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. 2024 Apr 17;21(4):e1004387.
doi: 10.1371/journal.pmed.1004387. eCollection 2024 Apr.

Potential impact of annual vaccination with reformulated COVID-19 vaccines: Lessons from the US COVID-19 scenario modeling hub

Sung-Mok Jung  1 , Sara L Loo  2 , Emily Howerton  3 , Lucie Contamin  4 , Claire P Smith  2 , Erica C Carcelén  2 , Katie Yan  3 , Samantha J Bents  5 , John Levander  4 , Jessi Espino  4 , Joseph C Lemaitre  1 , Koji Sato  2 , Clifton D McKee  2 , Alison L Hill  2 , Matteo Chinazzi  6 , Jessica T Davis  6 , Kunpeng Mu  6 , Alessandro Vespignani  6 , Erik T Rosenstrom  7 , Sebastian A Rodriguez-Cartes  7 , Julie S Ivy  7 , Maria E Mayorga  7 , Julie L Swann  7 , Guido España  8 , Sean Cavany  8 , Sean M Moore  8 , T Alex Perkins  8 , Shi Chen  9 , Rajib Paul  9 , Daniel Janies  9 , Jean-Claude Thill  9 , Ajitesh Srivastava  10 , Majd Al Aawar  10 , Kaiming Bi  11 , Shraddha Ramdas Bandekar  11 , Anass Bouchnita  12 , Spencer J Fox  13 , Lauren Ancel Meyers  11 , Przemyslaw Porebski  14 , Srini Venkatramanan  14 , Aniruddha Adiga  14 , Benjamin Hurt  14 , Brian Klahn  14 , Joseph Outten  14 , Jiangzhuo Chen  14 , Henning Mortveit  14 , Amanda Wilson  14 , Stefan Hoops  14 , Parantapa Bhattacharya  14 , Dustin Machi  14 , Anil Vullikanti  14 , Bryan Lewis  14 , Madhav Marathe  14 , Harry Hochheiser  4 , Michael C Runge  15 , Katriona Shea  3 , Shaun Truelove  2 , Cécile Viboud  5 , Justin Lessler  1   2
Affiliations

Potential impact of annual vaccination with reformulated COVID-19 vaccines: Lessons from the US COVID-19 scenario modeling hub

Sung-Mok Jung et al. PLoS Med. .

Abstract

Background: Coronavirus Disease 2019 (COVID-19) continues to cause significant hospitalizations and deaths in the United States. Its continued burden and the impact of annually reformulated vaccines remain unclear. Here, we present projections of COVID-19 hospitalizations and deaths in the United States for the next 2 years under 2 plausible assumptions about immune escape (20% per year and 50% per year) and 3 possible CDC recommendations for the use of annually reformulated vaccines (no recommendation, vaccination for those aged 65 years and over, vaccination for all eligible age groups based on FDA approval).

Methods and findings: The COVID-19 Scenario Modeling Hub solicited projections of COVID-19 hospitalization and deaths between April 15, 2023 and April 15, 2025 under 6 scenarios representing the intersection of considered levels of immune escape and vaccination. Annually reformulated vaccines are assumed to be 65% effective against symptomatic infection with strains circulating on June 15 of each year and to become available on September 1. Age- and state-specific coverage in recommended groups was assumed to match that seen for the first (fall 2021) COVID-19 booster. State and national projections from 8 modeling teams were ensembled to produce projections for each scenario and expected reductions in disease outcomes due to vaccination over the projection period. From April 15, 2023 to April 15, 2025, COVID-19 is projected to cause annual epidemics peaking November to January. In the most pessimistic scenario (high immune escape, no vaccination recommendation), we project 2.1 million (90% projection interval (PI) [1,438,000, 4,270,000]) hospitalizations and 209,000 (90% PI [139,000, 461,000]) deaths, exceeding pre-pandemic mortality of influenza and pneumonia. In high immune escape scenarios, vaccination of those aged 65+ results in 230,000 (95% confidence interval (CI) [104,000, 355,000]) fewer hospitalizations and 33,000 (95% CI [12,000, 54,000]) fewer deaths, while vaccination of all eligible individuals results in 431,000 (95% CI: 264,000-598,000) fewer hospitalizations and 49,000 (95% CI [29,000, 69,000]) fewer deaths.

Conclusions: COVID-19 is projected to be a significant public health threat over the coming 2 years. Broad vaccination has the potential to substantially reduce the burden of this disease, saving tens of thousands of lives each year.

