Scenario Projections of COVID-19 Burden in the US, 2024-2025

Importance: COVID-19 remains a disease with high burden in the US, prompting continued debate about optimal targets for annual vaccination. Objective: To project COVID-19 burden in the US for April 2024 to April 2025 under 6 scenarios of immune escape (20% and 50% per year) and levels of vaccine recommendation (no recommendation, vaccination for individuals at high risk only, vaccination for all eligible groups) and to assess the potential benefit of vaccine recommendations in reducing disease burden. Design, Setting, and Participants: For this decision analytical model, the US Scenario Modeling Hub, a collaborative modeling effort, convened 9 teams to provide scenario projections of US COVID-19 hospitalizations and deaths for April 2024 to April 2025, under 6 scenarios combining levels of immune escape and possible vaccine recommendations. Exposure: Annually reformulated vaccines were assumed to be 75% effective against hospitalization for variants circulating on June 15, 2024, and available on September 1, 2024. Age- and state-specific coverage was assumed to be as reported in September 2023 to April 2024. Main Outcomes and Measures: Ensemble estimates were made for weekly COVID-19 hospitalizations and deaths. Projections are presented for relative and absolute prevented hospitalizations and deaths averted due to vaccination over the April 2024 to April 2025 period. Results: For the US population (332 million, with an estimated 58 million aged ≥65 years), COVID-19 was expected to cause 814 000 (95% projection interval [PI], 400 000-1.2 million) hospitalizations and 54 000 (95% PI, 17 000-98 000) deaths for April 2024 to April 2025, comparable in magnitude to the prior year. Vaccination of high-risk groups only was projected to reduce hospitalizations (compared to no vaccination recommendation) by 76 000 (95% CI, 34 000-118 000) and deaths by 7000 (95% CI, 3000-11 000) across both immune escape scenarios. Compared with vaccinating high-risk groups only, a universal vaccine recommendation was projected to provide direct and indirect benefits, further preventing 11 000 hospitalizations and 1000 deaths in those aged 65 years and older. Conclusions and Relevance: In this decision analytical modeling study of COVID-19 burden in the US in 2024 to 2025, ensemble projections suggested that although vaccinating high-risk groups had substantial benefits in reducing disease burden, maintaining the vaccine recommendation for all individuals had the potential to save thousands more lives. Despite divergence of projections from observed disease trends in 2024 to 2025-possibly driven by variant emergence patterns and immune escape-averted COVID-19 burden due to vaccination was robust across immune escape scenarios, emphasizing the substantial benefit of broader vaccine availability for all individuals.