CS000000-A | 11/10/22

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

Routine Immunizations on 

Schedule for Everyone Report

November 10, 2022

Date Range: August 1, 2021 – August 10, 2022
Page: 2

State of Vaccine Confidence Insights Report | November 10, 2022

Summary

 Declines in routine vaccination occurred worldwide in 2021, 

with 25 million children missing out on diphtheria, tetanus and 

pertussis vaccinations. This is 2 million more than in 2020 and 6 

million more than in 2019.1 However, most WHO regions, except 

the South-East Asia region and the Western Pacific region, returned 

to or exceeded pre-pandemic pediatric vaccination baseline by 

December 2020.

 In the US, in 2020, coverage was approximately 94% for MMR, DTaP, 

and varicella vaccines for kindergarten students, approximately 

one percentage point lower than the previous school year. 

The exemption rate remained low at 2.2%, based on data from 

kindergarten vaccination assessments.2

 A study by Avalere, using pre-adjudicated medical benefit 

Medicare Fee-for-Service (FFS) claims, found that from January 

2020–July 2021, monthly vaccine claims decreased on average by 

32% for adults and 36% for adolescents when compared to the 

same months in 2019.3

 Stratification of CDC FluVaxView data found that after COVID-19 

vaccines became widely available in the 2021-2022 season, adult 

influenza vaccine uptake decreased from 43.7% to 39.2% in states 

with the lowest COVID-19 vaccine uptake and only decreased after 

the COVID-19 vaccine was made available.4

 A survey (N = 2232) by the American Academy of Family Physicians 

(AAFP) found that 20.8% of respondents reported decreased 

vaccine confidence.5

 Several studies found a decline in rates of routine vaccinations 

during the COVID-19 pandemic in the US.6,7,8,9,10,11 All studies found 

that routine vaccination rates rebounded to some extent, but most 

US-centric studies found that they did not return to pre-pandemic 

levels. 

Contents

5

Impact of the COVID-19 pandemic 

on routine vaccinations

5

Global Impact

5

Domestic Impact

5

Evidence negating an association 

of hesitancy between COVID-19 

vaccines and other vaccines

7

Legislation written in response to 

COVID-19 vaccines applicable to 

other vaccines in some cases

9

Bills that guarantee exemptions 

from vaccine requirements

9

Bills that outlaw vaccine 

requirements

10

Bills that hold employers liable for 

injuries associated with workplace 

requirements or by incentivizing 

vaccinations 

11

Suggestions for getting back on 

track from the data sources:
Page: 3

State of Vaccine Confidence Insights Report | November 10, 2022

 There are 39 bills in state legislatures that have the potential to 

loosen workplace vaccination requirements.12

 The following are suggested reasons why the COVID-19 pandemic 

may have affected vaccine confidence and uptake levels of nonCOVID-19 vaccines (sometimes referred to as a carryover effect):a

 Ongoing concern about going to healthcare settings for fear of 

contracting SARS-CoV-2.13

 Access to routine healthcare services has not recovered for some 

individuals and families.14

 Decline in trust in government, scientific processes, and the 

healthcare industry.15,16

 The proliferation of misinformation about routine immunizations 

and the fact that vaccine-preventable diseases are rare in the 

US have contributed to parents second-guessing whether they 

should vaccinate their children.17

 Promotion of beliefs that other protective measures are safer and 

more effective.18,19,20

 Pandemic-related increases in political polarization of vaccines 

and public health and the association between perceptions of 

COVID-19 vaccination and political affiliation.21,22

 Recommendations to improve vaccination rates include use of 

evidence-based interventions demonstrated to raise vaccination 

rates including:23

 Home visits to increase vaccination rates

 Vaccination requirements for childcare and schools

 Client reminder and recall interventions and provider reminders

 Client or family incentive rewards

 Provider assessment and feedback programs, when used alone or 

combined with additional interventions 

 Vaccination programs in Special Supplemental Nutrition Program 

for Women, Infants, and Children (WIC) settings

 Standing orders for vaccinations, to authorize nurses, 

pharmacists, and other healthcare providers to assess 

immunization status and administer vaccinations 

 Using a combination of community-based interventions to 

increase vaccination rates in targeted populations 

 Using a combination of healthcare system-based interventions 

 Reducing out-of-pocket costs

a

Based on hypothesized reasons cited in the peer-reviewed literature, news 

stories, and analysis of social media themes.

