CS000000-A | 04/20/21

In response to the joint CDC/FDA recommendation to pause the use of Johnson & Johnson’s Janssen COVID-19 

Vaccine, a rapid assessment based on the methods and inputs from the COVID-19 State of Vaccine Confidence 

Insights Report was conducted.

The Rapid COVID-19 State of Vaccine Confidence Insights Report seeks to better understand consumer, provider, 

and state and jurisdiction chief concerns about the recommendation to pause use of the J&J/Janssen vaccine. 

The report describes threats to COVID-19 vaccine confidence, content gaps and information voids, circulating 

mis- and disinformation, and action steps for federal agencies to take now. 

The information in this report is a snapshot from April 13, 2021 through April 15, 2021.

Rapid COVID-19 State of Vaccine 

Confidence Insights Report

Recommendation to Pause Use of Johnson & Johnson’s Janssen COVID-19 Vaccine

Special Report | April 21, 2021 | Date Range: April 13-15, 2021

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

Contents

2 Perceptions, Concerns, and Threats to Vaccine 

Confidence

3 Content Gaps and Information Voids

5 Misinformation and Disinformation Themes

6 Ways for Federal Agencies to Take Action Now

8 Appendix: Inputs and Sources

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence Team, Insights Unit
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Rapid COVID-19 State of Vaccine Confidence Insights Report 

April 13-15, 2021 | Recommendation to Pause Use of Johnson & Johnson’s Janssen COVID-19 Vaccine

Perceptions, Concerns, and Threats to Vaccine Confidence 

Following the announcement from Centers for Disease Control and Prevention (CDC) and Food and Drug Administration 

(FDA), consumers in the United States commented online that they perceived the decision to pause use of the J&J/Janssen 

COVID-19 Vaccine to be either beneficial or detrimental for the health and safety of the country. Some praised CDC and FDA 

for reacting quickly, noting that the decision demonstrates that vaccine safety is a priority.1,2

 However, more commonly, 

consumers expressed the belief that CDC and FDA may have misjudged the risk to the public.3,4,5,6 Given the rarity of the severe 

blood clotting events,7,8 pro-vaccine consumers were concerned that the decision to pause the vaccine would damage vaccine 

confidence broadly and undermine the safety of all three COVID-19 

vaccines.9,10,11 Consumers also expressed concern that the country’s 

vaccine uptake would suffer,12,13,14 despite White House attempts 

to assure the public that this pause would not have a significant 

impact on the rate of vaccinations or population vaccination 

goals.15 Broader implications of the pause include concerns about 

whether rural vaccination would be jeopardized,16 whether efforts 

to reach population immunity would be dampened,17 or if it is an 

indication that we would learn about long-term or other adverse 

vaccine events in the future.18,19,20 Polls indicate that such vaccine 

interruptions may shake consumers’ confidence in the safety of a 

vaccine;21 vaccine confidence fell significantly in Europe following 

the AstraZeneca pause, such that more than half of the people in 

Germany, France, and Spain believed the vaccine was unsafe.22,23

Early polling data in the United States suggest that the pause in 

the J&J/Janssen vaccine triggered a decline in consumer confidence in the safety of this vaccine. After the announcement, only 

37% called the vaccine safe, a drop of 15% in two to three days.24 A separate survey indicated that among consumers intending 

to get vaccinated against COVID-19, those willing to get the J&J/Janssen COVID-19 vaccine fell from 49% to 22% from April 12 

to April 14.25 Notably, the percentage of women willing to get this vaccine fell to 15% — a drop of 31 percentage points.26 So far, 

this drop in vaccine confidence does not appear to extend to the Pfizer-BioNTech and Moderna COVID-19 vaccines.27 Currently, 

59% of consumers consider them to be safe and 19% feel that they are unsafe. These data remained steady over time,28

indicating that concerns over the J&J/Janssen COVID-19 Vaccine may not have negatively affected confidence in the mRNA 

COVID-19 vaccines at this time.