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Conflict of interest statement

JE is president of General Biodefense LLC, a private consulting group for public health informatics, and has interest in READE.ai, a medical artificial intelligence solutions company. MR reports stock ownership in Becton Dickinson & Co., which manufactures medical equipment used in COVID-19 testing, vaccination, and treatment. JL has served as an expert witness on cases where the likely length of the pandemic was of issue. The remaining authors declare no competing interests.

Figures

Fig 1
Fig 1. Projected weekly COVID-19 hospitalizations in the United States across scenarios, April 2023–April 2025.
Ensemble projections from the COVID-19 SMH of national COVID-19 hospitalization for the period April 2023–April 2025 are shown by scenario. Dots indicate the observed weekly hospitalizations between December 1, 2022 and December 16, 2023. Shading from lightest to darkest represents 90%, 80%, and 50% projection intervals. Red dashed lines correspond to the CDC-designated COVID-19 community-level indicators: medium (10–19 weekly hospitalizations per 100,000) and high (>20 weekly hospitalizations per 100,000) levels. The vertical line on April 15, 2023, marks the start of the projection period. COVID-19, Coronavirus Disease 2019; SMH, Scenario Modeling Hub.
Fig 2
Fig 2. Percent and total prevented COVID-19 hospitalizations and deaths by annual vaccination recommendation with reformulated vaccines.
Relative and absolute differences in cumulative hospitalizations and deaths over the next 2 years (April 2023–April 2025) between different vaccination recommendations. Red and blue dots and error bars represent the median and 95% CI of percent prevented outcomes in high and low immune escape scenarios (50% per year and 20% per year), respectively. CI, confidence interval; COVID-19, Coronavirus Disease 2019.
Fig 3
Fig 3. Relationship between prevented COVID-19 hospitalizations and assumed vaccine coverage in individuals aged 65 and above across US states.
The relationship between the cumulative difference in COVID-19 hospitalizations for the next 2 years (April 2023–April 2025) under different vaccination recommendations and assumed vaccine uptake among those aged 65 and above (65+) in each US state: (A and B) vaccination of all compared to no vaccination and (C and D) vaccination of 65+, compared to no vaccination. The x-axis represents the assumed vaccine coverage among 65+ at saturation considering the higher severity in 65+ (likely to have the most significant contribution to decreasing hospitalizations). Dots in each panel correspond to individual US states. COVID-19, Coronavirus Disease 2019.
Fig 4
Fig 4. Comparison between the projected COVID-19 mortality by scenario and the 10 leading causes of pre-pandemic mortality in the United States.
Projected COVID-19 mortality by scenario and by period (April 2023–April 2024 and April 2024–April 2025) are compared with the 10 leading causes of mortality in the United States, which were obtained from the CDC age-adjusted disease burden rates in the pre-pandemic period [28]. COVID-19, Coronavirus Disease 2019.
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Update of

  • Potential impact of annual vaccination with reformulated COVID-19 vaccines: lessons from the U.S. COVID-19 Scenario Modeling Hub.
    Jung SM, Loo SL, Howerton E, Contamin L, Smith CP, Carcelén EC, Yan K, Bents SJ, Levander J, Espino J, Lemaitre JC, Sato K, McKee CD, Hill AL, Chinazzi M, Davis JT, Mu K, Vespignani A, Rosenstrom ET, Rodriguez-Cartes SA, Ivy JS, Mayorga ME, Swann JL, España G, Cavany S, Moore SM, Perkins A, Chen S, Paul R, Janies D, Thill JC, Srivastava A, Al Aawar M, Bi K, Bandekar SR, Bouchnita A, Fox SJ, Meyers LA, Porebski P, Venkatramanan S, Adiga A, Hurt B, Klahn B, Outten J, Chen J, Mortveit H, Wilson A, Hoops S, Bhattacharya P, Machi D, Vullikanti A, Lewis B, Marathe M, Hochheiser H, Runge MC, Shea K, Truelove S, Viboud C, Lessler J. Jung SM, et al. medRxiv [Preprint]. 2023 Nov 18:2023.10.26.23297581. doi: 10.1101/2023.10.26.23297581. medRxiv. 2023. Update in: PLoS Med. 2024 Apr 17;21(4):e1004387. doi: 10.1371/journal.pmed.1004387. PMID: 37961207 Free PMC article. Updated. Preprint.

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