CS000000-A | 1/26/23

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 3 Report 

January 26, 2023

Date Range: July 1 – September 30, 2022

SPECIAL UPDATE: CDC partners can now report vaccine-related rumors 

directly to CDC. To report a rumor, go to: www.cdc.gov/report-rumors and 

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 | January 26, 2022

Contents

5

Themes That Might Impact 

Vaccine Confidence

5

Consumers continue to have 

questions about the availability, 

eligibility, and effectiveness 

of the updated COVID-19 

booster doses, including 

coadministration with the 

annual influenza vaccine.

8

Consumers continue to have 

questions about the safety of 

the updated COVID-19 booster 

dose and the primary series, 

especially related to myocarditis. 

10

Consumer and news outlets 

express concern about the 

spread of monkeypox and the 

public health response.

14

The U.S. public continues to 

demonstrate pandemic fatigue 

and a desire to end the use of all 

mitigation measures.

16

Sources Cited in Report

23

Appendix: Inputs and Sources

Summary

Major themes identified from social media, news, and other sources 

that may impact vaccine confidence:a,b

 Consumers continue to have questions about the availability and 

effectiveness of the updated COVID-19 booster dose, including 

coadministration with the annual influenza vaccine.

 Consumers continue to have questions about the safety of the 

updated COVID-19 booster dose as well as the primary series, 

especially related to myocarditis. 

 Consumers and news outlets express concern about the spread of 

monkeypox and the public health response. 

 Consumers continue to express pandemic fatigue, especially with the 

continued transmission of SARS-CoV-2 and the monkeypox virus. 

Ways public health and partners can take action to improve vaccine 

confidence.

 Create communications materials with data explaining why and how 

updated vaccines were developed. Additionally, explain why booster 

doses continue to be important and necessary. 

 Continue to research the effectiveness of the updated COVID-19 

booster dose on humans and publish data as soon as it is available 

(see December 2, 2022 edition of CDC’s Morbidity and Mortality Weekly 

Report). Also, gather and disseminate additional data on side effects 

and effectiveness of coadministration with the updated COVID-19 

booster dose and influenza vaccine.

 Collaborate with community leaders, health care providers, and 

health care workers to craft and disseminate messaging to encourage 

individuals to receive the updated COVID-19 booster dose when 

eligible.

 Provide easy-to-read clinical findings showing the safety of all 

U.S.-approved vaccines. These findings should include data on 

reproductive health and risks of myocarditis and blood clots.

 Collaborate with trusted messengers to explain all the benefits of the 

updated COVID-19 booster dose while reducing inaccurate messaging 

that discourages vaccine use.

 Promote positive vaccine experiences, emphasize vaccine safety, and 

communicate the rarity of adverse events from the updated COVID-19 

booster doses.

 Reassure consumers that staying up to date with COVID-19 vaccines is 

still recommended.

a

Themes for this report come from integrated and thematic analysis of data 

from sources listed in the appendix.

b

Social media citations can be found in this linked document.
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State of Vaccine Confidence Insights Report | January 26, 2022

 Immediately share updated information about any significant changes in monkeypox cases.

 Clinical partners might consider technical assistance from the CDC-funded National Network of STD 

Clinical Prevention Training Centers (NNPTC) to create an inclusive clinical environment. 

 Partner with government and nongovernment groups that focus on the HIV epidemic to identify 

best practices for engaging and communicating with the LGBTQ+ community and reducing stigma 

in the general population.

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

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

media calendars that our partners can use to address the issues raised in this report: 

https://centersfordiseasecontrol.sharefile.com/d-s6719166fb0ef45efa3f71b52ea8f7113
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State of Vaccine Confidence Insights Report | January 26, 2022

Aims and Methods

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

Confidence Insights Report emphasizes major themes influencing vaccine hesitancy 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 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. 

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 | January 26, 2022

Themes That Might Impact Vaccine 

Confidencec

Consumers continue to have questions about the 

availability, eligibility, and effectiveness of the updated 

COVID-19 booster doses, including coadministration with the 

annual influenza vaccine. 