11

Peer-reviewed suggestions for 

providers and at point-of-care

12

Peer-reviewed suggestions for 

partnerships and collaborations

12

Peer-reviewed suggestions for 

public health communication 

strategies

12

Peer-reviewed suggestions of 

systemwide strategies

12

Suggestions from the American 

Academy of Family Physicians 

Report

14

Appendix: Inputs and Sources
Page: 4

State of Vaccine Confidence Insights Report | November 10, 2022

 Use immunization information systems (IIS). IIS are confidential, population-based, 

computerized databases that record all immunization doses given by participating 

providers who live within a certain geopolitical area 

 School and organized childcare center-located vaccination programs 

 Interventions with on-site, free, and actively promoted influenza vaccinations 

 A selection of peer-reviewed literature recommended additional interventions to address 

the recent decline in routine vaccinations:

 Expand vaccination sites by adding in‐car and in‐home vaccination programs to the routine 

in‐clinic immunization or establishing mobile vaccination centers that provide services in 

strategic places such as marketplaces and social or cultural centers.24,25

 Implement, improve or increase follow-up activities by schools and immunization programs

with under-vaccinated students.2

 Increase the frequency of well-child care during the next year.2

 Develop and implement a consolidated and coordinated effort among multiple partners to 

promote catching up and staying up to date on routine vaccinations through national, state, 

and local catch-up campaigns.28,29,30

 Identify and address vaccine misinformation, especially by supporting communities most 

impacted by misinformation and vaccine inaccessibility or in need of clarification and 

explanation of circulating misinformation.31

 Craft messages for demographic groups that need to catch up on routine vaccinations with 

the appropriate messaging modality (See page 7 of this report).31

 Shift equity-based approaches from equity of coverage to equity of resilience.33

Aims and Methods

The State of Vaccine Confidence Insights Report summarizes major themes influencing 

vaccine hesitancy and uptake that were identified through rapid review and analyses of 

numerous sources and inputs (see Appendix). 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.

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. 
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State of Vaccine Confidence Insights Report | November 10, 2022

Impact of the COVID-19 pandemic on routine 

vaccinationsb

Global Impactc

According to a November 2021 UNICEF report, 

declines in routine vaccination occurred worldwide 

in 2021, with 25 million children missing out on 

lifesaving vaccines. This is 2 million more than in 2020 

and 6 million more than in 2019.34

Several studies of vaccination rates in non-US 

countries also found a decline in adult and childhood 

routine immunizations during the COVID-19 

pandemic.6,7,8,9,10,11 A systematic review of country-level 

studies found that 21 of 26 studies (81%) demonstrated decreased vaccination rates in children 

during the COVID‐19 pandemic.35 A WHO pulse survey found that 45 (69%) of 65 countries 

showed disruption in vaccination outreach services compared with 27 (44%) of 62 countries 

with disrupted fixed-post immunization services, with the most significant decline (57%) in 

diphtheria–pertussis–tetanus-containing vaccine (DTP3) and first dose of measles-containing 

vaccine (MCV1) occurring in the WHO South-East Asia Region.36 However, the same survey 

found that most WHO regions, except the South-East Asia region and the Western Pacific 

region, returned to or exceeded pre-pandemic vaccination baseline by December 2020. 

Domestic Impact

Several studies found a decline in rates of routine 

vaccinations during the COVID-19 pandemic in the 

US.37,38,39,40,41 All studies found that routine vaccination rates 

rebounded to some extent, but most US-centric studies 

found that they did not return to pre-pandemic levels. 

A study by Avalere, using pre-adjudicated medical benefit 

Medicare Fee-For-Service (FFS) claims, found that from 

January 2020–July 2021, monthly vaccine claims decreased 

on average by 32% for adults and 36% for adolescents 

compared to the same months in 2019.42 Additionally, 

they found that declines in ACIP-recommended adult 

vaccinations persisted from December 2020–July 2021. 

Total vaccine claims in this timeframe were between 

7%–64% lower than 2019 claims in adolescents and 15%–62% lower than 2019 claims in adults. 

b

Citations in this report are illustrative examples and are not the total number of instances of the corresponding themes.

c

Social media citations can be found in this linked document.
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State of Vaccine Confidence Insights Report | November 10, 2022

