COVID-19 Deaths and Vaccination of Older Adults Worldwide, 2020–2022

CDC.

Key points

• In 2020 and 2021, people aged 60 and over accounted for more than 80% of COVID-19 deaths — in rich and poor countries alike.
• WHO's goal is 100% completed primary-series coverage for high-risk groups such as older adults. By the end of 2022, the median reported coverage among older adults was 76% — far lower in low-income countries.
• More effort is needed to complete primary series and give booster doses to older adults.

Background

After SARS-CoV-2 emerged in late 2019, WHO declared a public health emergency of international concern on January 30, 2020. Studies from Wuhan onward found that 80% of deaths were among people 60 and older. WHO set priorities for scarce vaccines in late 2020 and 2021, and its July 2022 strategy update aimed for 100% coverage of at-risk groups, including older adults (defined by each country, from 45 or older to 65 or older). Safe, highly effective vaccines were authorized in December 2020, and global supply met country needs by late 2021.

Deaths, 2020–2021

Three WHO data sources gave very different totals:

• In 73% of low-income and 31% of lower-middle-income countries — mostly in WHO's African, Eastern Mediterranean and European regions — estimated excess deaths were more than ten times reported deaths. In most higher-income countries, the gap was less than twofold.
• By age, deaths climbed steeply: people 60 and over were 80% of deaths in detailed reports and 82% in the excess-mortality model.
• Middle-income countries accounted for 81% of estimated excess deaths among people 60 and over; lower-middle-income countries alone for 52%, at 1,039 excess deaths per 100,000 older people a year.

Ratio of estimated excess COVID-19 deaths to reported deaths, 2020–2021. CDC, from WHO data.

Vaccination, end of 2022

154 of 194 countries (79%) had reported coverage for both the whole population and older adults.

• Only high-income countries passed the global target of 70% for the whole population.
• In 36 countries (23%), coverage among older adults was the same as or lower than in the population overall.

Completed primary-series coverage in each country, whole population versus older adults, by income group, December 2022. CDC, from WHO data.

What it means

• The gap between reported deaths and modeled excess deaths, especially in middle- and low-income countries, makes the true toll hard to pin down; modeled estimates may be more accurate. They show older people in lower-middle-income countries bore more than half of global COVID-19 mortality, at the highest rate.
• Vaccines came less than a year after the first cases, yet coverage among older adults remains far from 100% in much of the world, slowed by limited vaccine access and delivery capacity.
• Boosters restore or strengthen protection beyond the primary series — especially important now that most countries have ended mandated public health measures.
• Countries need stronger surveillance and reporting, with data by age and dose; efforts to understand why older people are missed; and integration of COVID-19 vaccination into primary care.

Limitations

• Mortality and vaccination data were self-reported by countries with varying frequency, verification and capacity; coverage may be lower here than countries' own published figures.
• Modeled excess deaths were available for 2020 and 2021 but not 2022, so deaths and vaccination coverage were not directly linked.

Sources

Based on Man Kai Wong, Donald J. Brooks, Juniorcaius Ikejezie et al., "COVID-19 Mortality and Progress Toward Vaccinating Older Adults — World Health Organization, Worldwide, 2020–2022," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, by authors from CDC and the World Health Organization; published by CDC.