On August 31, 2022, the U.S. Food and Drug Administration 

(FDA) amended the emergency use authorizations of 

the Moderna COVID-19 vaccine and the Pfizer-BioNTech 

COVID-19 vaccine to authorize bivalent formulations of the 

vaccines for use as a single booster dose at least two months 

following primary or booster vaccination. The updated (also 

known as bivalent) COVID-19 booster dose contains two 

messenger RNA (mRNA) components of SARS-CoV-2 virus, 

one of the original strain of SARS-CoV-2 and the other one in 

common between the BA.4 and BA.5 lineages of the omicron variant of SARS-CoV-2.1

As of September 20, 2022, the U.S. government has procured over 170 million doses of the updated 

COVID-19 booster dose for distribution and administration. This is part of a planned fall and early winter 

campaign that will include primary (monovalent) and booster (bivalent) vaccines intended to maximize 

availability and uptake across age groups to ensure population protection against circulating strains. 

It is expected that many vaccination providers will offer updated COVID-19 booster doses, but not all 

providers are expected to continue carrying primary series COVID-19 vaccines.2

Perceptions, Concerns, and Threats to Vaccine Confidence 

 Some social media users are sharing their experiences after receiving the influenza vaccine and updated 

COVID-19 booster dose simultaneously.3,4

Others are proposing reasons to space them 

out.5,6

 Some social media users are looking forward 

to receiving the updated COVID-19 booster 

dose and are encouraging others to receive the 

vaccine as well.7,8,9

 Some social media users are skeptical of the effectiveness of the updated COVID-19 booster dose in 

humans because they had only been tested in mice and human safety data were not yet available 

during the reporting period.10,11,12 Such data are now available (as detailed in the CDC’s November 4, 

2022 Morbidity and Mortality Weekly Report), indicating that adverse reactions are rare, typically mild, 

and comparable to the monovalent COVID-19 booster dose. 

c

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

themes.
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State of Vaccine Confidence Insights Report | January 26, 2022

 Some social media users believe the updated 

COVID-19 booster dose will soon be outdated as 

new SARS-CoV-2 variants evolve.13

 Some studies show that the updated COVID-19 

booster doses do not confer a better immune 

response than the original COVID-19 vaccine 

formulations.14,15,16 However, other studies also show 

that the updated COVID-19 booster dose enhances 

antibody response.17,18,19

 Some social media users have not been able to find 

pharmacies with the updated COVID-19 booster dose.20

 Data from the July 2022 KFF COVID-19 Vaccine Monitor show that vaccinated adults who have not 

yet gotten a booster are most likely to cite feeling they have enough protection from their initial 

vaccination or a prior infection (57%), just not wanting a booster (52%), and thinking the boosters are 

not effective (48%) as reasons why they have not gotten a booster dose.21

 Data from the September 2022 KFF COVID-19 Vaccine Monitor show that even awareness of the 

updated COVID-19 booster dose is modest, with about half of adults saying they have heard “a lot” 

(17%) or “some” (33%) about the updated booster, 31% saying they have heard “a little,” and one in five 

saying they have heard “nothing at all” about the updated booster doses.22

 Some parents interested in vaccinating their young children find that it has been challenging to get 

appointments for the primary series.23,24

Commonly asked questions and queries from the publicd

 What are the eligibility criteria for receiving the updated COVID-19 booster dose?e

 Everyone ages 5 years and older is recommended to receive 1 bivalent mRNA booster dose if they 

have completed a primary series with any FDA-approved or FDA-authorized COVID-19 vaccine. 

Children age 5 years are recommended to receive the Pfizer-BioNTech bivalent booster dose. People 

ages 6 years and older are recommended to receive either the Moderna or the Pfizer-BioNTech 

bivalent booster dose. The booster dose is administered at least 2 months after the last primary dose. 

For people who previously received 1 or more 

monovalent booster doses, the bivalent booster 

dose should be administered at least 2 months 

after the last monovalent booster dose.25

 Can COVID-19 vaccines and routine immunizations 

be administered at the same time?d

 In accordance with general best practices for immunizations, 

routine administration of all age-appropriate doses of vaccines 

simultaneously is recommended for children, adolescents, 

and adults for whom no specific contraindications exist at 

the time of the healthcare visit. This includes simultaneous 

administration of COVID-19 vaccine and other vaccines. 