Lastly, the pause in the J&J/Janssen vaccine might cause the “wait and see” group to wait even longer before getting vaccinated, 

thereby increasing their own risk of COVID-19 and affecting population immunity more broadly. About one-third of the movable 

middle—people who want to “wait and see” before getting vaccinated—indicate that vaccine effectiveness and vaccine safety 

data are most likely to influence their decision to get vaccinated. In this same group, 57% were most concerned about vaccine 

side effects.a

 Additionally, a recent poll found that people wanting to “wait and see” before deciding to get vaccinated reported 

that if they decided to get vaccinated they would probably or definitely get any of the three available brands (Pfizer-BioNTech, 

Moderna, and J&J/Janssen),29 but a slightly larger share indicates they would “definitely” get the one-dose J&J/Janssen vaccine 

(16%).30 

a

 Unpublished data. IPSOS and NORC Omnibus Surveys, March Wave 2 (Mar 19-29). For methods and previous Omnibus data, please see Nguyen KH, Srivastav A, Razzaghi H, et al. COVID-19 Vaccination Intent, Perceptions, and Reasons for Not Vaccinating Among Groups Prioritized for Early Vaccination — United States, September and December 2020. MMWR Morb Mortal Wkly Rep 

2021;70:217–222. DOI: http://dx.doi.org/10.15585/mmwr.mm7006e3
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Rapid COVID-19 State of Vaccine Confidence Insights Report 

April 13-15, 2021 | Recommendation to Pause Use of Johnson & Johnson’s Janssen COVID-19 Vaccine

Content Gaps and Information Voids

Consumers congregated on social media, where mentions of the J&J/Janssen COVID-19 Vaccine peaked on April 13 and 

increased by 1018% from the previous day across all platforms. Mentions have since declined but remain elevated. Facebook 

interactions regarding side effects or adverse effects also peaked on April 13 and increased by 343% from the previous day and 

continue to remain elevated. Several content gaps and information voids emerged related to guidance for people who have 

recently received the J&J/Janssen COVID-19 Vaccine, vaccine safety, and this specific adverse event. These questions should be 

anticipated and addressed through expanded online content and talking points. Questions from consumers emerged on social 

media in response to news coverage and federal government social media channels, organically through social media and 

forum platforms, and through CDC-INFO. 

Questions that emerged on April 13, 2021:

Potential Actions Needed for Those Recently or Soon-to-Be Vaccinated

 What next steps should consumers take who recently received the J&J/Janssen COVID-19 Vaccine?

 What side effects are normal and what side effects should they look out for?

 Are there some side effects that were previously considered normal, that are now potential signs of a severe blood clotting 

event?

 If consumers feel that they are experiencing symptoms of severe blood clots, who should they contact and where should 

they go for help?

 What if consumers are already scheduled to receive the J&J/Janssen COVID-19 Vaccine?

Blood Clots, COVID-19 Vaccine Brands, and Personal Risk

 Why is there not a risk of this type of adverse event with mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna)?

 What is the difference between mRNA vaccines and viral vector vaccines?

 Are rare blood clots associated with the Pfizer-BioNTech and Moderna vaccines?

 What is the difference between cerebral venous sinus thrombosis (CVST) and other types of blood clots?

 Did those patients affected by CVST have any underlying medical issues or conditions that put them at increased risk?

 Were birth control pills involved or related?

 Was Factor V Leiden, a genetic change of one of the clotting factors in the blood that can increase chances for developing 

blood clots, related?

 What were the demographics of those patients affected?

 Is this the same problem linked to the AstraZeneca vaccine in Europe?

 What is the relative risk of blood clots?

 As compared to COVID-19 illness?

 As compared to the rate of blood clots in the same demographic who are unvaccinated?

