Confidence Insights Report emphasizes major themes influencing vaccine confidence and uptake. 

These are characterized by the level and type of threat to vaccine confidence, degree of spread, and 

directionality. In addition, by examining how consumers think and feel, social processes, and the 

practical issues around vaccination, the Insights Report seeks to highlight emerging issues related to 

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

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 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 | August 21, 2023

Major Themes That Might Impact 

Vaccine Confidenceb

Vaccine availability and interest may be negatively 

impacted amid the end of the COVID-19 Public 

Health Emergency, political and legal reactions to 

COVID-19 vaccination, and widespread inaccurate health 

information

The first quarter of 2023 marked three years since COVID-19 was declared a pandemic by WHO in 

March 2020 and signaled the beginning of a new phase of the COVID-19 response in the United States. 

In February 2023, the U.S. Department of Health and Human Services (HHS) announced the planned 

end of the federal Public Health Emergency (PHE) for COVID-19, which expired on May 11, 2023.1 The 

end of the public health emergency presents both challenges 

and opportunities for vaccine confidence, especially as 

COVID-19 vaccination shifts from federal procurement to 

the commercial market, leaving many consumers concerned 

about potential increased vaccine costs and reduced 

vaccine availability. In addition, the reporting period can be 

characterized by continuing political, legislative, and legal 

efforts in reaction to the COVID-19 public health response,2

as well as an increase in vaccine-related inaccurate health 

information on social media.3

Perceptions, concerns, and threats to vaccine confidence

b

Social media posts referenced throughout this report can be found in this online document.

The end of the COVID-19 Public Health Emergency

 Some social media users expressed concern that the end of the COVID-19 PHE will end COVIDrelated medical coverage for uninsured individuals.4,5

 Vaccine-skeptical social media influencers contend that all COVID-19 vaccines should no longer 

be authorized or available following the end of the COVID-19 PHE.6,7

 Some social media users urged individuals to stockpile COVID-19 tests and get additional 

COVID-19 vaccines before May 11, 2023, fearing that this would be more difficult once the 

COVID-19 PHE ends.8,9

 Some social media users expressed disapproval, concern, and anxiety about the end of the 

COVID-19 PHE and felt that the decision will undermine public health.10,11,12

 Some social media users believe choosing to end the COVID-19 PHE in May was an arbitrary date 

rooted in political gain instead of epidemiological data.13,14,15
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State of Vaccine Confidence Insights Report | August 21, 2023

Concerns about the increased cost of Moderna’s COVID-19 vaccine

 On March 22, 2023, the CEO of Moderna testified before the Senate Health Committee on 

the expected 400% increase in price for the company’s COVID-19 vaccine when the vaccine is 

commerialized.16

 Some social media users expressed the Moderna vaccine price increase would create difficulty 

in finding additional doses17 and impede access for uninsured individuals.18 Moderna has 

maintained that vaccines will remain accessible to individuals regardless of insurance status, 

including through patient assistance programs.19

 Some social media users believe political leaders should focus on investigating claims of vaccine 

injury from Moderna’s COVID-19 vaccine instead of the higher price.20,21,22

 Some social media users and politicians believe Moderna increasing the cost of their vaccine 

signals corporate greed.23,24 This may negatively impact vaccine confidence among consumers 

who feel that pharmaceutical companies prioritize profit over the public’s health.25,26

Political, legal, and legislative reactions to COVID-19 vaccination

 More than 600 vaccine-related bills have been introduced so far in 2023, eclipsing the total 

number of bills introduced in 2022 according to the National Conference of State Legislatures.27

Many states are considering legislation that would prohibit or curtail COVID-19 vaccine 

requirements as well as routine vaccine requirements imposed by schools, employers, and other 

entities.28 Other bills introduced this session include legislation that would reinstate religious 

or personal belief exemptions for school entry; establish liability for adverse events following 

vaccination;28 criminalize the administration of mRNA vaccines;29 and ban individuals who have 

received a COVID-19 vaccine from donating blood.30

 Some news outlets have published articles 

claiming the lawsuits and the threat of 

litigation have limited the ability for public 

health agencies to enact protective measures 

against future outbreaks.2

 On February 15, 2023, the Florida Department 

of Health issued a health alert notifying 

residents about an increase in Vaccine 

Adverse Event Reporting System (VAERS) reporting following the state’s COVID-19 vaccine 

rollout.31 The safety and effectiveness of COVID-19 vaccines was further called into question by 