However, there are additional considerations for Moderna, 

Novavax, and Pfizer-BioNTech COVID-19 vaccines if 

administering an orthopoxvirus (monkeypox) vaccine.25

d

These questions come from online data sources such as social media, news stories, Google Trends, and CDC-INFO.

e

CDC-INFO.
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State of Vaccine Confidence Insights Report | January 26, 2022

 Can individuals receive the influenza and COVID-19 vaccines at the same time?d

 Yes, you can get a COVID-19 vaccine and an influenza vaccine at the same time if you are eligible and 

the timing coincides.26

 Is there data showing that it is safe to receive the influenza and COVID-19 vaccines at the same time?27

 Studies conducted throughout the COVID-19 pandemic indicate that it is safe to get both an 

influenza vaccine and a COVID-19 vaccine at the same visit. A CDC study published this summer 

showed people who got an influenza vaccine and an mRNA COVID-19 booster vaccine at the same 

time were slightly more likely (8% to 11%) to have reactions including fatigue, headache, and muscle 

ache than people who only got a COVID-19 mRNA booster vaccine, but these reactions were mostly 

mild and went away quickly. The findings of this study are consistent with safety data from clinical 

trials that did not find any safety concerns with receiving both vaccines at the same time.28

 Where can individuals receive the updated 

COVID-19 booster dose?29

 Use Vaccines.gov to find a location near you, 

then call or visit their website to make an 

appointment.30

 When will effectiveness data for the updated 

COVID-19 booster dose be available?31

 During this reporting period, CDC has not 

published any studies about the effectiveness 

of the updated COVID-19 booster in human 

populations.

 How long should you wait after having COVID-19 

to receive the updated COVID-19 booster dose?32

 If you recently had COVID-19, you may consider 

delaying your next vaccine dose (primary 

dose or booster) by 3 months from when your 

symptoms started or, if you had no symptoms, 

when you first received a positive test.33

Misinformation themes that may impact vaccine confidence 

 Some social media users claim the updated COVID-19 booster dose was developed for the 

pharmaceutical industry to profit.34,35,36

 Some social media users believe the vaccine is only necessary because previous boosters didn’t 

work.37,38,39

 Some social media users believe the updated COVID-19 booster dose is ineffective and 

unnecessary.40,41,42

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

 Create communications materials with data explaining why and how updated vaccines were 

developed. Additionally, explain why booster doses continue to be important and necessary. 

 Continue to research the effectiveness of the updated COVID-19 booster dose on humans and 

publish data as soon as it is available (see December 2, 2022 edition of CDC’s Morbidity and Mortality 

Weekly Report). Also, gather and disseminate additional data on side effects and effectiveness of 

coadministration with the updated COVID-19 booster dose and influenza vaccine.

 Collaborate with community leaders, health care providers, and health care workers to craft and 

disseminate messaging to encourage individuals to receive the updated COVID-19 booster dose when 

eligible.
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State of Vaccine Confidence Insights Report | January 26, 2022

Consumers continue to have questions about the 

safety of the updated COVID-19 booster dose and 

the primary series, especially related to myocarditis. 

Concerns over vaccine safety continue to contribute to vaccine hesitancy and reduced vaccine 

uptake among consumers and their families, 

especially children. One of the main safety 

concerns associated with mRNA vaccines for 

COVID-19 is the risk of myocarditis (inflammation 

of the heart muscle) or pericarditis (inflammation 

of the outer lining of the heart).43 CDC and its 

partners are actively monitoring reports of 

myocarditis and pericarditis after COVID-19 

vaccination. Active monitoring includes reviewing 

data and medical records and evaluating the relationship to COVID-19 vaccination.44 Reports of 

myocarditis and pericarditis following COVID-19 vaccination have been rare, primarily affecting 

adolescent and young adult males, and most patients with myocarditis or pericarditis who 