Content gaps and information voids shifting in the following days. While many of the questions in the ‘Potential Actions Needed 

for Those Recently or Soon-to-Be Vaccinated’ have been answered, new questions and concerns emerged, and some remained 

following the Advisory Committee on Immunization Practices (ACIP) meeting on April 14, 2021. Many of the questions above 

regarding ‘Blood Clots, COVID-19 Vaccine Brands, and Personal Risk’ continue to go unanswered, with additional contextual 

questions and questions regarding other COVID-19 vaccines surfacing. Questions from clinicians were also seen through 

CDC-INFO. 
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Rapid COVID-19 State of Vaccine Confidence Insights Report 

April 13-15, 2021 | Recommendation to Pause Use of Johnson & Johnson’s Janssen COVID-19 Vaccine

Content Gaps and Information Voids (cont.)

New questions that emerged from April 14, 2021 through April 15, 2021:

Potential Actions Needed for Consumers Recently or Soon-to-Be Vaccinated

 How do consumers report an adverse event after receiving J&J/Janssen COVID-19 Vaccine?

 How long should consumers who received J&J/Janssen COVID-19 Vaccine monitor their health for symptoms for CVST?

 What actions should consumers take after receiving J&J/Janssen COVID-19 Vaccine?

 Is there anything consumers can do to decrease their risk of CVST or another blood clotting event, such as take aspirin or 

blood thinners?

 Should consumers get their platelet counts checked?

 Should consumers delay airplane travel?

 Should consumers stop taking birth control pills?

 What about consumers who still want to get vaccinated with J&J/Janssen COVID-19 Vaccine?

Personal Risk Concerns

 Is there an increased risk for consumers who have a history of blood clotting, heart attack, high cholesterol, or high blood 

pressure?

Vaccine Pause 

 Why couldn’t interim recommendations be made?

 If cases were only seen among women, why can’t men continue to receive the J&J/Janssen COVID-19 Vaccine?

 If cases were only seen in people under 50 years old, why can’t people over 50 years old still receive the J&J/Janssen 

COVID-19 Vaccine?

 Why were Pfizer-BioNTech and Moderna COVID-19 vaccines not paused when CVST cases were identified after vaccination?

Vaccine Pause Implications 

 Will this pause delay ACIP decisions to recommend new COVID-19 vaccines? 

 Will this pause change ACIP future decisions about recommendations for COVID-19 vaccination for children?

Provider Inquiries

 Are providers prohibited from administering J&J/Janssen COVID-19 Vaccine during the pause?

 What actions need to be taken related to remaining supply of J&J/Janssen COVID-19 Vaccine?

 How can I effectively talk to patients who received J&J/Janssen COVID-19 Vaccine and are experiencing symptoms?
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Rapid COVID-19 State of Vaccine Confidence Insights Report 

April 13-15, 2021 | Recommendation to Pause Use of Johnson & Johnson’s Janssen COVID-19 Vaccine

Misinformation and Disinformation Themes themes

Vocal vaccine deniers were both validated and fueled by the April 13 announcement. Misinformation related to the pause 

in administration of J&J/Janssen COVID-19 Vaccine began to circulate rapidly including about the adverse events , broader 

conspiracy theories related to the J&J/Janssen vaccine, COVID-19 vaccines more generally, and the COVID-19 pandemic. Ranked 

in order of volume, the most common misinformation themes included:

1. There are more cases of severe blood clots from the J&J/Janssen COVID-19 Vaccine than the government is reporting; 

this is not actually a rare adverse event. Some allege that there are additional severe blood clot cases not being reported or 

that are underreported. Vaccine deniers claim that less than 10% of adverse events are reported to VAERS.31,32,33 Some believe 

that the government waited this long to pause any vaccine because reaching President Biden’s vaccine goal was of primary 

importance, rather than the safety and health of consumers.34

2. Pfizer-BioNTech and Moderna’s COVID-19 vaccines have the same rates of adverse events, but the government has 

incentive to keep these vaccines on the market. There are claims that the mRNA COVID-19 vaccines are also resulting in 

hospitalizations and death due to severe blood clots, but these vaccines were not paused because government leaders have 

financial motivations for keeping those vaccines on the market.35,36,37 Additionally, some believe the COVID-19 pandemic itself is 

a hoax formulated by the government as a means to work with pharmaceutical companies for financial gain.38

