Estimating vaccine-preventable COVID-19 deaths under counterfactual vaccination scenarios in the United States

Abstract In early 2021, effective SARS-CoV-2 (COVID-19) vaccines became available in the United States; by mid-April 2021, vaccine availability outstripped demand, daily vaccination rates peaked, and COVID-19 vaccines were found highly effective in adult populations. Accurate estimates of the number of vaccine-preventable deaths had higher vaccination rates been attained could have helped local policymakers and possibly persuaded more to get vaccinated. Because existing estimation methodologies are limited, for the period 1/1/21 – 4/30/22, we simulated the number of vaccine-preventable deaths associated with two-dose COVID-19 vaccination that incorporated state-level population, death, and vaccination numbers and three scenarios of vaccination rate achievement. Nationally, we found that had 100% of the population became fully vaccinated during the period examined, 318,979 deaths, or approximately 50% of actual COVID-19 deaths, might have been prevented; had 85% been so, 28% might have been prevented. Across states, we found substantial variation in the proportion of avoidable COVID-19 deaths that might have been avoided at the state level, from 25% in Massachusetts to 74% in Alaska. Our findings are sobering when considering the painful deaths, the survivors’ anguish, and the diversion of scarce and expensive healthcare resources that might have been averted had peak vaccination administration efforts been maintained.