received care responded well to medicine and rest and felt better quickly.44

Perceptions, Concerns, and Threats to Vaccine 

Confidence

 Some social media users and consumers are 

concerned about the risk of severe adverse 

events from the updated COVID-19 booster 

dose, such as heart issues, strokes, and 

death.45,46,47,48,49,50,e

 Some consumers are concerned about any 

long-term side effects of the updated COVID-19 

booster dose,51,52 such as blood clots and 

changes in menstrual cycles.53,54

 Rare cases of myocarditis and pericarditis have occurred in adolescent and young adult males 

between the ages of 12 and 29 years after receiving mRNA COVID-19 vaccines,43,55 leading 

some parents to have concerns about the safety and clinical trial data of the updated mRNA 

COVID-19 booster vaccines.56

 Medical experts are also emphasizing the rarity of developing myocarditis after COVID-19 

vaccination, encouraging consumers to receive COVID-19 vaccines.55

 Some pregnant individuals are reluctant to receive the updated COVID-19 booster dose, 

claiming the vaccines are too novel to trust. Additionally, they are concerned about the longterm effects the vaccine may have on their children.57

 Pregnant individuals are concerned about the lack of representation in COVID-19 vaccine 

clinical trials.57,58
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State of Vaccine Confidence Insights Report | January 26, 2022

Commonly asked questions and queries from the public 

 What are the side effects of the updated COVID-19 booster dose on pregnant people?59

 Side effects can occur after receiving any of the available COVID-19 vaccines, especially 

after the second dose for vaccines that require two doses, or after a booster. People who 

are pregnant have not reported different side effects from people who are not pregnant 

after vaccination with monovalent mRNA COVID-19 vaccines (Moderna and Pfizer-BioNTech 

vaccines). Although rare, some people have 

had severe allergic reactions after receiving a 

COVID-19 vaccine. Talk with your healthcare 

provider if you have a history of allergic 

reaction to any other vaccine or injectable 

therapy (intramuscular, intravenous, or 

subcutaneous).60

 Why is CDC recommending COVID-19 vaccines 

for children if myocarditis is a known side 

effect?d

 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.44

 What are the side effects of the updated COVID-19 booster dose?d

 Reactions reported after getting an updated COVID-19 booster dose are 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 (tiredness, and pain at the 

injection site).61

Identified misinformation themes that may impact vaccine confidence 

 Some social media users believe the updated COVID-19 booster dose will cause spontaneous 

abortions.62,63

 Some social media users believe myocarditis is more common in young men following 

vaccination than after SARS-CoV-2 infection.64

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

than the symptoms of COVID-19.65,66

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

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

findings should include data on reproductive health, and risks of myocarditis and blood clots.

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

booster dose while reducing exaggerated messaging that discourages vaccine use.

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

adverse events from the updated COVID-19 booster doses.
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State of Vaccine Confidence Insights Report | January 26, 2022

Consumer and news outlets express concern about 

the spread of monkeypox and the public health 

response.

On October 14, 2022, CDC published the Monkeypox State of Confidence Insights Report. The 

report is available here: CDC’s Monkeypox State of Vaccine Confidence Insights Report.

On July 23, 2022, the World Health Organization declared monkeypox a Public Health Emergency 

of International Concern.67 As of September 30, 2022, 26,522 cases of monkeypox have been 

reported in the United States.68 Following this, New York,69 California,70 and Illinois71 have 

declared states of emergency. In early 

July, the Biden-Harris administration 

made an additional 144,000 doses of the 

JYNNEOS vaccine available to states and 

jurisdictions as part of the administration’s 

comprehensive strategy to combat 

monkeypox.72 A month later, HHS Secretary 

Xavier Becerra also announced he will 

declare the ongoing spread of monkeypox 

virus in the United States a Public Health 

Emergency (PHE).73

After three months of steady growth,74

monkeypox cases are decreasing globally 

as more people get vaccinated and change 

their sexual behavior in response to the 

outbreak.75 In a technical report published 

on September 29, 2022, CDC assessed that 

daily monkeypox cases in the United States 

would most likely continue to decline or 

plateau over the next two to four weeks; 

this assessment remained unchanged in 

a subsequent technical report published 

on October 21, 2022. CDC has moderate 

confidence in this assessment but notes 

the possibility that incidence could 

increase again.76

Perceptions and Concerns, and Threats to Vaccine Confidence

 A survey by The Annenberg Public Policy Center of the University of Pennsylvania surveyed 

