Upgraded Covid-19 Boosters Could Save 90,000 American Lives This Winter—If We Get Them

The toll of covid-19 in the U.S. this winter will depend heavily on how many Americans are able and willing to get an upgraded booster shot, suggests a new expert analysis. Even a moderately successful booster campaign would save tens of thousands of lives as well as billions of dollars in medical costs, researchers with the Commonwealth Fund predict. Currently, however, booster rates are abysmally low.

The passage of time and the emergence of new variants, particularly the Omicron variant, have weakened the ability of the original vaccines to prevent infection and illness from the coronavirus. But they’ve remained very effective at preventing severe illness and death, and for those at higher risk, such as the elderly, the first round of booster doses have further lowered the odds of serious outcomes from infection.

Throughout the pandemic, the Commonwealth Fund—a nonprofit organization focused on health care reform—has conducted research trying to quantify the exact benefits of covid-19 vaccination. Their latest report, released Wednesday, is an update to a similar analysis conducted in July. Since then, the Food and Drug Administration has authorized the release of an upgraded booster dose for the general public, one meant to boost immunity to both the original strain of the coronavirus and the most common Omicron variants now circulating in the world.

This time, the researchers plotted out three forecasts for the country from October through March 2023, assuming that covid cases will once again surge this winter. In the baseline scenario, the current daily rate of Americans getting boosted would remain the same. In another, around 50% of eligible people would get boosted by the end of the year, mirroring the rate of seasonal flu vaccination during the 2020 to 2021 winter. And in the last, 80% of eligible Americans would get the booster.

Under the status quo, the researchers predict that the country would once again experience a wave of death and illness, though not as huge as those seen in past winters. At its peak, they estimated, covid-19 would kill up to 1,200 Americans a day, while hospitalizing another 16,000 (last winter saw a sustained average of over 2,000 deaths a day and nearly 150,000 Americans hospitalized at any one time). But under either of the other two scenarios, daily deaths would be kept below 400.

Overall, the roughly 50% vaccination scenario was estimated to result in ​​​​​75,347 fewer deaths, 745,409 fewer hospitalizations, and over 19 million fewer infections, while the 80% vaccination scenario would prevent around 90,000 deaths, 936,000 hospitalizations, and over 25 million infections. The savings in direct medical costs would also range from $44 billion to $56 billion.

“The recent FDA approval of bivalent boosters offers an opportunity to curb transmission; a vaccination campaign that moves aggressively could avert a surge of hospitalizations and deaths, and save money in the process,” the authors wrote.

The authors note that many of the assumptions they’ve made in these forecasts might lead to a conservative estimate of the benefits provided by a successful booster campaign.

For instance, research has suggested that the upgraded shots should provide even stronger and perhaps longer-lasting protection against the current iteration of the coronavirus than the original boosters. But the authors assumed that the added level of protection seen with these shots would be about the same as that provided by the original boosters against the primary Omicron variant seen last winter. Cases of covid-19 this winter might also be higher than they predicted, especially if a new variant better at partially evading previous immunity once again emerges. The analysis also didn’t look at the potential impact of long covid, which vaccines seem to reduce the risk of.

As things stand now, however, even a modestly effective booster campaign isn’t certain. Only around 5% of eligible Americans have gotten the upgraded boosters to date. Some of this lag might be due to timing, since it’s recommended that people wait at least three months following their last covid-19 case to get a new booster. But the U.S. has already done worse at boosting its residents than many peer countries, with less than half of Americans having gotten their first booster. That said, a recent Pew survey has indicated that 48% of Americans have gotten or plan to get the upgraded boosters.

Without a more dedicated effort and funding to promote and deliver those shots, though, the authors caution that we’re gearing up to see many more preventable deaths and hospitalizations this winter.

“As population immunity wanes and new variants capable of evading protection from earlier vaccines and natural infection continue to emerge, surges in hospitalizations and deaths during the upcoming fall and winter are increasingly likely. Federal funding for COVID-19 vaccines and treatments has stagnated, hindering access at a crucial time,” they wrote.