CS323178-A | 03/26/21

Summary

Public trust in the U.S. to manage COVID-19 vaccination is slowly improving, but we 

have much more work to do. Consumers are frustrated and confused about states 

and jurisdictions’ varied prioritization plans, insufficient systems for scheduling 

appointments, and inequitable access to COVID-19 vaccine. Concurrently, 

information about adverse events and serious side effects is being highlighted 

and spread across digital and print media; anti-vaccine supporters may also be 

intensifying fears and concerns of those who choose to “wait and see” or those 

less inclined to get vaccinated. Coordination with states and jurisdictions to 

increase transparency, address systemic barriers, and confront circulating rumors is 

necessary and essential to increase vaccine confidence broadly.

COVID-19 State of Vaccine 

Confidence Insights Report

Report 1 | February 12, 2021 | Date Range: January 24, 2021 – February 6, 2021

Report Contents

2 States and jurisdictions’ differing vaccine 

prioritization plans causing confusion and 

inequitable distribution

3 High-priority populations facing physical and 

digital barriers to vaccination

4 Concerns about vaccine side effects 

decreasing vaccine confidence

5 Emerging Topics

7 Appendix

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
COVID-19 State of Vaccine Confidence Insights Report | Report 1 | February 12, 2021

Aims and Methods

The Insights Report examines the state of the vaccine confidence field on a biweekly basis to ascertain where CDC—and the 

Vaccine Task Force in particular—has the potential to impact science, communication, and action. By rapidly reviewing and 

analyzing numerous sources of digital media, print media, peer-reviewed research, polling data, social listening platforms, 

CDC-INFO, and web metric data, the Insights Report strives to emphasize major themes in COVID-19 vaccine confidence

influencing hesitancy and uptake. 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 impact vaccine confidence across the U.S.

Major Themes

States and jurisdictions’ differing vaccine prioritization plans causing confusion and 

inequitable distribution

BeSD domains affected: Thinking and feeling – Perceived risk and trust; Social processes – Vaccination provider and health system 

recommendations; Practical issues – Vaccine availability, appointment access, changes in eligibility status

States and jurisdictions have the freedom to enact their own vaccine prioritization 

plans. Consumers are confused about their eligibility status and why their eligibility 

may change over time, between states, and even within membership groups.1,2

Frustration and concern about vaccine eligibility and prioritization dominate 

the conversation. Eligibility and prioritization are prominent themes in JIC’s daily 

communication surveillance report, among CDC’s most viewed FAQs, and account 

for a considerable proportion of Google searches related to COVID-19 vaccines.

Over 1,500 calls per week to CDC-INFO focus on a lack of adequate appointments, 

and questions are raised about lack of equity in the prioritization process. A 

perceived or actual lack of vaccine supply has resulted in the phenomenon of 

“vaccine hunters” — “hunters” and “tourists” that travel to find states where they meet 

prioritization standards, serving to further exacerbate supply issues, perceptions of 

unfairness, and inequitable vaccine access.3

In some states, demand and capacity to administer doses are greater than the 

number of available vaccine doses.4 This pattern is even more prominent in rural 

areas, where residents and clinicians are frustrated at the lack of available doses 

to allocate to jurisdictions. Such limited resources, staffing, and storage restrict 

vaccination capacity when compared to larger urban areas.5

Short-term recommendations

 Offer clear and transparent information about how distribution plans translate

to vaccine doses available and eventual vaccinations administered. Depict how

changes in demand may influence supply and anticipated availability of vaccines

in the following weeks and months. Perceptions of vaccine scarcity and unequal

distribution are fueling panic and distrust of the vaccine rollout process.

 Work with states and jurisdictions to publish vaccination location maps and

eligibility criteria on a regular basis and determine promising practices

to disseminate. Assist states and jurisdictions in building capacity to manage

this process.

Long-term recommendations

 Partner with states and jurisdictions to work toward a centralized, simple, and transparent eligibility process. Rely on

well-established partnerships and community ambassadors to communicate a streamlined plan, with predetermined

eligibility guidelines.

 Work with states to use uptake data to drive subsequent phases of the prioritization and allocation process, and

continually adjust distribution plans as often as necessary.

Negative Sentiment about 

Vaccination Pervasive

Negative sentiment includes:

 Vaccine rollout (overloaded

appointments, frustration with

eligibility, people skipping

line, etc.)