In the US, in 2020, coverage was approximately 94% for MMR, 

DTaP, and varicella vaccines for kindergarten students in the U.S., 

approximately one percentage point lower than the previous 

school year. The exemption rate remained low at 2.2%, based on 

data from kindergarten vaccination assessments.43

A study using CDC FluVaxView data found that adult influenza 

vaccine uptake decreased from 43.7% to 39.2% in states with 

the lowest COVID-19 vaccine uptake and only decreased after 

the COVID-19 vaccine was introduced. This suggests that some 

factors associated with COVID-19 vaccine confidence may have 

carried over to affect influenza vaccination rates. However, 

it is important to note that after COVID-19 vaccines became 

widely available (2021–2022 season), adult influenza vaccine 

uptake increased within states in the top two quartiles of COVID-19 vaccine uptake. Additionally, 

pediatric influenza vaccination decreased in all states and influenza vaccination levels increased in 

adults 65 years and older.44

In addition to COVID-19 vaccine hesitancy affecting decreased routine childhood vaccination 

rates, lockdown and shelter-in-place orders also likely impacted childhood vaccination 

uptake.45 During the early months of the COVID-19 pandemic, patients canceled or postponed 

visits,46 and increased use of online or telemedicine appointments.47

Evidence negating an association of hesitancy between COVID-19 vaccines and other vaccines 

 Some social media users opposed to the COVID-19 vaccine still support routinely recommended 

vaccines because of a perception of fewer or less severe side effects,48 longer-lasting 

protection,53,54 and more data on the safety of routine vaccines.

49,50

 Some social media users state that other vaccines are safe because they were made in a more 

traditional way than the COVID-19 mRNA vaccines.51,52,53,54

 A Google Trends analysis found no meaningful differences from 2018-2022 in the frequency 

of searches related to the influenza vaccine, MMR vaccine, tetanus vaccine, or the varicella 

vaccine.d

 However, when focusing only on searches related to getting each vaccine (i.e., “get flu 

vaccine”), searches increased 142% for the influenza vaccine and 16% for the varicella vaccine 

when comparing the peak annual searches in 2019 and 2021.e

d

Google Trends. The Y-axis represents the number of searches per week.

e

The vertical line on the trends graph indicates when Google applied an improvement to their data collection system.
Page: 7

State of Vaccine Confidence Insights Report | November 10, 2022

 A study among parents in California during September 2020 and February 2021 (n = 175) 

found no statistically significant change from before to during the pandemic in how parents 

perceived the importance of influenza vaccines.55

 A survey (N = 2232) by the American Academy of Family Physicians (AAFP), fielded from 

March 4th and 5th, 2021, found that 33% of respondents had delayed their medical care due 

to concerns about COVID-19, and 16% of parents had delayed their child’s/dependent’s 

medical care. The same survey found that the majority of respondents expressed either no 

change (39.3%)f or an increase (29.3%) in vaccine confidence since the pandemic’s start.56

Evidence supporting an association of vaccine hesitancy between COVID-19 vaccines and other 

vaccines

 The AAFP survey (N = 2232), however, also found that 20.8% of respondents reported a 

decrease in vaccine confidence since the start of the COVID-19 pandemic.57

 A cross-sectional study in May 2020 of parents and guardians with children ages 6 months 

through 5 years old found that of the respondents (N = 2,164) whose children did not 

receive the 2019-2020 seasonal influenza vaccine, 34% reported they were less likely to get 

their child the 2020-2021 seasonal influenza vaccine due 

to the COVID-19 pandemic.58

 Some social media users,59,60,61,62,63 websites64 and news 

outlets65,66,67,68,69,70 are explicitly stating that their concern 

or some patient’s and parents’ concerns about the 

COVID-19 vaccine now applies to other vaccines. 

 Some social media users leveraged online COVID-19 

conversations to amplify their claim that routine vaccines 

are “just as dangerous” as the COVID-19 vaccines or that “all vaccines 

are dangerous.”71,72,73

 Some social media users claim that the COVID-19 pandemic caused 

people to learn more about vaccines, including misinformation, 

causing them to be concerned about all vaccines.74,75

 Some social media users perceive the liability protection of 

COVID-19 vaccine manufacturers as evidence of likely vaccine 

harm.76,77

 Some social media users are using conversations of COVID-19 vaccine VAERS data to mention 

the adverse events reported in VAERS for all vaccines and promoting misinterpretations of 

VAERS data and conclusions that can be drawn from VAERS.78,79

 Some members of the public asked questions to CDC-INFO looking for more information 

about how side effects from COVID-19 vaccines might predict side effects from routine 

vaccinations. Questions like these might indicate that some people might have similar 

questions that are stopping them from getting vaccinated.g

f

From the AAFP study: It should be noted that no change in confidence could represent people with a high 

degree of confidence prior to the pandemic remaining confident; however, it could also represent people with 

a low degree of confidence remaining skeptical.