Florida’s Surgeon General when sharing the health alert on social media.32 The FDA and CDC 

subsequently released a joint letter to the Florida Surgeon General, stating that “the claim that 

the increase of VAERS reports of life-threatening conditions reported from Florida and elsewhere 

represents an increase of risk caused by the COVID-19 vaccines is incorrect, misleading, and 

could be harmful to the American public.”33

Social media ecosystems see an increase in the spread of inaccurate vaccine information 

 Just prior to the reporting period, Twitter (currently rebranding to X) announced that it would 

no longer enforce its policy to label or remove false and misleading COVID-19 claims34 and 

that previously suspended Twitter accounts would be reinstated, sparking concerns about an 

increase in misinformation on the platform.35 Recent analysis from Media Matters for America 

found that between October 1, 2022 and March 31, 2023, anti-vaccine accounts comprised 

roughly 25% of the top 250 accounts tweeting about COVID-19.3
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State of Vaccine Confidence Insights Report | August 21, 2023

 New Twitter owner Elon Musk—now the most-followed 

person on the platform—expressed concern that the 

updated COVID-19 vaccine does more harm than good.36

Musk, who had spread inaccurate COVID-19 information 

on Twitter37 prior to acquiring the platform in late 2022, 

also shared that he experienced “major side effects” after 

receiving an updated COVID-19 vaccine and that one of 

his relatives was hospitalized with myocarditis following 

COVID-19 vaccination.38 

 One of the most viral social media posts (and a breakout 

theme among Internet search queries)c during the 

reporting period was a video released by Project Veritas, 

a partisan activist group with a well-documented history 

of misleading tactics and content. The video’s allegations 

that Pfizer was considering experimental mutation of the 

SARS-CoV-2 virus were subsequently refuted by Pfizer.39 The 

video was promoted by U.S. Rep. Marjorie Taylor Greene,40

whose Twitter account was among those reinstated after 

previously being suspended for promoting inaccurate 

COVID-19 information.41 Although some consumers do 

not believe the inaccurate information and anti-vaccine rhetoric promoted by Greene,42,43 many 

continue to endorse these views.44,45

c

Google Trends.

d

Note that this information is accurate at the time of reporting but will likely change over the next few months as 

COVID-19 vaccines become commercially available. Refer to vaccines.gov for the latest information on COVID-19 

vaccine availability.

Commonly asked questions and queries from the public 

 What will be affected by the end of the COVID-19 Public Health Emergency?d

 Vaccines will remain available. Access to COVID-19 vaccines will generally not be affected 

for now. The U.S. government is currently distributing free COVID-19 vaccines for all adults 

and children. To help keep communities safe from COVID-19, HHS remains committed to 

maximizing continued access to COVID-19 vaccines.

 COVID-19 at-home tests may not be covered by insurance. Insurance providers will no 

longer be required to waive costs or provide free COVID-19 tests. CDC’s No Cost COVID-19 

Testing Locator can help people find current community and pharmacy partners participating 

in the Increasing Community Access to Testing (ICATT) program.

 Treatments will remain available. Medication to prevent severe COVID-19, such as Paxlovid, 

will remain available for free while supplies last. After that, the price will be determined by the 

medication manufacturer and your health insurance coverage. Check with your healthcare 

provider if you need early treatment to prevent severe COVID-19.

 National reporting of COVID-19 may change. CDC has data for this phase of COVID-19 that 

will allow an understanding of what’s happening with the virus in the U.S. in near in real-time. 

Simply put, available data going forward will still allow CDC, local public health officials, and 

the members of the public to understand COVID-19 dynamics at the community level.46
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State of Vaccine Confidence Insights Report | August 21, 2023

 Where can individuals find COVID-19 vaccines?e

 Vaccines.gov helps people find the latest information on COVID-19 vaccine availability at 

certain providers and pharmacies.47

e

CDC-INFO.

Inaccurate vaccine information themes that may impact vaccine confidence 

 Some social media users believe Moderna’s COVID-19 vaccine is ineffective and are enraged at 

the plan to increase the price.48,49,50

 Some social media users believe Moderna can increase the cost of their COVID-19 vaccine 

because it is not actually a vaccine.51,52

 Some social media users continue to express their belief that politicians and pharmaceutical 

companies fabricated the COVID-19 pandemic to make money.53,54

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

 Disseminate resources (such as the NRC-RIM toolkit or HHS fact sheet) for individuals explaining 

how the COVID-19 PHE ending will impact their coverage and access to preventative and 

curative COVID-19 measures. 