1,850 U.S. adults. Results showed that about 1 in 5 of those surveyed (19%) are either somewhat 

worried (14%) or very worried (5%) about getting monkeypox in the next three months, while 

81% are not too worried (41%) or not at all worried (40%). In addition, 66% of respondents either 

do not believe there is a vaccine for monkeypox or are not sure.77
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State of Vaccine Confidence Insights Report | January 26, 2022

 An online survey conducted by Emory 

University with American Men’s Internet 

Survey (AMIS) of gay, bisexual, and other men 

who have sex with men (MSM) conducted 

in early August found half of respondents 

reported that they had changed their 

behavior and reduced sexual partners 

and encounters due to the monkeypox 

outbreak.78 Therefore, continued effective 

health communication and protective 

behavior messaging, coupled with strong and 

equitable vaccination uptake, are necessary 

to sustain declines in cases. If these efforts are 

not sustained, there is a possibility that the 

declining trends could be reversed, and the 

incidence of new cases could increase again. 

This is from an interim data analysis and, therefore, findings are subject to change.78

 Some consumers believe the government is not doing enough to stop the monkeypox 

outbreak.79,80,81

 Some public health officials and experts are conflicted about whether the monkeypox outbreak 

in the U.S. can be contained.82,83,84

 Some social media users and consumers are frustrated 

about the lack of available monkeypox testing and 

vaccines.85,86,87,88,89

 Some social media users are concerned by the government’s 

lack of guidance to address monkeypox transmission in 

schools, college campuses, county jails, and airplanes.90,91,92

 Some social media users are frustrated that guidance 

and news media have disproportionately focused on 

monkeypox incidence among the MSM population.93,94,95

 Consumers and public health officials are concerned with 

the growing misconception that only members of the 

LGBTQ+ community are at risk for monkeypox.96,97,98

 Some social media users are confused about the sudden 

absence of monkeypox media attention.99,100,101

Commonly asked questions and queries from the public

 How is monkeypox transmitted and spread?102,103

 Monkeypox can spread from person to person through direct contact with the infectious rash, 

scabs, or body fluids. It also can be spread by respiratory secretions during prolonged, face-toface contact, or during intimate physical contact, such as kissing, cuddling, or sex.104

 A person with monkeypox can spread it to others from the time symptoms start until the 

rash has fully healed and a fresh layer of skin has formed. Some people have been found to 

have infection but no symptoms. To date, however, there is no evidence that monkeypox 

spreads from people with no symptoms. CDC will continue to monitor for new or changing 

information about transmission.104
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State of Vaccine Confidence Insights Report | January 26, 2022

 Where can I get the monkeypox vaccine?d

 In some large cities, monkeypox vaccines may be 

available at the health department, public health 

clinics, hospitals, or even at large social gatherings or 

venues where people who engage in behaviors that 

may increase their chances of getting monkeypox can 

get vaccinated. In other areas, monkeypox vaccines 

may only be available from the health department.

Contact your local health department to see what 

the vaccination options are in your community. A 

monkeypox vaccine locator tool has been launched by 

Building Health Online Communities (BHOC). This tool is not affiliated with CDC but can help you 

find locations that provide the monkeypox vaccines near you.105

 Is it safe to get the monkeypox vaccine with COVID-19 or influenza vaccines?d

 Currently, there are no data on administering the JYNNEOS vaccine (approved for the prevention 

of monkeypox) at the same time as other vaccines. Because JYNNEOS is based on a live, 

attenuated non-replicating orthopoxvirus, JYNNEOS typically may be administered without 

regard to timing of most other vaccines. This includes simultaneous administration of JYNNEOS 

and other vaccines, including an influenza vaccine, on the same day, but at different anatomic 

sites if possible.106

 However, there are additional considerations if administering a COVID-19 vaccine (Interim 

