Official figures show COVID-19 killed more than 5.4 million people through 2021, but the real toll may have been closer to 15 million. And the pandemic remains far from over. But a powerful new study suggests that were it not for the miracle of vaccines, COVID-19 would have taken about 20 million more lives from early December 2020 through early December 2021—the first year that vaccines were available—alone.
That represents about half the people killed during the entire span of World War II.
Yet the scientific prowess of vaccines—developed in a record time of less than 12 months after COVID-19 was first reported—could have saved millions more lives were it not for extremist politicians, conspiracy theories, and gross inequality across the planet.
Science led the way. But our political leaders, mostly on the political right, failed us badly. If they had the moral fortitude to place public welfare above their own self-interest—pushing their constituents to get shots they were skeptical of, and looking out for those abroad—many millions would be alive today. Parents. Grandparents. Children.
What did the study released on Thursday, and published in Lancet Infectious Diseases, find? Researchers at Imperial College, London, looked at excess mortality—how many people actually died compared to how many would have been expected to die in the absence of COVID-19—in a modeling study that, as such studies necessarily are, based on reasonable but not necessarily perfectly accurate assumptions. They found that nearly 20 million deaths were averted, and that more than 60 percent of those were in higher-income countries. Most deaths averted were due to vaccines’ ability to prevent severe disease, but also because they reduced transmission and relieved the strain on health systems.
In other words, despite the political rhetoric of populist leaders, vaccines have been spectacularly effective. This study highlights what we have known all along, yet with numbers of such magnitude, we can only hope they can move policymakers to heed some key lessons.
First, science is a modern miracle. When we invest in it, it repays us literally with our lives. Failure to support medical science is not only foolhardy; it is deadly. Incredibly, we still have not learned this lesson. As Congress failed to re-authorize emergency COVID-19 funding, the Biden administration had to slash research funding for the next generation of vaccines. Members of Congress who stand in the way of science research are risking the lives or their constituents.
Second, political leaders have cast doubt on science and public health, questioning the safety of COVID-19 vaccines and doing all they can to fight any sort of vaccine mandate—and it has cost lives. GOP governors have challenged virtually every vaccine mandate, and conservative courts have mostly obliged. Florida Gov. Ron DeSantis even threatened the Special Olympics over its vaccine requirements. What if political leaders didn’t look to the next election, but rather stood up for public health and science? We’d see vastly higher vaccination rates in America. And perhaps we’d avoid the embarrassment of having vastly higher COVID-19 death rates in red (or pro-Trump) counties than in blue ones.
Third, vaccine equity saves lives. If the U.S. and Europe had not hoarded scarce vaccine supplies (amassing vaccine doses sufficient for double or even triple their populations), many more people would be alive today. The new study found that if WHO’s goal of vaccinating 40 percent of people in low-income countries had been met, about 600,000 lives would have been saved. But the benefits of vaccines could have been dramatically higher. If lower-income countries had sufficient vaccine supply and vaccine delivery infrastructure to save lives at the same rate as higher-income countries reported in the Lancet Infectious Diseases study, it could have saved millions of lives.
Even today, nearly 1 in 4 African health workers are not fully vaccinated.
This leads to a fourth lesson: invest early. We could have largely avoided vaccine scarcity—which precluded early, high vaccination rates across the world—if we made strategic investments and had different rules aimed at ramping up vaccine supply. We can still learn this lesson to save lives now, and for future pandemics. Regional vaccine hubs should be established to produce mRNA and other vaccines in large quantities. After nearly two years of haggling, the WTO finally reached a deal early this month to waive intellectual property rights for COVID-19 vaccines. Such a waiver should be extended to all future global health emergencies. Scientific data should be open to all. And countries should use any necessary suasion, incentives, contract negotiating power, and legal tools, like the Defense Production Act in the United States, to ramp up vaccine production.
Yet rapid production will not be enough. As lower-income countries are now experiencing, having vaccine doses will do little if the infrastructure—the personnel, transportation, and cold storage chains, for example—are not in place. This takes funding. The world has consistently underinvested in this vaccine infrastructure. Even now, the vaccine funding gap (the gap between the funding needed, according to WHO, and that actually allocated) through 2022 is about $3.6 billion. The biggest obstacle is no longer supply, but operational bottlenecks as well as falling demand, which will require new approaches such as integrating vaccine delivery into other health activities, political leadership, and public communications campaigns.
Finally, invest early not only in capacity, but truth. Future analysis may well tell us how many of the people who did die from COVID-19 in wealthier countries were due to vaccine hesitancy, mis- and dis-information. The current study should be read along with an earlier study from the Lancet, which found that the top factor associated with lower infection rates and fewer deaths per COVID-19 infection was trust.
People must trust public health and science. People must trust the truth. That means a major effort to expand vaccine trust and combat vaccine hesitancy, from building media literacy and working with social-media companies to keep their platforms from being purveyors of deadly information to building networks of community-based organizations and leaders who can create vaccine confidence. And voters must reject politicians who are, literally, killing them.
We now have some of the most powerful evidence of the immense live-saving power of COVID-19 vaccines since they first began to make their way into people’s arms. At the flip side of that data is society’s failure—our collective failure. With COVID-19 plummeting on the political priority list, we are setting ourselves up for further disaster. We can only urge our political leaders to pause to reflect on the millions of lives that vaccines saved, and act.
Less than ever can we claim that we didn’t know.