 Work with healthcare workers, community leaders, and trusted messengers to dispel any 

circulating mis- and disinformation related to COVID-19 vaccination. 

Consumers and social media users were concerned 

about COVID-19 vaccine side effects following Damar 

Hamlin’s collapse during a football game

On January 2, 2023, Buffalo Bills safety Damar Hamlin suffered from cardiac arrest and collapsed 

during an NFL game.55 Hamlin’s near-fatal injury immediately became one of the biggest stories in the 

country, resulting in a surge of conjecture, inaccurate health information, and conspiratorial claims 

linking his injury to COVID-19 vaccination and fueling consumer concerns about cardiovascular risks 

posed by COVID-19 vaccination. 

Hamlin later indicated that his 

collapse was unrelated to his 

vaccination status and was 

caused by commotio cordis, a 

rare condition of sudden cardiac 

arrest that occurs following a 

severe blow to the chest.
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State of Vaccine Confidence Insights Report | August 21, 2023

Perceptions, concerns, and threats to vaccine confidence

Damar Hamlin’s collapse 

 Many social media users and consumers attributed Damar Hamlin’s collapse to the COVID-19 

vaccine.56,57 Such claims are not unique to Hamlin’s injury; as noted in the Q4 2022 Insights 

report, accounts of young athletes and other prominent individuals experiencing heart-related 

events or unexpected deaths have led some consumers to believe that these events are 

connected to COVID-19 vaccines.

 Vaccine-skeptical influencers actively engaged in spreading inaccurate information about the 

cause of Damar Hamlin’s cardiac arrest without any evidence.58

 Fake accounts posing as medical professionals declared COVID-19 vaccines as dangerous 

following Hamlin’s collapse.59

 Political pundits and anti-vaccination doctors claimed that more than 1,500 total cardiac arrests 

have occurred in athletes since COVID-19 vaccinations began. However, the sources used for this 

information came from an inaccurate blog post instead of peer-reviewed sources, continuing to 

undermine trust in the vaccines.60

 On Google, queries for “Damar Hamlin”, “was Damar Hamlin vaccinated,” and “Damar Hamlin 

COVID vaccine” ranked among the largest increases in search frequency during the reporting 

period. As of July 2023, “Damar Hamlin” remains the #1 rising search term on Google in 2023.c

 Many health care professionals and social media users worked to communicate commotio cordis 

as the cause of Damar Hamlin’s cardiac arrest, while showing the rarity of myocarditis as an 

adverse consequence of mRNA COVID vaccination.61,62,63

Myocarditis, strokes, and blood clots

 Consumers expressed concern about the risk of myocarditis after vaccination in adolescents.d

 “Causes of myocarditis,” “myocarditis,” and “COVID-19 vaccine statistics,” and “cures for 

myocarditis” were all searches that increased in this reporting period.c

 Consumers and social media users expressed concerns over the possibility of severe vaccine side 

effects including myocarditis, strokes, and blood clots.64,65,66,67

 Some social media users believe that updated COVID-19 vaccines may create a heightened risk 

of severe adverse reaction in adolescents.68,69

 Fears that the vaccines would 

cause the consumer to die 

suddenly spread rapidly across 

social media and became a 

prominent talking point among 

anti-vaxxers.70,71 Consumers and 

social media users accused vaccine 

manufacturers of ignoring the 

dangers and releasing vaccines 

that were unsafe for consumer use.72
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State of Vaccine Confidence Insights Report | August 21, 2023

 CDC and FDA investigated a potential increased risk of stroke associated with Pfizer-BioNTech’s 

updated COVID-19 vaccine in adults ≥65 years old after a preliminary safety signal was detected 

in one safety monitoring system, the Vaccine Safety Datalink (VSD).73,74,75 Other safety monitoring 

systems have not observed similar signals, and the current evidence does not support the 

existence of a safety issue.75 FDA and CDC will continue to evaluate data as they are available 

and update the public as needed.76

 Some consumers with a personal or family history of blood clots stated that they were more 

hesitant to receive the COVID-19 vaccines due to concerns of experiencing an adverse reaction.d

Commonly asked questions and queries from the public 

 Was Damar Hamlin’s cardiac arrest caused by the COVID-19 vaccines?