g

CDC-INF
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State of Vaccine Confidence Insights Report | November 10, 2022

 Some social media users leveraged COVID-19 conversations to tell others about the National 

Vaccine Compensation Injury Program as evidence that all vaccines are unsafe.80,81,82

 Some social media users leveraged COVID-19 vaccine conversations to promote alternatives 

to all routine vaccinations, such as diet, exercise, and supplements.83,84,85

 Several studies have identified specific demographic groups that require additional support 

to increase routine vaccination rates. Of those studies that identified groups, the following 

groups might be more susceptible to lower routine vaccine uptake due to COVID-19 and 

therefore require targeted vaccination campaigns to improve routine vaccination:86,87,88,89

 Certain racial and ethnic groups such as non-Hispanic Black 

children, non-Hispanic Black adults, American Indian or Alaska 

Native populations, and those who identify as gender nonconforming

 Younger parents

 Highly educated parents

 Families with less education, people of lower socioeconomic 

status, and people without a primary care provider

 People who did vaccinate their children with influenza 

vaccination in the previous season

 Parents with a history of SARS-CoV-2 infection among their 

children

Suggested reasons for how impacts of the COVID-19 pandemic carried 

over to other routine immunizations:h

 Some believe that economic stability, including access to routine 

healthcare services, has not recovered for some individuals and 

families since the start of the pandemic which may impact access to 

care and routine vaccination services.90

 Some authors, social media users and news stories report that pandemic-related increases 

in lack of trust in government, scientific processes, and the healthcare industry continue to 

impact vaccination rates.91,92

 Some authors and news outlets suggest possible contributors to routine vaccine hesitancy 

include medical mistrust, an increase in the availability of vaccine misinformation and 

concerning factual vaccine information due to newly developed and expanded vaccine 

skeptic networks, especially with political extremist groups, which led to more people 

believing vaccines are neither safe nor effective.93,94,95

 Some social media users frequently shared and promoted their beliefs that other protective 

measures are safer and more effective, including a healthy diet, exercise, sunlight, and a 

variety of vitamin and mineral supplements.96,97,98

 Some social media users promoting the COVID-19 vaccines may have unintentionally 

highlighted that some people opposed to COVID-19 vaccination were supportive of other 

routine vaccinations. This may have supported the reevaluation of previously held vaccine 

beliefs by people with low vaccine confidence.99

h

Based on hypothesized reasons cited in the peer-reviewed literature, news stories, and analysis of social 

media themes.
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State of Vaccine Confidence Insights Report | November 10, 2022

 Some news outlets and thought leaders believe a cause for the transfer of low COVID-19 

vaccine confidence to other vaccines is at least partly caused by increased political 

polarization.100,101

Proposed vaccine legislation drafted in response to 

COVID-19i

Legislative efforts continue across the country to codify vaccine exemptions in law, outlaw all 

vaccine requirements altogether, and/or hold employers liable for vaccine injury when they 

require or promote vaccination for workers. Some consider this as evidence that concern 

about the COVID-19 vaccines has been applied to routine vaccinations. Although these laws 

were generally written in response to COVID-19 vaccination requirements, the following 

examples of legislation were written broadly enough to apply to all vaccines.

Bills that guarantee exemptions from all or multiple vaccine requirements 

 Alaska House Bill 274 was referred to the Health & Social Services Committee on January 18, 

2022

 Minnesota House File 2347 was referred to the Health Finance and Policy Committee on 

March 22, 2021.

 Montana House Bill 702 bill was signed into law on May 7, 2021, and took effect 

immediately.

 Nebraska Legislative Bill 643 was re-introduced on January 5, 2022, as a carryover bill from 

the previous session.

 New Hampshire House 1210, pending Senate approval as of March 17, 2022 

Bills that guarantee exemptions from workplace vaccine requirements

 Iowa House File 902 was signed into law on October 29, 2021.

 Missouri House Bill 1641 underwent a public hearing on January 12, 2022.

 Missouri House Bill 1485 received a “do pass” recommendation from the House on January 

31, 2022. 

 Nebraska Legislative Bill 906 was approved by the Governor on February 28, 2022

 Pennsylvania Senate 1004, pending Senate Veterans Affairs and Emergency Preparedness 

Committee as of January 11, 2022

Bills that outlaw all or multiple vaccine requirements 

 Arizona Executive Order 2021-18 took effect on August 16, 2021

 Florida Senate 734 failed after three attempts.