 Racial disparities with availability,

white Americans seeking

vaccines in minority community

settings

 Hesitancy (“false claims,” side

effects, misinformation)

NCIRD Weekly Social Listening Report, COVID-19 

Vaccine Communication. 2021, February 8.
COVID-19 State of Vaccine Confidence Insights Report | Report 1 | February 12, 2021

High-priority populations facing physical and digital barriers to vaccination

BeSD domains affected: Thinking and feeling – Trust; Social processes – Vaccination provider and health system 

recommendations; Practical issues – Vaccine availability, appointment access, location access

As wider vaccination efforts begin across the United States, 

issues with the systems used to schedule and register people 

for appointments have been widespread. Some states and 

jurisdictions have had to either stop scheduling appointments 

due to an overburdened system6

 or create lottery systems 

to meet the high demand.7 Many older adults report various 

problems with their vaccination appointments , including not 

knowing how to schedule an appointment, not knowing where 

to get vaccinated, or long wait times upon arrival.8 About one 

out of every four calls to CDC-INFO concerns barriers to appointment access. Difficulties in accessing appointments can 

translate into feelings of mistrust and helplessness, which can subsequently weaken vaccine uptake.

Physical barriers are also contributing to access issues among underserved populations. Minority neighborhoods have fewer 

vaccination sites than their white counterparts,9,10 and vaccination sites are often located in more affluent and whiter areas 

where infrastructure already exists, 

suggesting that minority residents must 

travel farther for vaccinations.10 Black 

and Hispanic populations also report 

feeling that vaccine distribution is not 

taking their needs into account.

11

This includes not having vaccination 

sites in or close to their communities, 

not having appointments available 

outside of normal working hours, 

or not having time built into their 

vaccination appointment to discuss 

concerns with providers.12

Short-term recommendations









Identify states and jurisdictions that have overcome scheduling and appointment barriers and share innovative

strategies and approaches with those facing challenges in balancing vaccine supply, demand, and administration. Assess

ongoing Vaccine Administration Management Systems (VAMS) frustrations to identify functions needing improvement to

ensure a more robust vaccine administration system.

Work with states and jurisdictions to develop plans for excess end-of-day vaccine doses. Determine how those doses

should be distributed quickly and equitably, especially among current priority populations. Consider developing tiered

contact lists to reach out to people who need doses urgently.

Long-term recommendations

Engage community leaders and partner with novel vaccination sites in high-burden areas (e.g., Historically Black

Colleges and Universities, polling sites, community centers, religious facilities) and do not limit vaccination sites to areas that

already have existing infrastructure.

Identify promising practices related to scheduling timely second dose vaccine appointments. Work with states

and jurisdictions to consider creating a centralized hub for second dose appointments and schedule second vaccination

appointments immediately after patients receive their first dose.13
COVID-19 State of Vaccine Confidence Insights Report | Report 1 | February 12, 2021

Misinformation about adverse events and side effects decreasing confidence in 

COVID-19 vaccines 

BeSD domains affected: Thinking and feeling – Trust and safety concerns; Social processes – Influencer, vaccination provider and 

health system recommendations, information sharing and norms in social networks, exposure to rumors and mis/disinformation

Media has seized upon stories of individuals who have died14 or had a significant reaction soon after receiving a COVID-19 

vaccine, regardless of context. This coverage has been met with an abundance of public comments reflecting personal 

stories of illness following vaccination.15,16 At the same time, a subset of health professionals is also posting to social 

media as “whistleblowers,” citing significant side effects or adverse events, such as deaths of the elderly in long-term care 

facilities following vaccination.17 Such reporting and public comments are magnifying fear and raising questions about the 

underreporting of adverse reactions by healthcare professionals and the health system, eroding trust in the vaccine and those 

who promote vaccination.

There is misrepresentation of adverse events, using data derived from the 

Vaccine Adverse Event Reporting System (VAERS), which are easy for the public 

to download.18 Anti-vaccine supporters are sharing and aggregating reported 

episodes, manipulating the information to support a causal relationship between 

vaccination and subsequent death; such posts are widely circulated and shared.19

Some of the public is turning to the wrong sources for clinical advice; high 

levels of dangerous reactions after vaccination are being reported to agents using 

CDC-INFO. The public also perceives the v-safe after vaccination health checker to

be a link to medical assistance. During the report period, 1 in 5 calls to CDC-INFO

were from individuals with troubling clinical symptoms and appeared to necessitate

urgent care by a trained clinician – most also expected callbacks from V-safe

immediately.

Short-term recommendations









Establish reasonable expectations for the public regarding v-safe. Be clear on the role of CDC after vaccination, including

when and if users should expect personalized health check-ins, whether they should expect follow-up calls from CDC

clinicians or other personnel, and whom they should contact locally if they are experiencing troubling and persistent side

effects.

Develop messaging related to VAERS, how the system works, its limitations, and how consumers should interpret the data.

Long-term recommendations

Address perceptions of adverse events and deaths head-on with transparent and complete communication. With clear and

direct messaging, regularly update the public on what is known, not known, and how this information might change as more

people are vaccinated.

Partner with trusted messengers, including faith leaders, community leaders, and local healthcare personnel; empower these

ambassadors to directly address myths and misinformation about vaccine safety.

