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. 2021 Mar 16;118(11):e2026322118.
doi: 10.1073/pnas.2026322118.

Vaccinating the oldest against COVID-19 saves both the most lives and most years of life

Joshua R Goldstein  1 , Thomas Cassidy  2 , Kenneth W Wachter  3
Affiliations

Vaccinating the oldest against COVID-19 saves both the most lives and most years of life

Joshua R Goldstein et al. Proc Natl Acad Sci U S A. .

Abstract

Many competing criteria are under consideration for prioritizing COVID-19 vaccination. Two criteria based on age are demographic: lives saved and years of future life saved. Vaccinating the very old against COVID-19 saves the most lives, but, since older age is accompanied by falling life expectancy, it is widely supposed that these two goals are in conflict. We show this to be mistaken. The age patterns of COVID-19 mortality are such that vaccinating the oldest first saves the most lives and, surprisingly, also maximizes years of remaining life expectancy. We demonstrate this relationship empirically in the United States, Germany, and South Korea and with mathematical analysis of life tables. Our age-risk results, under usual conditions, also apply to health risks.

Keywords: COVID-19; age; demography; vaccine; years of life lost.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Fig. 1.
Fig. 1.
Age patterns of (A) COVID-19 death rates, (B) remaining life expectancy, and (C) person-years saved per effective vaccination in the United States, Germany, and South Korea. In all three countries, within an age-based framework, vaccination of the oldest group will maximize person-years saved per effective vaccination. (Details are provided in Materials and Methods).
See this image and copyright information in PMC

Comment in

  • Prioritizing COVID-19 vaccination by age.
    Castro MC, Singer B. Castro MC, et al. Proc Natl Acad Sci U S A. 2021 Apr 13;118(15):e2103700118. doi: 10.1073/pnas.2103700118. Proc Natl Acad Sci U S A. 2021. PMID: 33731429 Free PMC article. No abstract available.
  • Transmission dynamics are crucial to COVID-19 vaccination policy.
    Dushoff J, Colijn C, Earn DJD, Bolker BM. Dushoff J, et al. Proc Natl Acad Sci U S A. 2021 Jul 20;118(29):e2105878118. doi: 10.1073/pnas.2105878118. Proc Natl Acad Sci U S A. 2021. PMID: 34230099 Free PMC article. No abstract available.
  • Optimal vaccination age varies across countries.
    Arolas HPI, Acosta E, Myrskylä M. Arolas HPI, et al. Proc Natl Acad Sci U S A. 2021 Jul 20;118(29):e2105987118. doi: 10.1073/pnas.2105987118. Proc Natl Acad Sci U S A. 2021. PMID: 34230100 Free PMC article. No abstract available.

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