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December 21, 2021

US COVID-19 Vaccination Efforts May Have Prevented More than 1 Million Deaths, 10 Million Hospitalizations

Author Affiliations
  • 1Contributing Editor, JAMA Health Forum
JAMA Health Forum. 2021;2(12):e215118. doi:10.1001/jamahealthforum.2021.5118

As the number of US deaths from COVID-19 exceeded 800 000 last week—and with the fast-spreading Omicron variant bringing fresh challenges—a new report from the Commonwealth Fund underscores that the toll would have been far greater if COVID-19 vaccines had not been rolled out to the US public beginning in mid-December 2020.

“The US vaccination program has profoundly altered the trajectory of the COVID-19 pandemic, preventing nearly 1.1 million deaths” by November 2021, the authors noted. The rollout of the vaccines also averted more than 10.3 million additional hospitalizations for COVID-19 in the same time frame.

The report also estimates that the vaccination program prevented nearly 36 million additional COVID-19 infections in US residents, “reducing the prospect that millions of Americans could develop long COVID and its debilitating symptoms,” the authors wrote.

To estimate the effects of the vaccine program, the researchers used a computer model to analyze features of the coronavirus (of variants that emerged before the Omicron variant, including the highly infectious Delta variant), its transmission, and its effects, accounting for factors such as waning immunity and changes in population behavior over time as travel increased and schools and businesses reopened. They then compared the trajectory of infections, hospitalizations, and deaths occurring between December 12, 2020, and November 30, 2021, with those estimated under a scenario without the vaccine rollout.

They explained that changing certain assumptions in the analysis could raise or lower their estimates of the number of hospitalizations and deaths averted. For example, their estimates assumed that despite the emergence of the highly infectious Delta variant, the reopening of businesses and schools and the increase in travel and social gatherings last summer continued, whereas if businesses and schools had closed and people restricted their social activity and travel, those mitigation measures would have prevented many hospitalizations and deaths even in the absence of vaccination.

Alternatively, the model’s estimates of the number of deaths might be too low if hospitals had been overwhelmed by patients with COVID-19, resulting in preventable deaths resulting from causes other than COVID-19.

More than 386 000 COVID-19 deaths and 2.6 million COVID-related hospitalizations have been reported in 2021 to date. The report said that without the US vaccine effort, COVID-19 deaths would have been approximately 3.2 times higher and COVID-19 hospitalizations approximately 4.9 times higher than the actual numbers during 2021.

Deaths would have peaked at a much higher level as well. “If no one had been vaccinated, daily deaths from COVID-19 could have jumped to as high as 21 000 per day—nearly 5.2 times the level of the record peak of more than 4000 deaths per day recorded in January 2021,” the authors said.

Currently, on average, there are approximately 1200 COVID-19 deaths daily in the US.

Most of the potential deaths and hospitalizations averted by the vaccination program would have occurred as the Delta virus began to surge in Southern states and spread to other regions in the US during the late summer and early autumn of 2021, the report said. Because Delta spread rapidly throughout the US, vaccination efforts prevented a surge of COVID-19 deaths that would have “far exceeded” all previous peaks.

“Our estimates suggest that in 2021 alone, the vaccination program prevented a potentially catastrophic flood of patients requiring hospitalization,” the authors wrote.

According to the American Hospital Association, the US has 6090 hospitals with a total of about 919 000 licensed hospital beds, typically accommodating about 36 million hospitalizations each year. Even with the vaccinations program, hospitals have been strained under the burden imposed by COVID-related hospitalizations, losing staff members to both COVID-19 and burnout.

“It is difficult to imagine how hospitals would have coped had they been faced with 10 million people sick enough to require admission,” the authors wrote, adding that if faced with such an unprecedented demand, US hospitals would likely have had no alternative to turning away tens of thousands to hundreds of thousands of individuals.

The authors stress the urgent need to vaccinate and give booster shots to many more people in the US. Only about 62% of the US population is fully vaccinated.

“As the Omicron variant begins to spread and the Delta variant surge continues, our results point to the tremendous power of vaccination to reduce disease and death from COVID-19,” they said. “Sadly, they also highlight the ongoing tragic consequences of failing to vaccinate every eligible American.”

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Article Information

Published: December 21, 2021. doi:10.1001/jamahealthforum.2021.5118

Correction: This article was corrected December 28, 2021, to fix the year in the first sentence in the first paragraph.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Stephenson J. JAMA Health Forum.

Corresponding Author: Joan Stephenson, PhD, Consulting Editor, JAMA Health Forum (Joan.Stephenson@jamanetwork.org).

Conflict of Interest Disclosures: None reported.

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