How Many People Did the COVID-19 Vaccines Save?

Fewer than the advocates hoped but more than the detractors thought

Many of us who followed the arc of the COVID-19 vaccines are nonetheless unclear how effective the shots actually were. How many people were saved? Were the shots beneficial? How beneficial? How many people suffered adverse events?

One of the researchers I respect greatly, John Ioannidis of Stanford University, has published a paper entitled “Global Estimates of Lives and Life-Years Saved by COVID-19 Vaccination During 2020-2024.” In the paper, he and his coauthors attempted to answer these lingering questions.

Of course, it would have been ideal for the companies developing the vaccines, such as Moderna, Pfizer, and BioNTech to run longer-term clinical trials to show empirically how effective the vaccines were. But that never happened. Given that no such trials were ever run, researchers such as Ioannidis were left to piece together bits of information from disparate sources to provide such estimates.

Background

On 18 December 2020, the FDA gave emergency authorization to Moderna for the mRNA-1273 vaccine, one week after the FDA had given approval for the similar Pfizer/BioNTech vaccine. This was an exciting development. I got my first dose of the Pfizer shot as soon as it was made available, which was on 2 April 2021. I got the second dose on 23 April 2021. I was ecstatic that “my industry” had so quickly developed a vaccine to save people around the world.

Why wouldn’t I be ecstatic to get injected with a shot that was shown in a Phase 3 clinical trial to be 94.5% effective at preventing SARS-CoV-2 infections? I assumed that these vaccines were similar to other vaccines and would protect me long-term from infection.

However, subsequent news wasn’t as rosy. There were reports that the efficacy of the vaccines wore off quickly, perhaps as fast as a few months. There were also reports of adverse events. There was discussion of the downside of so-called vaccine “imprinting,” which happens when a vaccine ramps up the immune system for a specific virus but then the actual virus is a slightly different variant. That earlier investment in a “immune blueprint” hinders the immune system’s fight against the actual virus because the immune system must unlearn incorrect things before it learns the correct things.

Then heavy-handed governments, throwing out the pandemic playbook they had spent decades honing, mandated vaccinations, even to children and young adults, who appeared largely resistant to the complications of SARS-CoV-2 infections, and those who had already been infected and had, evidence suggested, a better immunity to SARS-CoV-2 than that offered by the vaccines.

Some smart and informed people I know claimed that the vaccines were dangerous and simply didn’t work. In December 2021, David R. Henderson and I wrote an article for the Wall Street Journal in which we said, “With voluntary approaches, we get the benefit of millions of people around the world actively trying to solve problems and make our lives better. We get high-quality vaccines from BioNTech/ Pfizer, Johnson & Johnson and Moderna, instead of the suspect vaccines from the governments of Cuba and Russia.” One friend took umbrage at our characterization of the vaccines as “high-quality.” He challenged our assessment and we had no good responses; we simply didn’t have the data.

That’s one reason I was so excited to read the analysis by Ioannidis and his coauthors.

Study Results

More than 2.5 million lives were estimated to have been saved by all COVID-19 vaccines—mRNA and other—worldwide from the onset of vaccination campaigns until the end of September 2024. Given the number of doses administered, the authors calculated that there was one death averted for every 5,400 doses delivered.

More than 14.8 million life-years were estimated to have been saved. This equates to one life-year saved per 900 doses delivered.

Given these results, I’ll stand by our adjective of high-quality. However, our friend had some good points—these vaccines provided only a modest benefit.

Saving 2.5 million lives is good in an absolute sense, but the world is a big place. According to Ioannidis: “The 2.5 million lives correspond to approximately 1% of total global mortality in that period.” Reducing mortality by 1% during a global pandemic seems underwhelming.

The Ioannidis paper doesn’t break out results by country. However, the United States has about 4% of the world population. Given that we are richer, older, and have more concomitant conditions than those in some other countries, such as India and Africa, let’s assume that 8% of the lives saved were in America. That would mean that 200,000 lives were saved here.

In a typical year, about 3 million American die. During the period that this paper studied, the background death total would have been about 10.5 million. Those 200,000 people saved would have equaled just 2% of those who would have died anyway. That just seems underwhelming.

USAFacts tallies the American deaths from COVID at 1.23 million. Combining the two results means that only 14% of potential American victims were saved (14% = 200,000 divided by 1.43 million).

Also underwhelming is the number of life-years saved, which works out to an average of six life-years per life saved. This is another way of saying that those saved were old and were going to die relatively soon anyway. This is a far cry from saving two-year-olds who can look forward to thriving into old age.

