Since COVID-19 vaccines became widely available in the spring of 2021, there has been a wide gap in deaths between the unvaccinated and vaccinated. Toward the end of 2022, though, data showed that most deaths from COVID-19 were among those who are vaccinated. But that doesn’t mean COVID-19 vaccines and boosters are ineffective. It’s quite the opposite.
The bivalent COVID-19 vaccine booster—which was first recommended last fall—protected against infection and death during the circulation of BA.4 and BA.5 Omicron subvariants. In fact, people who received the updated COVID-19 bivalent booster were 14 times less likely to die compared with those who received no vaccine. They were also three times less likely to die compared with those who received only the primary series of COVID-19 vaccines, according to a report from the Centers for Disease Control and Prevention (CDC).
In an interview, AMA member Elisa Choi, MD, an internal medicine and infectious diseases physician, shared why COVID-19 deaths among vaccinated people are happening and why boosters remain key.
A lot more people are vaccinated
“Fortunately, there are a lot more people who are vaccinated now. The number you start with will reflect the number of people who then fit in that category when you are looking at any particular category, like COVID-19 deaths,” said Dr. Choi, who is also a member of the American College of Physicians’ delegation to the AMA House of Delegates. It should be noted that Dr. Choi’s views, as expressed in this story, are exclusively hers and do not necessarily reflect official policies or positions of any organization with which she is affiliated.
“When you start with a denominator of a greater number of people, then when you draw from that larger number of vaccinated people versus unvaccinated, the total population of those who are vaccinated is greater,” she explained. “So, the number of deaths may be higher in vaccinated individuals because there are far more vaccinated than unvaccinated individuals. A greater number of vaccinated individuals is a function of the success of COVID-19 vaccination, which is a good thing.”
Some are older or immunosuppressed
“People who are vaccinated and boosted tend to be older and have more complex medical conditions,” said Dr. Choi. “That is a positive outcome of our initial success with COVID-19 vaccinations among older or immunocompromised individuals, who were counseled that they are at higher risk of COVID-19 death and severe infection.”
“Vaccination against COVID-19 does not completely eliminate the risk of dying from COVID-19 infection, for those who have higher risk for severe COVID, but COVID-19 vaccination is important because it will reduce the risk of death from COVID-19 infection,” she explained. “There has been generally lower COVID-19 booster uptake overall in the general population. However, individuals who have had at least one COVID-19 booster dose also tend to be older and have more complicated medical conditions.”
There’s waning immunity
“We do know that both immunity from COVID-19 infection and from COVID-19 vaccination wane over time,” Dr. Choi said. “The important takeaway message is that COVID-19 infection does not fully protect against reinfection with COVID-19 subsequently.”
“Similarly, if one has been vaccinated against COVID-19, unless one has been vaccinated with the most up-to-date COVID-19 vaccine—depending on when the last vaccine dose was received— individuals also may still be susceptible to COVID-19 infection,” she said. “Those individuals who have previous COVID-19 infection and have also been vaccinated against COVID-19, they would have ’hybrid immunity,’ which may offer the most immunologic protection.”
“We are definitely seeing that regardless of how the person has developed some level of immunity against COVID-19—whether it is infection versus vaccination—there is waning of that immunity,” Dr. Choi said. “This reinforces why COVID-19 booster vaccinations are so important.”
“Vaccines are one of the most critical components to ending the COVID-19 pandemic,” she said. “We are in a very different place than when the pandemic first began, but we cannot get complacent, and we cannot let misinformation and disinformation dissuade us from still doing what we know is important to do, to prevent severe disease and death from COVID-19.”