COVID-19 Boosters: If The US Had Matched Israel's Speed And Take-Up, An Estimated 29,000 US Lives Would Have Been Saved

Abstract

Israel was the first country to launch COVID-19 boosters, in late July 2021, with strong public health messaging. The booster campaign reversed rising infection rates from the Delta variant and reduced hospitalizations and deaths. The US booster rollout was slower, and public health messaging was mixed. We used the Israeli experience to ask the counterfactual question: How many lives could the US have saved if it had authorized boosters sooner? We estimated that through June 30, 2022, if the US had moved at Israel's speed and booster take-up percentages, it would have saved 29,000 lives. US regulatory caution, in the middle of a pandemic, thus had a large, avoidable cost. Yet the US booster rollout still avoided 42,000 deaths. Moving more slowly to approve boosters, as some advocated, would have cost many additional lives.

EXHIBIT 1. Cumulative booster rates for people with primary COVID-19 vaccination in Israel and the US, July 25, 2021–June 26, 2022

SOURCE Authors’ analyses of Israeli vaccination data from TIMNA, Israel’s National Health Research Platform, Israel Ministry of Health; and US data from the Centers for Disease Control and Prevention (CDC) COVID Data Tracker. NOTES Weekly data, for the indicated age groups, for weeks beginning July 25, 2021–June 26, 2022, are shown for people who received a booster dose as a fraction of people receiving primary vaccination. Age groups for US data (50–64, 65–74, and 75+) were the only age groups available in the national data. Vertical dashed lines indicate initial Food and Drug Administration (FDA) and CDC booster authorization for people ages 65 and older and others at high risk during the week of September 19, 2021 (Pfizer vaccine recipients only), and FDA and CDC authorization for all vaccines and all ages during the week of November 14, 2021.

EXHIBIT 3. The timing of lives saved or lost related to COVID-19 booster timing in Israel and the US, July 25, 2021–July 26, 2022

SOURCE Authors’ analyses of Israeli vaccination data from TIMNA, Israel’s National Health Research Platform, Israel Ministry of Health; linked Milwaukee County data on vaccination (from the Wisconsin Immunization Registry) and COVID-19 mortality (from Wisconsin Vital Statistics); and US national data on vaccination rates and COVID-19 mortality from the Centers for Disease Control and Prevention COVID Data Tracker. NOTES Figure provides weekly data on the number of lives saved in each counterfactual scenario relative to actual US booster approval and rollout, for people ages 55 and older, for the weeks beginning July 25, 2021–June 26, 2022. Solid lines show lives saved in Israel-based counterfactuals, relative to the US baseline. Dashed lines show additional lives that would have been lost, relative to the US baseline, if US booster approval had been delayed by 2, 4, 6, 8, 10, or 12 weeks relative to the actual approval date. The vertical dashed line shows the start of the Omicron period (weeks with Omicron accounted for more than 50 percent of US confirmed infections).

EXHIBIT 4. Cumulative lives saved or lost related to COVID-19 booster timing in Israel and the US, July 25, 2021–June 26, 2022

SOURCE Authors’ analyses of Israeli vaccination data from TIMNA, Israel’s National Health Research Platform, Israel Ministry of Health; linked Milwaukee County data on vaccination (from the Wisconsin Immunization Registry) and COVID-19 mortality (from Wisconsin Vital Statistics); and US national data on vaccination rates and COVID-19 mortality from the Centers for Disease Control and Prevention COVID Data Tracker. NOTES This figure uses the same data as used in exhibit 3, but it provides weekly data on cumulative lives saved in each counterfactual scenario relative to actual US booster approval and rollout for people ages 55 and older, for weeks beginning July 25, 2021–June 26, 2022. Solid lines show lives saved in Israel-based counterfactuals, relative to the US baseline. Dashed lines show additional lives that would have been lost, relative to the US baseline, if US booster approval had been delayed by 2, 4, 6, 8, 10, or 12 weeks relative to the actual approval date.