3. The severe adverse events are actually related to the J&J/Janssen COVID-19 Vaccine production issues. Deniers believe 

that victims received contaminated vaccine or vaccine mixed with the AstraZeneca vaccine, which has been linked to the same 

type of blood clots in Europe.39,40,41

4. It is not possible for COVID-19 vaccines to be safe because they are not FDA approved and are “experimental.” Deniers 

stated that such adverse events should be expected because the COVID-19 vaccines have not been tested thoroughly and that 

an Emergency Use Authorization is merely an extension of the clinical trial period. Additionally, many claims also cited that 

vaccine companies not being liable for adverse events as an additional reason to not trust vaccines.42,43

5. Tech companies have been censoring the truth about COVID-19 vaccines. Some contend that the news out of federal 

agencies on April 13 aligns with the content they have been posting for months about the dangers of COVID-19 vaccines. They 

feel that previous removal of posts or account restrictions are a double standard as the government has been claiming these 

vaccines are “safe and effective.”44,45,46,47

6. The pandemic is about government control. Claims that government agencies are working with technology companies to 

cover-up the truth about the COVID-19 pandemic and vaccinations were among the top shared posts on Facebook following 

the announcement to pause the J&J/Janssen COVID-19 Vaccine.48,49,50
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Rapid COVID-19 State of Vaccine Confidence Insights Report 

April 13-15, 2021 | Recommendation to Pause Use of Johnson & Johnson’s Janssen COVID-19 Vaccine

Ways for Federal Agencies to Take Action Now

Disseminate messages focused on the importance of vaccination as an important tool to 

end the pandemic. 

 Disseminate messages on agency channels highlighting that vaccination will play a key role in ending the COVID-19 

pandemic.

 Disseminate messages that the U.S. vaccination system will continue to offer safe and effective vaccines and will continue to 

monitor vaccine safety through rigorous vaccine safety monitoring systems. 

 Disseminate messages that the integrity and transparency of safety monitoring systems will be maintained. Increased reports 

of adverse events to safety monitoring systems are expected and will be appropriately investigated. 

 Disseminate messages about how ACIP makes decisions and their role in safety monitoring and the U.S. vaccination system.

 Coordinate messages across all federal agencies to ensure alignment and credibility.

 Work with partners to identify trusted messengers and local influencers to amplify vaccination stories

 Leverage #SleeveUp and #WeCanDoThis for consumers to highlight their continued confidence in COVID-19 vaccines, vaccine 

providers, and the vaccination system. 

Fill content gaps and information voids. 

 Create clear, consistent messaging about vaccine developments and communicate often about what is known and unknown 

about J&J/Janssen COVID-19 Vaccine

 Expand web content to include additional frequently asked questions, expanded guidance for individuals who received the 

J&J/Janssen COVID-19 Vaccine, and clinical guidance for healthcare providers.

 Develop content in a variety of styles, including easy to use graphics, videos, and social media content, to answer questions 

and fill information gaps.

Address mis- and disinformation. 

 Develop and disseminate plain language talking points and suggested social media messages and unbranded assets for social 

media influencers and the COVID-19 Community Corps. 

 Partner with technology companies and notify them of key messages to flag or remove. Ensure technology companies 

promote resources with credible, evidence-based information about COVID-19 vaccines beyond resources from federal 

agencies and health departments. 

 Expand Myths and Facts web content to address new mis- and disinformation themes and update content regularly. 

 Empower consumers to have effective, empathetic conversations about vaccines with family and friends online and offline.

Work with healthcare providers, with additional focus on OB/GYNs and women-focused 

health organizations.