 After an extensive investigation, medical professionals have determined that Damar Hamlin 

suffered from a rare heart condition called commotio cordis, which creates an irregular 

heartbeat. Damar Hamlin was tackled at a point in his cardiac cycle that triggered ventricular 

fibrillation leading to cardiac arrest. Damar Hamlin’s COVID-19 vaccination status was 

unrelated to his injury.61

 Do the risks of myocarditis and pericarditis outweigh the benefits of the COVID-19 vaccines?

 The benefits of COVID-19 vaccination outweigh the 

known and potential risks. The risks for myocarditis 

and pericarditis are very low and occur in rare 

circumstances.77 Moreover, the risk of myocarditis 

from SARS-CoV-2 infection is seven times greater

than the risk associated with COVID-19 vaccination. 

Myocarditis has been observed most frequently in 

adolescent and young adult males within 7 days after 

receiving the second dose of an mRNA COVID-19 

vaccine, but is still a rare occurrence.76 To date, an 

increased risk of stroke in adults 65 years and older has not been validated.76 CDC and FDA 

investigated a potential increased risk of stroke associated with Pfizer-BioNTech’s updated 

COVID-19 vaccine in adults ≥65 years old after a preliminary safety signal was detected in one 

safety monitoring system, the Vaccine Safety Datalink (VSD). Other safety monitoring systems 

have not observed similar signals, and the current evidence does not support the existence of 

a safety issue.75 FDA and CDC will continue to evaluate data as they are available and update 

the public as needed.76

 Are COVID-19 vaccines safe and effective? 

 The CDC resource on Ensuring COVID-19 Vaccine Safety in the U.S. relays information on the 

effectiveness of COVID-19 vaccines at providing protection from serious illness, hospitalization, 

and death. Vaccination remains the safest strategy for avoiding severe outcomes of infection.78

Serious side effects that could cause a long-term health problem are extremely rare following 

any vaccination, including COVID-19 vaccination.79 CDC, FDA, and other federal agencies 

continue to monitor the safety of COVID-19 vaccines.

 What are the side effects of the updated (bivalent) COVID-19 vaccines? 

 Reactions reported after getting an updated COVID-19 vaccine were similar to those after the 

two-dose or single-dose primary shots. Most side effects were mild to moderate. The most 

commonly reported side effects were fever, headache, fatigue and pain at the injection site.80
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State of Vaccine Confidence Insights Report | August 21, 2023

 Why is CDC recommending COVID-19 vaccines for children if myocarditis is a potential adverse 

event? 

 The known risks of COVID-19 illness and its related, possibly severe complications, such as 

long-term health problems, hospitalization, and even death, far outweigh the potential risks 

of having a rare adverse reaction to vaccination, including the possible risk of myocarditis or 

pericarditis.77

Inaccurate vaccine information themes that may impact vaccine confidence

 Some social media users believe that the symptoms following COVID-19 vaccination are more 

severe than the symptoms of COVID-19 infection.81

 Some social media users believe the updated COVID-19 vaccines will cause severe adverse 

events including heart attack, ischemic stroke, and other claims made by the popular antivaccine film Died Suddenly. 60,66,67,82,83

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

 Address any lingering questions and concerns that the public may have about Damar Hamlin’s 

collapse (as well as similar narratives regarding other athletes or celebrities) and continue to 

share accurate information with the public when available. 

 Provide easy-to-read clinical findings demonstrating the safety of all U.S approved vaccines and 

the rarity of potential adverse events. 

 Promote positive vaccine experiences, emphasize vaccine safety, and communicate the rarity of 

severe adverse events from the updated COVID-19 vaccines.

Continuing and Evolving Themes

Consumers continue to experience pandemic fatigue

Consumer concerns about the safety of COVID-19 vaccines for the elderly, immunocompromised, 

and those with high-risk conditions continue to play a role in vaccine hesitancy among these 

groups.84 Vaccination uptake for the updated (bivalent) COVID-19 vaccine—initially recommended 

in September 2022—remains low when compared to completion of the primary series.85 As of May 

2023, 84.3% of adults and 32.9% of children have completed their COVID-19 vaccine primary series; 

however, only 29% of adults and 7.2% of children have received the updated COVID-19 vaccine 

and are considered up to date in their 

protection against COVID-19.86 Low trust 

in medical institutions, government, and 

masking effectiveness, decreased use 

of non-pharmaceutical interventions, 

and perceived COVID-19 ineffectiveness 

may be contributing to pandemic 

fatigue.87,88,89,90 Lastly, both politicians and 

social media users continue to assert the 

COVID-19 pandemic is over.91,92,93
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State of Vaccine Confidence Insights Report | August 21, 2023

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

 Continue to amplify messages about how COVID-19 vaccines function.