Concerns about vaccine side effects decreasing vaccine confidence

BeSD domains affected: Thinking and feeling – Trust and safety concerns; Social processes – Influencer, vaccination provider and 

health system recommendations, information sharing and norms in social networks, exposure to rumors and mis/disinformation

A leading reason for vaccine reluctance among unvaccinated 

adults is concern about side effects.20 The possibility of longterm effects and serious side effects is the most common 

concern among those who have not yet been vaccinated or 

who have received only one dose, with Black and Hispanic 

adults particularly concerned and hesitant.21 Additionally, the 

majority of unvaccinated adults report that they do not have 

enough information about COVID-19 vaccine side effects.

21

People are turning to the web and social media for advice and 

clarity, with a quarter of the top 500 Google searches related to 

COVID-19 vaccines focusing on side effects, long-term effects, 

I am very concerned that my 

daughter has had a reaction 

to the Moderna vaccine, 

which caused her to go to the 

emergency room along with 

being treated for 10 days at 

home. No one has contacted 

her... this is scary. She is 

registered with V- safe and no one 

has contacted her.

—CDC-INFO call, 1/25
COVID-19 State of Vaccine Confidence Insights Report | Report 1 | February 12, 2021

or adverse events. However, on social media, those who received at least one vaccine dose commented about the side effects; 

these effects were most often described as mild, temporary, or absent.22,23,24

Short-term recommendation

 Communicate what is known about vaccine side effects and normalize the side effects that are known to occur. Share

data on the likelihood of experiencing mild to no side effects versus severe side effects per v-safe data and other safety data

sources.

Long-term recommendation

 Identify states and jurisdictions where COVID-19 vaccination series completion is high to see what techniques have

been used to address concerns about side effects and ensure that people receive their second dose. Share those innovative

strategies widely.

Emerging Topics

Concerns increasing about effectiveness of vaccines against variant SARS-CoV-2 strains

BeSD domains affected: Thinking and feeling – Trust and safety concerns

One in 4 media inquiries to the Vaccine Task Force focused on worries 

about efficacy of vaccines, including the one from Johnson and Johnson. 

Conversations related to variant strains encompass the possibility of 

changing the time between doses, prioritizing more people for their first 

dose,25 and the possibility of booster vaccines.26 However, experts and 

manufacturers warn there are insufficient data to support changing the 

timing between doses and that waiting longer between doses could 

result in less protection.27 FDA is expected to release new guidelines 

about booster shots in the coming weeks.28

Short-term recommendations

 Reinforce messages that vaccination is a safe way to build protection, including how vaccination reduces the likelihood of

moderate to severe illness.

 Develop messaging about what is known and not known about the effect of variant strains on currently available vaccines,

and expand content on emerging strains web page.

Confusion about maintaining mitigation measures after COVID-19 vaccination.

BeSD domains affected: Thinking and Feeling – Perceived risk; Social processes – Norms in social networks regarding adherence 

and mitigation

Consumers are confused about whether or not vaccinated individuals can still carry and spread the virus, even if they don’t 

have symptoms29 and wondering how long mitigation methods will need to continue after they are vaccinated or most people 

in the country are vaccinated.30 Returning to “normal” is a motivational factor for many seeking to get vaccinated. Many are 

unclear what practices they will need to maintain once fully vaccinated and whether mitigation measures are recommended to 

continue for an extended time; 22% of people said that they will feel safe enough to return to normal in-person gatherings once 

everyone in their circle is vaccinated.31 Media interest and views of FAQs on the topic on CDC’s website have increased. Dr. Fauci 

said new guidelines related to mitigation efforts would be shared soon.32

Short-term recommendations

 Integrate vaccination messaging into mitigation “takeaways” for all communication products.

 Develop messaging about what is known and not known about asymptomatic spread after vaccination, including prevention

messages.
COVID-19 State of Vaccine Confidence Insights Report | Report 1 | February 12, 2021

Concerns that COVID-19 vaccines reduce both female and male fertility

BeSD domains affected: Thinking and feeling – Perceived risk and trust; Social processes: Vaccination provider and health system 

recommendations, information sharing and norms in social networks, exposure to rumors and mis/disinformation

Rumors that COVID-19 vaccines cause miscarriages and reduce 

fertility in both males and females continue to circulate widely.33,34

Prominent anti-vaccine voices point to data on VAERS35 and assert 

that the FDA has not actually approved the vaccine for pregnant 

women.34 While there is no evidence that the vaccines currently 

authorized and recommended pose a risk to pregnant women,37

there are limited data about the safety of COVID-19 vaccines for 

people who are pregnant. Consumers are additionally confused due 

to changing guidance on the topic—WHO initially recommended 

against use38 and then altered its guidance a few days later,39 with 

guidelines not matching CDC’s.40

Short-term recommendations

 Partner with OB/GYNs and adjacent organizations to develop and disseminate messaging, tools, and resources about

COVID-19 vaccines because recommendations from healthcare providers are the most important factor in maternal

decision-making.41

 Identify data from v-safe about pregnant women who have received the vaccine and discern if any of the information can be

used to create messaging about the safety of COVID-19 vaccination during pregnancy.