 Georgia Senate Bill 345 was introduced on January 14, 2022

 Idaho House Bill 431 was referred to the Health and Welfare Committee on November 15, 

2021.

 Indiana Senate Bill 114, was referred to the Committee on Health and Provider Services on 

January 4, 2022.

i

These legislative efforts are tracked by the Insights Team at the law firm of Husch and Blackwell and can 

be found here. 
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State of Vaccine Confidence Insights Report | November 10, 2022

 Minnesota House File 1245 and Senate File 2394 were referred to 

the Health Finance and Policy Committee by April 12, 2021.

 New Hampshire House Bill 1224 underwent a public hearing on 

February 1, 2022.

 Pennsylvania Senate 471 was set for reconsideration on January 

26, 2022.

Bills that outlaw workplace vaccine requirements 

 Hawaii House Bill 241 was carried over to the 2022 regular session 

on December 10, 2021.

 Indiana Senate Bill 30, Senate Bill 31, and Senate Bill 286, Senate 

Bill 330 were referred to the Committee on Health and Provider 

Services on January 4, 2022.

 Kentucky House Bill 28, House Bill 52 and House Bill 93 were 

introduced on January 4, 2022.

 Michigan Public Act No. 82 was signed into law on September 29, 

2021, and took effect immediately.

 Minnesota House File 2541 and companion Senate File 2424 

were referred to the Labor, Industry, Veterans and Military Affairs 

Finance and Policy Committee on April 17, 2021, and the Labor 

and Industry Policy Committee on April 15, 2021, respectively.

 New Jersey Assembly Bill 781 and its counterpart Senate Bill 

125 were referred to the Community Development and Affairs 

Committee and the Health, Human Services, and Senior Citizens Committee on January 11, 

2022, respectively.

 New York Assembly Bill 4602 and Assembly Bill 7100 were re-introduced to the Health 

Committee on January 5, 2022.

 North Dakota House Bill 1465 was signed into law on May 7, 2021, and took effect 

immediately.

 Oklahoma Senate Bill 1128 was referred to the Business, Commerce and Tourism Committee 

on February 8, 2022.

 Oklahoma Senate Bill 1296 was referred to the Judiciary Committee on February 8, 2022.

 Pennsylvania Senate Bill 1004 was referred to the Veterans Affairs and Emergency 

Preparedness Committee on January 11, 2022.

 South Carolina House Bill 4560 were referred to the Committee on Judiciary on January 11, 

2022

 Tennessee Act No. 6 was signed into law November 12, 2021, and took effect on November 

18, 2021.

Bills that hold employers liable for injuries associated with workplace requirements or by 

incentivizing vaccinations 

 Alaska House Bill 16 was referred to the Committee on Judiciary on January 11, 2022

 Alaska House Bill 29 referred to the Committee on Judiciary on January 11, 2022

 Arizona Senate Bill 1494 was approved by Governor on July 6, 2022
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State of Vaccine Confidence Insights Report | November 10, 2022

 Oklahoma Senate Bill 1106 was referred to the Judiciary and Appropriations committees on 

February 8, 2022.

 South Dakota House Bill 1008 was referred to the Judiciary Committee on January 13, 2022.

 West Virginia House Bill 4030 was referred to the Workforce Development Committee on 

January 12, 2022.

Select suggestions for increasing routine vaccinations from the data 

sources:

The following suggestions for increasing routine immunization rates were identified in a 

selection of peer-reviewed literature specifically related to increasing routine vaccinations 

caused by the decline in routine immunizations during the COVID-19 pandemic. The 

suggestions are ordered based on the frequency they were recommended:

Peer-reviewed suggestions for providers and at point-of-care

 Consider evidence-based practices highlighted in The Community Guide. Some evidencebased strategies recommended by the Community Preventative Services Task Force 

include:102

 Worksite vaccinations sites

 Home vaccination visits

 Vaccination requirements for child care, school and college attendance

 Reducing client out-of-pocket costs

 Schools and organized child care centers vaccination sites

 Clinic-based client education

 Expand vaccination sites by adding in‐car and in‐home vaccination programs to the routine 

in‐clinic immunization or establishing mobile vaccination centers that provide services in 

strategic places such as marketplaces and social or cultural centers.103,104

 Develop or build healthcare provider capacity to use electronic medical records to identify 

skipped pediatric [and adult] vaccinations.105,106

 Healthcare providers can implement Reminder/Recall systems allowing patients to be 

informed of vaccine appointments via email, text messages, or phone calls.107,108