Clinical Considerations for Use of COVID-19 Vaccines): People who previously received COVID-19 

vaccination (i.e., Moderna, Novavax, or Pfizer-BioNTech) may be given orthopoxvirus vaccine 

(either JYNNEOS or ACAM2000) without a minimum interval between vaccinations. Those who 

previously received orthopoxvirus vaccination (either JYNNEOS or ACAM2000), particularly 

adolescent or young adult males, might consider waiting 4 weeks before receiving a COVID-19 

vaccine (i.e., Moderna, Novavax, or Pfizer-BioNTech) because of the observed risk for myocarditis 

and pericarditis after receipt of ACAM2000 orthopoxvirus vaccine and COVID-19 vaccines (i.e., 

Moderna, Novavax, or Pfizer-BioNTech) and the unknown risk for myocarditis and pericarditis after 

JYNNEOS administration.106

 Who is eligible to receive the monkeypox vaccine?a

 In the current outbreak, you may want to get vaccinated if you might have already been 

exposed to monkeypox if:105

 You have been identified as a close contact of someone with monkeypox. 

 You learn that one of your sex partners in the past 2 weeks has been diagnosed with 

monkeypox.

 You are a man who has had sex with other men, or if you are a transgender or nonbinary 

person, and in the past 2 weeks you have had:

» Sex with multiple partners or group sex. 

» Sex at a commercial sex venue (like a sex club or bathhouse). 

» Sex at an event, venue, or in an area where monkeypox transmission is occurring. 

 In the current outbreak, you may want to get vaccinated if you might be exposed to monkeypox 

in the future if:105

 You are a man who has sex with other men, or if you are a transgender or nonbinary person and 

in the past 6 months have had any of the following:
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State of Vaccine Confidence Insights Report | January 26, 2022

» A new diagnosis of one or more sexually transmitted diseases including acute HIV, chancroid, 

chlamydia, gonorrhea, or syphilis.

» More than one sex partner. 

 You are a person who in the past 6 months has had any of the following:

» Sex at a commercial sex venue (like a sex club or bathhouse) 

» Sex at an event, venue, or in an area where monkeypox transmission is occurring.

 You are a person whose sexual partner identifies with any of the above scenarios.

 You are a person who anticipates experiencing any of the above scenarios.

 How can someone distinguish monkeypox symptoms?107

 People with monkeypox get a rash that may be located on or near 

the genitals (penis, testicles, labia, and vagina) or anus (butthole) 

and could be on other areas like the hands, feet, chest, face, or 

mouth. The rash will go through several stages, including scabs, 

before healing. The rash can initially look like pimples or blisters 

and may be painful or itchy. Other symptoms of monkeypox can 

include fever, chills, swollen lymph nodes, exhaustion, muscle aches 

and backache, headache, and respiratory symptoms (e.g., sore 

throat, nasal congestion, or cough). You may experience all or only a few symptoms. Sometimes, 

people have flu-like symptoms before the rash. Some people get a rash first, followed by other 

symptoms. Others only experience a rash.108

Identified misinformation themes that may impact vaccine confidence

 Some social media users believe monkeypox is only sexually 

transmitted. 109,110,111

 Some consumers believe monkeypox was bioengineered in a 

lab.112,113,114

 Some social media users believe only gay men can be infected with 

the monkeypox virus.115,116,117

 Some social media users believe the monkeypox outbreak was 

a fear campaign orchestrated by the government because cases 

disappeared so abruptly.118,119,120

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

 Immediately share updated information about any significant changes in monkeypox cases.

 Clinical partners might consider getting technical assistance from the CDC-funded National 

Network of STD Clinical Prevention Training Centers (NNPTC) to create a more inclusive clinical 

environment. 

 The NNPTC also offers regular clinical update webinars on the monkeypox virus and has a free 

clinical consultation line to answer clinicians’ questions about the monkeypox virus and STIs.

 Partner with government and nongovernment groups that focus on the HIV epidemic to identify 

best practices for engaging and communicating with the LGBTQ+ community and reducing stigma 

in the general population.
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State of Vaccine Confidence Insights Report | January 26, 2022

The U.S. public continues to demonstrate pandemic 

fatigue and a desire to end the use of all mitigation 

measures. 