 Collaborate with trusted messengers to explain the benefits of the updated COVID-19 vaccines 

while addressing questions, concerns, and inaccurate health information discouraging vaccine 

uptake.

 Continue to research the safety and effectiveness of the updated COVID-19 vaccine in humans 

and publish data as soon as it is available. 

Consumers and social media users continue to have 

questions and concerns about COVID-19 vaccination 

in children

Research continues to support evidence that 

COVID-19 vaccines are safe and effective for 

children.94 In an effort to provide guidance 

and maintain population protection, 

COVID-19 vaccines have been added to 

the recommended childhood vaccination 

schedule.95,96 In response, some parents 

and vaccine skeptics took to social media to 

express their anger and opposition to this 

decision due to their concerns about vaccine safety as well as the misperception that COVID-19 vaccines 

would now be required for children.97,98,99According to Google Trends analysis, search interest related 

to the childhood immunization schedule was actually eclipsed by search interest in the World Health 

Organization’s updated vaccination recommendations, which categorized children and adolescents as 

low risk and therefore lower priority for additional COVID-19 booster doses.100,101 Some vaccine-skeptical 

consumers felt WHO’s revised guidelines confirmed their previously held beliefs that vaccinating children 

against COVID-19 was not supported by science or evidence-based policy.102,103 

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

 Continue to support research into the safety and effectiveness of COVID-19 vaccines. 

 Continue to support provider COVID-19 vaccine recommendations for pediatric patients.

 Continue to create communications products emphasizing the importance of COVID-19 

vaccines in all children.
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State of Vaccine Confidence Insights Report | August 21, 2023

Consumers have questions and concerns about the 

FDA’s proposed plan for annual COVID-19 booster 

doses

Social media and Google Trends data indicate that consumers continue to have questions about 

whether newer COVID-19 vaccines would be made available to replace the current bivalent 

formulations and how often they should vaccinate against COVID-19.104,c As part of an effort to 

simplify COVID-19 vaccination guidelines, in January 2023 the FDA outlined their proposed plan to 

make COVID-19 booster doses available annually each fall, similar to the approach used for influenza 

vaccines.105 This recommendation was questioned by some social media users and vaccine experts, 

who expressed uncertainty as to whether annual COVID-19 vaccination is appropriate based on 

the available data.105,106 Other users who are vulnerable to COVID-19 voiced dissatisfaction with the 

plan, indicating that they would prefer having an option to receive a COVID-19 booster dose more 

frequently than once per year.107 Some consumers with low vaccine confidence took to social media 

to discourage others from receiving additional COVID-19 vaccines, feeling that annual COVID-19 

vaccination is the next step in a long-term plan motivated by profit and social control.108,109 The 

reporting period also saw consumers sharing positive experiences with receiving an updated 

COVID-19 booster dose as a way to counteract anti-vaccine rhetoric on social media.110,111

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

 Create or disseminate materials communicating information about the current and future 

guidelines regarding the availability and timing for receiving an updated COVID-19 dose.

 Partner with healthcare workers and local community leaders to craft and disseminate messages 

about reasons eligible individuals should receive the updated COVID-19 vaccine. 

 Create venues or mechanisms to hear and respond to communities’ questions and concerns, 

such as town halls, hotlines, and social media.

Other Continuing and Evolving Themes

Lab leak theory

On February 26, 2023, the U.S. 

Department of Energy stated 

with “low confidence” that they 

now believe that the COVID-19 

pandemic was caused by a 

laboratory leak in Wuhan, 

China.112 Soon after, the U.S. 

House Select Subcommittee 

on the Coronavirus Pandemic held a hearing on “Investigating the Origins of COVID-19” on March 

8, 2023.113 These news stories reignited debate about the hypothesized origins of the virus, as many 

social media users believe that COVID-19 originated from a laboratory in Wuhan, China,114,115,116 while 

many public health experts have asserted SARS-CoV-2 has zoonotic origins.117,118,119 (It should also 
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State of Vaccine Confidence Insights Report | August 21, 2023

be noted that these theories are not necessarily mutually exclusive.) Government agencies remain 

divided on this issue, with two agencies (including the Department of Energy) indicating support 

for the lab leak hypothesis, four agencies concluding that COVID-19 emerged through natural 

transmission from animals to humans, and two agencies that are still undecided.112 Discussions about 

the origins of SARS-CoV-2 are likely to reinforce vaccine skepticism and distrust of public health 

among individuals with low vaccine confidence, so it is important to frame these discussions with 

appropriate context whenever possible. 

