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How do COVID-19 infection risks and vaccine-related risks compare in terms of deaths prevented versus deaths potentially caused?
Executive summary
COVID-19 has continued to cause substantial mortality in recent years—about 48,000 deaths in 2024 in U.S. data cited by the AAMC [1] and roughly 31,400 death certificates listing COVID as the underlying cause in another recent report [2]. Multiple public-health reviews and local studies show vaccines substantially reduce hospitalizations and deaths (for example, 82.5% of infections and 89.1% of deaths in Cali occurred in incompletely or unvaccinated people) [3], while guideline and surveillance summaries find serious vaccine adverse events are rare and, in some comparisons, less common than risks tied to infection [4].
1. How many deaths are we talking about from COVID infection now?
Recent U.S. reporting places COVID mortality well below the pandemic peak but still in the tens of thousands per year: about 48,000 deaths in 2024 (AAMC summary) [1] and roughly 31,400 death certificates listing COVID as the primary cause in another review (CNN) [2]. Public-health modeling and seasonal outlooks continue to treat COVID as a persistent respiratory pathogen that contributes substantial morbidity and mortality during the fall–winter respiratory season (CDC season outlook) [5].
2. How much do vaccines reduce deaths and severe outcomes?
Multiple sources report clear reductions in severe illness and deaths among vaccinated people. A city-level study from Cali, Colombia, found 82.5% of infections and 89.1% of deaths occurred in people with incomplete or no vaccination, implying a large share of mortality among the unvaccinated [3]. National and advisory-panel analyses presented to ACIP and summarized by FactCheck and the AAMC indicate the 2024–2025 vaccine formulations reduced hospitalizations and critical illness especially among people 65+ [6] [1]. Clinical guidance for high-risk and immunocompromised patients likewise emphasizes vaccine benefit in preventing severe outcomes [4].
3. What about vaccine-related deaths or serious adverse events?
Authoritative guideline summaries and systematic reviews report that serious adverse events tied to COVID vaccines are rare. The IDSA 2025 guidance explicitly states little or no serious adverse events were associated with currently available COVID-19 vaccines, and notes myocarditis was observed but estimated to be rare (<1:48,000 after first and second doses) and in some analyses the vaccinated group had lower observed myocarditis risk than the unvaccinated group—possibly because COVID infection itself raises myocarditis risk [4]. FactCheck and other explainer pieces emphasize that benefit-risk is strongest in older and high-risk groups [6].
4. How do those risks compare, numerically and practically?
Available sources do not provide a single, global deaths-prevented-versus-caused number that combines all age groups and time periods; they instead present complementary findings: deaths from COVID infection remain in the tens of thousands annually in the U.S. [1] [2], while vaccine-associated serious events are characterized as rare in guideline and review documents [4]. Local effectiveness data (Cali) suggest a large majority of deaths occur among un- or under-vaccinated people, consistent with vaccines preventing a substantial fraction of deaths [3].
5. Who benefits most from vaccination and where is the tradeoff smallest?
Experts and CDC/ACIP analyses consistently identify older adults (65+), pregnant people, infants and toddlers, and those with underlying high-risk conditions as the groups that gain the most substantial, lasting protection against hospitalization and death from updated COVID vaccines [6] [1]. IDSA guidance stresses immunocompromised patients should be prioritized because their baseline risk of severe outcomes is higher [4].
6. What are the counterarguments and areas of uncertainty?
Some reporting highlights that vaccine effectiveness against infection wanes and that policy bodies have narrowed universal recommendations, shifting to shared decision‑making for lower-risk groups—reflecting uncertainty about marginal benefits for the young and healthy [2] [6]. FactCheck and CDC modeling note that vaccine effectiveness can vary year to year and across age groups [5] [6]. Claims that vaccines have caused widespread excess deaths are repeatedly challenged in explanatory pieces; Reason notes such mass‑death predictions have not borne out, and that quantifying lives saved globally remains complex [7]. Available sources do not quantify global lives saved by vaccines in a single figure.
7. Bottom line and practical guidance
Public-health sources and clinical guidelines agree: COVID still causes substantial deaths annually, and vaccines reduce severe illness and death—most strongly in older and high‑risk people—while serious vaccine adverse events are rare per guideline reviews [1] [2] [4] [6]. For individual decision‑making, experts recommend prioritizing vaccination for those 65+, pregnant people, infants/toddlers at risk, and people with underlying conditions; for lower‑risk adults the benefit is smaller and guidance shifts toward shared clinical decision‑making [6] [2]. Limitations: available reporting does not provide a single composite deaths‑prevented vs deaths‑caused ratio across all populations and years, and local circumstances (variant circulation, immunity from prior infection, vaccine uptake) materially affect the balance [5] [6].