A few months after the initial rollout of COVID-19 

vaccines, many consumers reported feeling a sense 

of pandemic fatigue, i.e., a demotivation to follow 

recommended protective behaviors, emerging 

gradually over time and affected by a number of 

emotions, experiences and perceptions.121,122,123

Pandemic fatigue could have unintended 

consequences on public health, including a 

reduction or elimination of funding for infectious 

diseases that could lead to future outbreaks.124 Given the rise of variants such as BA.4 and BA.5, U.S. 

health officials are still urging consumers to take precautions against reinfection and serious illness.125

A sense of pandemic fatigue among U.S. consumers is evident through vaccine uptake data, poll 

results, and social media posts. 

Perceptions, Concerns, and Threats to Vaccine Confidence 

 Some social media users are concerned they will have to receive a COVID-19 booster every eight 

weeks.126,127,128

 Public health experts and medical professionals continue to encourage unvaccinated individuals to 

receive their primary dose of a COVID-19 vaccine and vaccinated individuals to receive an updated 

COVID-19 booster dose, if eligible.129,130,131

 Many social media users are frustrated and 

apathetic towards the constant influx of COVID-19 

information about vaccines.132,133,134

 Some social media users are using President 

Biden’s remark to spread messages that the 

COVID-19 pandemic is over.135,136,137 This could 

negatively impact vaccine confidence if individuals 

believe there is no longer a reason to receive a 

COVID-19 vaccine.138

 Some social media users are looking forward to 

receiving the updated COVID-19 booster dose and are encouraging others to receive the vaccine as 

well.7,8,9

 The September KFF Vaccine Monitor survey finds about half (53%) of parents of children ages 6 

months through 4 years old say they will “definitely not” get their child vaccinated for COVID-19. 

The proportion who say they will “definitely not” get their young child vaccinated for COVID-19 has 

increased from surveys taken earlier this year, when the vaccines were not yet available. Reported 

vaccine uptake among children ages 5-11 has also slowed slightly in recent months.22 This plateau 

in vaccine uptake could be indicative of pandemic fatigue.
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State of Vaccine Confidence Insights Report | January 26, 2022

 An August Gallup poll found that a majority of U.S. Americans 

believe the pandemic is not over. However, an acceptance 

that life will never be the same as it was before the pandemic 

began might cause pandemic fatigue as consumers abandon 

COVID-19 mitigation measures and accept high likelihood of 

infection.139

Commonly asked questions and queries from the public

 How can the updated COVID-19 booster dose protect against 

new and future COVID-19 variants?d

 New variants of SARS-CoV-2, the virus that causes COVID-19, are expected to occur. CDC 

is working with state and local public health officials to monitor the spread of all variants. 

Staying up to date with your COVID-19 vaccines reduces your risk of severe illness, 

hospitalization, and death from COVID-19.140

 Why should I bother to get the updated COVID-19 booster dose when there are breakthrough 

COVID-19 cases occurring?d

 COVID-19 vaccines available in the United States are effective at protecting people from 

getting seriously ill, being hospitalized, and dying. As with other vaccine-preventable diseases, 

you are protected best from COVID-19 when you stay up to date with the recommended 

vaccinations, including recommended boosters.33

 How can I find out more information about emerging variants?d

 Numerous variants of the virus that causes 

COVID-19 are being tracked in the United States 

and globally during this pandemic. CDC is 

working with public health officials to monitor 

the spread of all variants and provide an estimate 

of how common they are in the nation and at the 

regional level. This data can change over time as more information is available.

140

Identified misinformation themes that may impact vaccine confidence

 Some social media users claim the pandemic is over.141,142,133

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

 Collaborate with health care providers on the importance of vaccination and create talking 

points to encourage patients to receive the updated COVID-19 booster dose when eligible. 

 Reassure consumers that staying up to date with COVID-19 vaccines is still recommended.
Page: 16

State of Vaccine Confidence Insights Report | January 26, 2022

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State of Vaccine Confidence Insights Report | January 26, 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
Page: 24

State of Vaccine Confidence Insights Report | January 26, 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

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