These saved lives were not spread equally across the population. A mere 10.4% of the saved lives were among those who were younger than 60 years old. About 69% of the saved lives were among people 70 years old and older. This disease was dangerous to old people, not young people.

People 50 and younger faced very little risk from COVID-19. This was known early in the pandemic. A rational response to the virus would have been to allow younger people to go about their lives and to vaccinate and protect older, more vulnerable folks, which was the approach proposed in the Great Barrington Declaration.

Younger people didn’t derive much benefit from the vaccines but did expose themselves to vaccine harms, which Ioannidis also covers. “The three very well documented harms that can result in death [from these vaccines] are thrombosis (along with thrombocytopenia) after adenovirus vector-based vaccines [non-mRNA]; myocarditis after mRNA vaccines (more common in young men); and death after vaccination in very debilitated nursing home residents.” In total, he estimates that 20,000 people died from adverse events caused by the vaccines.

These deaths are two orders of magnitude lower than the lives saved. However, the ratio of vaccine deaths to vaccine lives saved was much higher for young people than for older people. The benefit to risk ratio was worse for younger people.

About two years ago, while eating lunch with Jay Bhattacharya, one of the authors of the Great Barrington Declaration and now head of the National Institutes of Health, I asked point blank: What percentage of Americans benefited from the mRNA COVID-19 vaccines? A difficult question, for sure, but he bravely tried to answer. My interpretation of his response was that about 70% of people benefited at the onset of the vaccination campaign and that number dropped to virtually zero by the beginning of 2024. Why had the percentage dropped? Because almost everyone had already been infected by SARS-CoV-2, probably multiple times, and had, evidence suggested, a better immunity to SARS-CoV-2 from the natural infection than what they could get from the vaccines. Jay struggled to think of types of people who at that time would still benefit from the vaccines. (For a deep dive on this issue, please see this video.)

Jay’s response dovetailed nicely with Ioannidis’s findings.

Summarized Results

• The rapid development of the COVID-19 vaccines was a major achievement.

• The lack of long-term clinical trials has left researchers struggling to piece together bits of information from disparate sources to provide estimates of the vaccines’ benefits and risks. Consequently, all estimates depend on assumptions and have wide error bars.

• COVID-19 vaccines are estimated to have saved 2.5 million lives and 14.8 million life-years, worldwide.

• Almost all these benefits were in people 60 and older.

• Children and young adults experienced almost no benefits from COVID-19 vaccines.

• Vaccine protections were not permanent but waned relatively quickly.

• Protection because of natural infections proved stronger and more durable than that from vaccines. Correspondingly, the benefit of COVID-19 vaccines declined over time as more people experienced natural infections, often multiple times.

• Roughly half of all SARS-CoV-2 infections were asymptomatic, meaning many people were infected multiple times and yet didn’t know it.

• COVID-19 vaccine adverse events are estimated to have killed 20,000, worldwide.

• Most vaccines provide long-lasting benefits to younger people. The COVID-19 vaccines provided temporary benefits to older people. Therefore, in terms of life-years saved, the COVID-19 vaccines paled in comparison to vaccines for measles, hepatitis B, human papillomavirus, yellow fever, Haemophilus influenzae type b, Streptococcus pneumoniae, and rubella.

While the COVID-19 vaccines did help many people, they were poorly tested, oversold, and their use was mandated. This led to a reduction in trust and pushback from various quarters.

On a personal note, working in the biopharmaceutical industry for the past 36 years has been one of my proudest achievements. However, recently I have noticed a substantial increase in antagonism toward my chosen industry. To hear some people tell it, my industry is lurking in the shadows, seeking to control governments, reap windfall profits, and hurt patients. Had prominent public health experts not oversold the vaccines and, especially, had governments not mandated the vaccines to everyone, including young children, we wouldn’t have had these image issues. Had the drug companies just said: “Hey, we’ve got a vaccine available. Here are the data. It’s here if you want to pay for it,” everything would have been fine.

While not the final word, the Ioannidis analysis is a big step toward understanding the value of the COVID-19 vaccines.

Ultimately, the problem with the COVID-19 vaccines was heavy-handed governments trampling on rational pandemic responses and informed patient consent. The vaccines were much better than nothing, but I’ll fall back on the title and the theme of the WSJ article David and I wrote: “Coercion Made the Pandemic Worse.” The vaccines helped while government missteps hurt.