Editors Choice

Does Vaccination Against COVID-19 Really Work?

I think, at this stage in the pandemic, that we are beyond stressing over whether or not people are vaccinated against SARS CoV-2. I think, just like with masking in public, we should just “live and let live.” If you want to be vaccinated and doubly boosted (like I am), that is fine, and there should be no criticism of this. And if you do not want to be vaccinated or boosted at all, that is also fine, and there should be no criticism of this. It does not mean I will not disagree with the decision, but I will “live and let live.”

Yet, living and let living should not prevent us from asking the question, “Does vaccination against SARS CoV-2 work? Does vaccination against SARS CoV-2 save lives?” Researchers set out to answer this question.

Dr. Alyssa Bilinski and others from Brown University and the University of Pennsylvania analyzed COVID-19 and all-cause excess mortality between June 2021 and March 2022. They compared overall US mortality with that of multiple countries and, interestingly, also compared mortality from the top ten most-vaccinated states (73% vaccination rate) to the ten least-vaccinated states (52% vaccination rate). They found that COVID-19 deaths per capita in the US overall and in both state subgroups was higher – much higher – than all the peer countries during the study period (figure below).

From: COVID-19 and Excess All-Cause Mortality in the US and 20 Comparison Countries, June 2021-March 2022. JAMA. Published online November 18, 2022. doi:10.1001/jama.2022.21795. Date of download: 11/19/2022 Copyright 2022 American Medical Association. All Rights Reserved.

In fact, the per capita COVID-19 mortality in the ten least-vaccinated states was almost double that of the ten most-vaccinated states, and the overall COVID-19 mortality was the most of all the countries and the US overall, by quite a margin. These are pretty striking data.

The researchers also looked at excess mortality from all causes during the same time period, and the same result was found: US excess all-cause mortality also exceeded mortality of peer countries in all periods, as did excess all-cause mortality in the least-vaccinated states. But, this time, the all-cause excess mortality of the ten most-vaccinated states was comparable to that of several countries (Denmark, Germany, the Netherlands, Austria, Italy, Finland).

From: COVID-19 and Excess All-Cause Mortality in the US and 20 Comparison Countries, June 2021-March 2022. JAMA. Published online November 18, 2022. doi:10.1001/jama.2022.21795. Date of download: 11/19/2022. Copyright 2022 American Medical Association. All Rights Reserved.

Now, the overall vaccination rate in the US was 63%. If the overall US vaccination rate was similar to many of the peer countries, the US would have averted hundreds of thousands of deaths according to their mortality models.

The study did have limitations: some of the mortality estimates were provisional, and the mortality was not adjusted by age and comorbid conditions. Yet, the researchers made a good point about this last point: “unadjusted estimates remain important, because a country’s response to COVID-19 should reflect risks in its population rather than a hypothetical standardized population.”

So, in short, did COVID-19 vaccination save lives? Yes, it did. In those countries and states in the US that had higher vaccination rates, the per capita COVID-19 mortality rates were lower. If someone does not want to be vaccinated, that’s fine. That same person, however, should not say, “the vaccines don’t work.” Clearly, the data show that they do.

Dr. Hesham A. Hassaballa

Dr. Hesham A. Hassaballa is a NY Times featured Pulmonary and Critical Care Medicine specialist in clinical practice for over 20 years. He is Board Certified in Internal Medicine, Pulmonary Medicine, Critical Care Medicine, and Sleep Medicine. He is a prolific writer, with dozens of peer-reviewed scientific articles and medical blog posts. He is a Physician Leader and published author. His latest book is "Code Blue," a medical thriller.

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