COVID’s ‘new normal’: 120,000 U.S. deaths per year?

Since the pandemic hit our shores in early 2020, more than a million people living in the U.S. have died from COVID-19. Even in 2022, a year with an ample supply of vaccines and medicines to treat severe infections, more than 250,000 Americans lost their lives to the virus.

Are we supposed to accept this as our new normal?

In a bad influenza season, up to 50,000 Americans may die. HIV and respiratory syncytial virus — or RSV — may each kill about 10,000 people in the U.S. every year. Several thousand may die from viral hepatitis.

As the world’s undisputed leader in science and medicine, are we willing to allow the SARS-CoV-2 virus to kill more than a hundred thousand Americans each year?

This is not the America that I know. Our country eliminated smallpox by the 1940s through mass vaccination campaigns. Polio was eliminated after vaccination was introduced in 1955. Expanded access to measles vaccines in the 1960s, 1970s, and 1980s led to the near-elimination of measles; last year, only 121 cases were reported in the entire country.

However, the near-term outlook for COVID vaccine coverage does not look nearly as good as it did for smallpox, polio, and measles.

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In 2022, my colleagues and I estimated that only 39% of Americans got a COVID vaccine, and only 16% have gotten the latest version, the bivalent booster. Based on this, my colleagues and I conducted a simple projection — using peer-reviewed and published mathematical models of COVID-19 transmission — to determine how many people would die of COVID-19 each year if current trends continue.

We found that, unless the country manages to convince more people to get regular vaccinations, the U.S. will settle into a permanent pattern of 90,000 to 120,000 COVID deaths (or more) every year. That’s more than the deaths caused by all other infectious diseases combined.

In order to get this number below 50,000 — similar to what we’d see during a bad flu season — we should be aiming at 80% of Americans getting an annual COVID vaccine. To get below 10,000 deaths each year, we may need at least 85% of U.S. residents to get vaccinated each year. We are a long way from this goal.

And many seem to think this goal is impossible to achieve.

Understandably, Americans are tired of public health messaging about COVID. We want to go back to our “old” lives — without mask mandates, restrictions on work and social gatherings, and quarantines. It’s long past time to relax many of the public health measures that were necessary in the pre-vaccine period, but the one intervention we can’t roll back is vaccination.

I realize we spent most of the pandemic arguing over ways to prevent COVID, such as masks, distancing, and quarantines. Vaccination is the one intervention that we need to normalize, promote, broaden, and establish as a routine part of our health care. Asking Americans for 15 minutes every year to get vaccinated for COVID is not asking too much.

This is not the first time we have faced a challenge like this. During the HIV crisis, we didn’t simply make condoms available at pharmacies — we promoted safe sex at all levels; for instance, condom sales soared in 1987 after the surgeon general released a report on AIDS. Seat belt requirements and indoor smoking bans were once viewed as an affront to our way of life, but are now accepted as reasonable accommodations to keep ourselves and others safe.

“This is not the first time we have faced a challenge like this.”

These were hard-won victories through decades of informative and accurate public health communication. The same can be done for COVID deaths.

When we needed people to embrace a public health measure in the past, we treated them maturely, presented them with basic public health realities, and repeatedly underlined their importance. To convince more people to get vaccinated, we need targeted communications about the ongoing risks COVID poses, and the power of the vaccine to keep them safe. The major challenge, of course, will be countering the sea of disinformation that has transformed many people into vaccine skeptics.

Many will say this effort demands the impossible. But like everything else before it in science or society, it is only impossible until it gets done.

Many of today’s public health workers may not have been around for the smallpox, polio, and measles vaccination campaigns of the 20th century, so they may have forgotten the hidden superpower of vaccine rollouts — they get stronger and more effective as you vaccinate more people. The relief, joy, and finality of the campaign to vaccinate against polio were expressed best by historian Jill Lepore: “That’s the great blessing of a vaccination program,” she said. “We forget how bad the disease was.”

As a society, let’s ensure that we heed the warning implicit in this message, and not come full circle in how much we have forgotten.

Maciej Boni is an associate professor of biology at Penn State University.