 Implement, improve or increase follow-up activities by schools and immunization programs

with under-vaccinated students.10

 Health care providers should assess the vaccination status of both pediatric and adolescent 

patients and contact those who are behind schedule to ensure that both groups are fully 

vaccinated.110

 Recommend increasing the frequency of well-child care medical visits during the next year.11

 Creating devoted places and times for vaccination‐only services, using safety protocols by 

the vaccinators, limiting the number of people in clinics, and changing public perception of 

vaccination and the consequences of the delay in routine vaccinations.112

 Increase outreach by schools and immunization programs to first-time students, including

kindergartners and first graders.113

 Recommend offering patient incentives to vaccinate.114
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State of Vaccine Confidence Insights Report | November 10, 2022

Peer-reviewed suggestions for partnerships and collaborations

 Develop and implement a consolidated and coordinated effort among multiple partners to 

promote catching up and staying up-to-date on routine vaccinations through national, state, an

local catch-up campaigns.115,116,117,11

 Identify and address vaccine misinformation, especially by supporting communities most 

impacted or in need.119

 Establishment of an observatory for collecting and analyzing misinformation jointly with national 

and international health organizations.120

 Provide additional support to those communities that were at higher risk before the pandemic, 

such as communities with children who are not immunized or defined as zero dose with several 

risk factors for poor health outcomes.121

Peer-reviewed suggestions for public health communication strategies

 Public health authorities should work with providers and the general public to ensure 

messages clearly and more consistently communicate the importance, value and safety 

of routine immunization, and increase knowledge of recommended vaccines (including 

the rationale for use and safety aspects) to help alleviate concerns and address vaccine 

hesitancy.123,124

 Craft messages for demographic groups that need to catch up on routine vaccinations with 

the appropriate messaging modality (See page 7 of this report).125

 Identify, engage, and work with trusted leaders in the community to craft and disseminate 

public health messages about the value of routine vaccines that resonate with the community. 

This is especially important when the discussion around public health becomes tainted with 

political and/or non-medical aspects.126

 Leverage social media to create awareness regarding the need for and importance of routine 

immunization and encourage people to vaccinate.127

Peer-reviewed suggestions of systemwide strategies

 Develop health-system resilience features when developing or restructuring health programs 

and establishing best practices to ensure strong primary health care would more efficiently 

address future pandemics and benefit societal health.128

 Shift equity-based approaches from equity of vaccine coverage to equity of community 

resilience. As an illustration, similar vaccination coverage in two individual communities might 

belie true health equality if one community is more vulnerable to disruption and less able to 

recover from serious health system incursions.129

 Expand vaccination requirements. This may help close gaps that emerged during the 

COVID-19 pandemic. Additionally, there is strong evidence that school-related vaccine 

requirements support and maintain high immunization coverage in K-12 schools.130

Suggestions from the American Academy of Family Physicians Report 

Surveying the Effect of the COVID-19 Pandemic on Public Confidence in Vaccines and Vaccine 

Messengers: Lessons Learned and Challenges Ahead:5

 Increase funding for primary care training programs to expand the primary care workforce.

 Increase compensation for public health and preventive health care services.
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State of Vaccine Confidence Insights Report | November 10, 2022

 Increase funding and support for health care professionals who work in rural and 

underserved communities.

 Return vaccines and vaccine conversations back into the hands of primary care clinicians 

through funding for clinic-based vaccine programs.

 Encourage the role of primary care clinicians and representative organizations, including the 

AAFP, in public vaccine messaging and in the news media.

 Increase representation of people from racial and ethnic minority groups in the fields of 

science, medicine, and public health.

 Focus on the inclusion of people from racial and ethnic minority groups and other 

underrepresented populations in research trials.

 Partner with leaders and community members from racial and ethnic minority groups to 

provide better education, nutrition, technology, and access to medical care on an ongoing 

basis, not just in times of crisis.

 Value and promote public representatives and government officials with a scientific or 

medical background.

 Encourage governmental organizations, such as the National Institutes of Health (NIH), the 

Centers for Disease Control and Prevention (CDC), and the US Food and Drug Administration 

(FDA), to have a more public presence and to increase transparency and improve 

communication with the general public to garner trust.
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State of Vaccine Confidence Insights Report | November 10, 2022

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
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State of Vaccine Confidence Insights Report | November 10, 2022

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

AAFP Report One time Web-based survey 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

UNICEF Impact of COVI19 ReportOne time Country-level data National and international 

trends in routine vaccine uptake