Confusion that taking ibuprofen before vaccination could reduce effectiveness

BeSD domains affected: Thinking and feeling – Perceived risk, trust and safety concerns; Social processes – Vaccination provider 

and health system recommendations, information sharing and norms in social networks, exposure to rumors and mis/disinformation

A recent study found that NSAIDS “reduced both the antibody and pro-inflammatory cytokine response to SARS-CoV-2 

infection,” which may indicate NSAIDS impact the body’s response to vaccination.42 Although the study did not address 

vaccination, media coverage of the story was misleading,43 contributing to an increase in web queries on the topic and 

consumer concerns and confusion.44

Short-term recommendations

 Monitor topic on social media and news to determine if action is needed.

 If interest in and coverage of the topic amplifies, expand messaging to include recommendations about how to prepare for

vaccination appointments.

Jay Huber, a fertility doctor in New Orleans, 

is asked daily by his patients if the vaccine 

causes infertillity. He said there's no evidence 

of that happening. So then, what is the 

biggest misconception? "This concept that 

the vaccination will actually train the human 

immune system to create an antibody that would 

cross-react with the vital placenta protein, which 

would ultimately cause infertility," he said.33
COVID-19 State of Vaccine Confidence Insights Report | Report 1 | February 12, 2021

Appendix

Appendix A: Increasing Vaccination Model

What people 

think and feel

Perceived risk, worry

Confidence

Trust and safety concerns

Motivation

Readiness

Willingness

Intention

Hesitancy

Practical issues

Vaccine availability, 

convenience, and costs

Service quality and 

satisfaction, Requirements

Incentives

Intervention fatique

Vaccination

Schedule appointment

Consent, accept vaccine

Delay

Refuse Social processes

Provider recommendation

Social norms

Gender norms and equity

Information sharing and 

rumors

Source: The BeSD expert working group. Based on: Brewer NT, Chapman GB, Rothman AJ, Leask J, and Kempe A (2017). Increasing vaccination: Putting psychological science into action. 

Psychological Science for the Public Interest. 18(3):149–207. https://doi.org/10.1177/1529100618760521
COVID-19 State of Vaccine Confidence Insights Report | Report 1 | February 12, 2021

Appendix B: Report Inputs and Sources

Type Input Cadence Sources Tactics for Utilization

Mixed 

Methods

Communication Surveillance 

Report

Daily, weekdays Google news

 Meltwater

CrowdTangle

Native platform searches

 Share of voice topic analysis to identify 

themes

 Emerging topics 

Tanaq Social Listening +Media 

Monitoring Report

Weekly, 

Mondays 

Hootsuite

 Muck Rack

 Sprout Social

 First Draft

 Stronger

Native platform searches

 Trending topics

Demographic and geographic 

conversation monitoring

Social 

Media 

Listening

CDC Channel COVID-19 Post 

metrics

Weekly, 

Wednesdays 

 Sprout Social

Native OADC account analytics

Analyze # of posts, topics

 Success of messages, # of impressions, 

reach, # engagements

OADC Channel Comment 

Analysis and Individual Review

Daily, weekdays Native platform searches  Sentiment analysis

Identify message gaps/voids

CrowdTangle content insights 

report

Biweekly, 

Mondays

 Facebook  Top pages (voices), groups

General trends/sentiment analysis

News analysis through posts

FEMA Social Listening Report Weekdays, daily Various General trends/sentiment analysis

National and global news analysis

Direct 

Reports

CDC-Info Metrics Weekly, 

Mondays

CDC-Info inquiry line list

 Prepared response (PR) usage report

Cross-compare PR usage with inquiry 

theme analysis

 Sentiment analysis

Identify information gaps/voids

VTF Media Requests Weekly, 

Mondays

 Media request line list  Leading indicator for news coverage

Identify information gaps/voids

Web Metrics Weekly, 

Wednesdays

 Top pages

Google search queries

 Top FAQs

 Referring domains

Identify information gaps/voids, identify 

keywords/search terms, changes in web 

traffic

Research

Poll Review Weekly, 

Mondays

Harris Poll

 PEW research

Gallup Poll

 KFF

New data related to vaccine 

hesitancy/ COVID-19 vaccines

Identify socio-behavior indicators related 

to motivation and intention to vaccinate 

Literature Review Weekly, 

Mondays

 PubMed

 LitCovid

 ProQuest Central

New data related to vaccine 

hesitancy/ COVID-19 vaccines

Identify current vaccination intention

Identify barriers to vaccination