 Empower healthcare proiders to relay information about vaccine effectiveness and vaccine safety to patients; strengthen their 

capacity to have empathetic vaccine conversations.

 Offer healthcare providers and trusted advocates content prioritized for female patients concerned about vaccine safety and 

effectiveness.

 Provide guidance for how to communicate with consumers who recently received the J&J/Janssen COVID-19 Vaccine 

including what they should do, whom they should contact, and where they should go if they think they are experiencing an 

adverse event or side effect.
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Rapid COVID-19 State of Vaccine Confidence Insights Report 

April 13-15, 2021 | Recommendation to Pause Use of Johnson & Johnson’s Janssen COVID-19 Vaccine

Ways for Federal Agencies to Take Action Now (cont.)

Support research efforts to better understand which communities are most affected by 

the pause of J&J/Janssen COVID-19 Vaccine.

 Determine which communities are most impacted by the J&J pause, including vaccine access issues following the pause and 

the restricted choice of 2-dose mRNA COVID-19 vaccines. 

 Identify which communities are most impacted due to barriers to vaccine confidence that are specific to J&J/Janssen 

COVID-19 Vaccine (e.g., one dose vaccination, non-mRNA vaccine).

 Expand current polling mechanisms to include questions about the pause of J&J/Janssen COVID-19 Vaccine and other safety 

concerns. 

 Identify poll indicators that could be used to better understand how current safety concerns impact people’s intent to get 

vaccinated.

Work with states and jurisdictions to ensure continuity of COVID-19 vaccination.

 Address how the pause of J&J/Janssen COVID-19 Vaccine impacts affects COVID-19 immunization programs, community 

needs for J&J/Janssen COVID-19 Vaccine, and what actions they need to take.

 Identify jurisdictions that had specific needs related to J&J/Janssen COVID-19 Vaccine and support the adjusting of tactics to 

administer 2-dose mRNA COVID-19 vaccines.

 Provide guidance for how to communicate with consumers who have J&J/Janssen COVID-19 Vaccine appointments about 

rescheduling and what next steps are (e.g., receiving a 2-dose mRNA COVID-19 vaccine at same appointment, re-registering 

for a 2-dose mRNA COVID-19 vaccine at a later date).

 Provide guidance for adjusting existing webpages and content that mention J&J/Janssen COVID-19 Vaccine.
Page: 8

Rapid COVID-19 State of Vaccine Confidence Insights Report 

April 13-15, 2021 | Recommendation to Pause Use of Johnson & Johnson’s Janssen COVID-19 Vaccine

Input Sources Tactics for Utilization

Meltwater  Facebook, Twitter, Instagram

 Blogs

News media

Online forums

Conduct share of voice topic analysis

Identify emerging topic themes

Detect high reach and high velocity topics

OADC Channel Comment Analysis • Native platform searches Conduct sentiment analysis

 Recognize message gaps and information 

voids

CrowdTangle  Facebook View top pages (voices) and top groups

General trends/sentiment analysis

 Examine news analysis through posts

FEMA Social Listening Report Hootsuite

 Brandwatch

CrowdTangle

 Meltwater

Identify trends

Conduct sentiment analysis

 Examine national and global news analysis

CDC-INFO Metrics CDC-INFO inquiry line list

 Prepared response (PR) usage report

Compare PR usage report with inquiry theme 

analysis

 Recognize message gaps and information 

voidss

Poll Review Harris Poll, PEW Research, Gallup Poll, KFF, de 

Beaumont 

New, emerging poll data sources (e.g., YouGov 

polling data)

Identify socio-behavior indicators related to 

motivation and intention to vaccinate

Appendix: Inputs and Sources

The Rapid COVID-19 State of Vaccine Confidence Insights Report collected and synthesized data from over 15 data streams to 

distill patterns of consumer, provider, and state and jurisdiction questions, comments, and concerns about the recommendation 

to pause use of the J&J COVID-19 Vaccine.