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Unless most people get an annual COVID vaccine, tens of thousands will die in the U.S. each year, a Penn State team finds

Just 16% of people have gotten the bivalent booster, yet COVID is still blamed for hundreds of deaths each day.

A bag of empty vials of the Pfizer-BioNTech COVID-19 vaccine at Juniper Village at Williamstown Assisted Living in 2021.
A bag of empty vials of the Pfizer-BioNTech COVID-19 vaccine at Juniper Village at Williamstown Assisted Living in 2021.Read moreELIZABETH ROBERTSON / Staff Photographer

Public health experts warned from the beginning of the COVID-19 pandemic that the disease was “not like the flu,” resulting in far more deaths and hospitalizations each year.

Unless most people get annual booster shots, that grim tide is not going to let up anytime soon, a new Pennsylvania State University study finds.

Just under half of people in the United States got a dose of vaccine in 2022, and if the annual vaccination rate stays at that level for the next decade, 89,000 to 120,000 people will die of COVID each year, the authors projected.

To drive the annual number of deaths below 10,000, at least 68% to 84% of people would need to get an annual shot, they found.

“If we don’t change our current COVID management strategy, then we’re going to expect every year to see twice as many deaths as we would see from a very bad flu season,” said epidemiologist Joseph L. Servadio, one of the authors.

The Food and Drug Administration recently proposed that the COVID vaccines be updated annually, but a yearly shot may be a hard sell, given that just 16% of people have gotten the latest booster since it became available in late August.

And some researchers not involved with the Penn State study, among them Paul Offit at Children’s Hospital of Philadelphia, are skeptical that widespread annual vaccination for all ages is the answer. They recommend instead that health-care providers focus on vaccinating older people and, when they get COVID, treating them with antiviral drugs.

Yet as the three-year anniversary of the pandemic approaches, infectious-disease specialists generally agree that the current approach is falling short. Even now, when nearly everyone has some degree of immunity due to vaccination or a past infection, older people and those with compromised immune systems remain at risk of hospitalization and death.

For many months, the daily number of COVID deaths has remained stubbornly in the hundreds, and there is no sign it is going down anytime soon, said another author of the new study, Penn State associate biology professor Maciej F. Boni.

“It seems we have surrendered to COVID and decided that this death toll is fine,” he said.

The Penn State study has yet to be published in an academic journal, and therefore has yet to undergo formal review by other scientists. But the methodology is sound, according to Boston University infectious-disease specialist Benjamin Linas, who was not involved with the research and reviewed it at The Inquirer’s request.

“The message I take from this paper is that COVID is not over and has not become a typical upper respiratory infection, like flu,” he said. “Today, COVID mortality is more concentrated among patients with risk factors, which makes it less palpable to many Americans. But the numbers do not lie. We are losing tens and even hundreds of thousands of people to this disease, and we will continue to do so if we minimize the risk and lose focus on vaccination.”

Projecting COVID’s continued toll

The Penn State team projected annual COVID cases, hospitalizations, and deaths for a variety of scenarios.

Among the variables was the degree of virus transmissibility in the future. The projection of 89,000 to 120,000 deaths was based on the assumption that the virus would continue to spread at the current rate. The authors projected different totals for other scenarios in which the virus becomes more or less transmissible.

The model was also based on the latest figures for the risk of COVID hospitalization and death in various age groups, if they do not receive treatment with an antiviral drug. For example, the risk of hospitalization was effectively zero for children under 10, 3.8% for adults in their 50s, and 24% for those aged 80 and up.

The low rates in younger people are why Offit, the CHOP vaccine specialist, argues that they don’t need to get repeated annual vaccines. They already are protected against severe disease, so there is no sense subjecting them to the very slight risk of vaccine side effects when the added benefit is minimal, he said in a phone interview.

“If the goal of the vaccine is to prevent hospitalization and death, that’s not the group to target,” he said.

» READ MORE: Paul Offit, Philly’s most vocal vaccine advocate, on science, truth, and why he’s not a fan of the latest COVID boosters

He acknowledged that vaccinating younger people also reduces their risk of even a mild infection, thereby reducing the chance that they pass on the virus to those who are more vulnerable. But this protection starts to wear off within a few months, Offit said.

Boni, the Penn State biologist, countered that the extra protection is worth it.

“We’re only asking Americans to give 15 minutes a year,” he said. “I think it’s a fair ask for the common good.”