Renewed debate about masking

The reporting period included renewed debate about the effectiveness of mask wearing in reducing 

the transmission of COVID-19 following the publication of a meta-analysis review by Cochrane Library. 

Initial editorial commentary113 of the Cochrane review coupled with inaccurate statements from one 

of its lead authors114 resulted in confusion among the public and led many to assert that masks don’t 

work, a claim which is not supported by the review itself.115 Cochrane Library subsequently released a 

statement in an effort to reduce the widespread misinterpretation of these findings.116
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State of Vaccine Confidence Insights Report | August 21, 2023

References

Note: omitted numbers are social media citations, which can be found in this online document.

1. Assistant Secretary for Public Affairs. (2023, February 22). Fact Sheet: COVID-19 Public Health 

Emergency transition roadmap. U.S. Department of Health and Human Services. https://

www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html

2. Weber, L., & Achenbach, J. (2023, March 9). COVID backlash hobbles public health and 

future pandemic response. Washington Post. https://www.washingtonpost.com/

health/2023/03/08/covid-public-health-backlash/

3. Carter, C. & Seavey, R. (2023, April 24). As Musk attempts to court Twitter advertisers, new data 

from Media Matters provides insight into the prevalence of COVID-19 misinformation on the 

platform. Media Matters for America. https://www.mediamatters.org/elon-musk/musk-attempts-court-twitter-advertisers-new-data-media-matters-provides-insight

16. C-SPAN. (2023, March 22). Moderna CEO Testifies on COVID-19 Vaccine Price Increase [Video]. 

https://www.c-span.org/video/?526580-1/moderna-ceo-testifies-covid-19-vaccine-priceincrease

19. Moderna’s commitment to patient access in the United States [press release]. (2023, February 15). 

Moderna. https://investors.modernatx.com/Statements--Perspectives/Statements--Perspectives-Details/2023/Modernas-Commitment-to-Patient-Access-in-the-United-States/default.

aspx

27. National Conference of State Legislatures. (2023, May 30). State Public Health Legislation Database. https://www.ncsl.org/health/state-public-health-legislation-database

28. Joseph, B. (2023, February 16). States continue to roll back vaccine requirements. LexisNexis. https://www.lexisnexis.com/community/insights/legal/capitol-journal/b/state-net/posts/

states-continue-to-roll-back-vaccine-requirements

29. Lee, B. Y. (2023, February 18). New Idaho bill would criminalize anyone administering Covid-19 

mRNA vaccines. Forbes. https://www.forbes.com/sites/brucelee/2023/02/18/new-idaho-bill-would-criminalize-anyone-administering-covid-19-mrna-vaccines/?sh=43907def3ba8

30. Cohen, L. (2023, March 3). Montana rep files bill to ban blood donations from people vaccinated 

against COVID-19. NBC Montana. https://nbcmontana.com/news/coronavirus/montanarep-greg-kmetz-bill-ban-blood-donations-people-covid-19-vaccine-coronavirus-lawmakerhouse-republican-gay-lgbtq-men-sex-fda-restriction-food-drug-administration

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59. Linder, B. (2023, January 4). ‘Doctor’ who claimed he gave Damar Hamlin COVID-19 booster last 

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73. Sabes, A. (2023, January 14). CDC investigating whether Pfizer COVID vaccine increases stroke 

risk for people over 65. New York Post. https://nypost.com/2023/01/14/cdc-investigatingpfizer-covid-vaccine-for-stroke-risk/

74. U.S. FDA, CDC see early signal of possible Pfizer bivalent COVID shot link to stroke. (2023, January 14). Reuters. https://www.reuters.com/business/healthcare-pharmaceuticals/us-sayspfizers-bivalent-covid-shot-may-be-linked-stroke-older-adults-2023-01-13/

75. Shimabukuro, T. (2023, April 19). mRNA COVID-19 bivalent booster vaccine safety update [presentation]. Advisory Committee on Immunization Practices, Centers for Disease Control and 

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76. Centers for Disease Control and Prevention. (2023, May 31). Selected adverse events reported after 

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77. Centers for Disease Control and Prevention. (2023, March 23). Clinical considerations: Myocarditis 

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78. Centers for Disease Control and Prevention. (2023, May 11). Benefits of getting a COVID-19 

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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: 20

State of Vaccine Confidence Insights Report | August 21, 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