A major new UK study has revealed the staggering impact of people not getting vaccinated against COVID-19, with tens of thousands of hospitalizations and deaths over the last two years being largely avoidable if more people had taken up the vaccine when offered.
Scale of avoidable harm caused by under-vaccination revealed
The study published in The Lancet02467-4/fulltext) looked at over 24 million people across the UK between December 2020 and December 2022. It found that around 39,100 avoidable hospital admissions and 34,200 excess deaths occurred among unvaccinated individuals aged 40 years and older, representing 41% of all COVID hospitalizations and 31% of all COVID-19 deaths in this population over the study period.
The analysis included all hospital admissions and deaths involving COVID-19 among those who were unvaccinated, as well as breakthrough infections and deaths among fully vaccinated people. By comparing the observed events to the expected number of events if everyone had been fully vaccinated, the researchers were able to quantify the amount of harm that might have been avoided with higher vaccine uptake.
Lead researcher Professor Aziz Sheikh, from the University of Edinburgh, said the figures were startling and underlined why getting vaccinated remained vitally important: “Over the two years since the COVID vaccines first became available, many lives would have been saved if more of the eligible population had come forward when first invited.”
Majority of hospitalizations and deaths in people over 50
The vast majority of the avoidable harm from under-vaccination was concentrated among those aged 50 years and older. An estimated 71% of the excess hospital admissions and 87% of the excess deaths occurred in this age group who were eligible for vaccination, despite accounting for just 23% of the total population.
This aligns with the known higher risks of severe illness and death from COVID-19 in older age groups, underscoring the critical importance of vaccination in this vulnerable population. However younger unvaccinated adults also experienced thousands of potentially avoidable hospital stays.
Waning immunity contributes in 2022
Interestingly, the study found that most of the excess hospitalizations and deaths occurred during mid-2022, despite the early success of the vaccine program. The researchers said this pointed to the need for people to take up all recommended vaccine doses in a timely way, not just their initial shots, to maintain protection over time.
“The dominance of excess hospital admissions and deaths in 2022 compared to earlier periods clearly demonstrates the need for uptake of vaccine boosters if the population is to maintain robust immune protection against severe COVID-19 over time,” said Professor Sheikh.
This waning protection also highlights the ongoing threat posed by new variants like Omicron that have evolved to partially evade immunity. Regular boosters with updated vaccine formulations are likely needed to keep protecting against emerging strains.
Renewed vaccination push vital before next winter
In response to the concerning findings, health leaders said a renewed vaccination push was vital in the coming months to maximize protection ahead of winter when virus circulation could intensify again.
Dr Mary Ramsay, Director of Public Health Programmes at the UK Health Security Agency, said: “It is very concerning that such a substantial proportion of hospitalizations and deaths have occurred among those not vaccinated. This underlines the importance of deploying COVID-19 vaccines to the maximum possible level to prevent unnecessary loss of life.”
Professor Wei Shen Lim, Chair of COVID-19 immunization on the UK’s Joint Committee on Vaccination and Immunisation, urged those still unvaccinated not to delay any longer:
“It is still not too late to come forward for your initial vaccinations course and booster doses to gain vital protection against severe disease over next autumn and winter.”
While most people continue to have some protection from their prior vaccination or natural infection, the collective scale of gaps in immunity has created pockets of vulnerability that allow ongoing viral spread. Experts warn that new immunity-evading variants could still emerge in future with unpredictable implications.
Sustaining consistently high vaccination coverage remains key to reducing disruptive waves of hospitalizations as well as cutting off chains of transmission before problematic new variants arise. Health systems need to ensure continued easy access to vaccines and clarity around who needs boosters and when.
Individuals also have an important ongoing role to play by checking their own vaccination status, understanding recommendations around boosters, and being responsive to any public health messaging around taking up doses they are eligible for. Keeping COVID vaccines working effectively is a shared responsibility between public health authorities and the general population.
Future direction of the pandemic remains uncertain
While the outlook has improved markedly since vaccines first arrived, the future direction of the COVID-19 pandemic remains uncertain. Viral evolution remains an ever-present threat and there are still pockets of vulnerability globally where vaccine access and uptake has lagged. It’s plausible that complete eradication will prove impossible and the virus may transition to being endemic in communities long-term.
Against that backdrop, sustaining widespread, durable population immunity will be key to avoiding further deadly waves while restoring normal freedoms of travel, gatherings and commerce. COVID vaccines are likely to become an ongoing background routine like seasonal influenza immunization, rather than a time-limited campaign.
Professor Sheikh concluded: “Our findings highlight the need for continued efforts to sustain vaccine uptake in people still unvaccinated, as well as maintaining high levels of boosting in those already vaccinated.”
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