Higher COVID vaccine uptake can protect the unvaccinated

Higher levels of COVID-19 vaccine uptake in a population are tied to lower rates of infection in unvaccinated younger individuals (those 16 years and below who not yet eligible for the vaccine at the time of the trial). 

This is according to an observational, real-world study in Israel and published in Nature Medicine.

The study lead by investigators from Technion-Israel Institute of Technology in Haifa, Maccabitech, Maccabi Healthcare Services, and Tel-Aviv University, involved mining vaccination records and COVID-19 test results gathered during a rapid vaccine rollout in 177 communities. 

They found that vaccination rates in each community were linked to a large subsequent decline in COVID-19 infections in the unvaccinated youth. For every 20 percentage points of vaccinated people in a population, on average, COVID-19 test positivity declined about two-fold.

Unvaccinated includes those not eligible and the immune-compromised

Participants were 1.37 million members of Israel’s second-largest health maintenance organization who received their first dose of the Pfizer/BioNTech mRNA COVID vaccine from Dec 9, 2020, to Mar 9, 2021, as well as a cohort of the unvaccinated youths. 

The researchers evaluated changes in the number of positive COVID-19 tests in each community in fixed time intervals to account for international coronavirus patterns and intracommunity differences. They noted that some people may have chosen not to be vaccinated, been ineligible owing to age, or been vaccinated yet still at risk owing to immunodeficiency. 

For each community, the team calculated the average cumulative proportion of people who received their first dose of COVID-19 vaccine during two consecutive 3-week periods for those 16 to 50 years, who were assumed to be most likely to interact with those younger than 16. 

For each time interval, a period 28 days after the vaccine dose was defined to capture the full effects of immunization and later cross-protection of unvaccinated people.

The authors then calculated the rate of positive COVID-19 tests among the unvaccinated cohort and compared both periods to identify the change in the proportion of positive test results of the unvaccinated group as well as the change in vaccination rate. To reduce the confounding effect of natural immunity, the researchers narrowed the results to test records since Mar 1, 2020 and included only communities in which the fraction of the population who tested positive for coronavirus by Mar 9, 2021 was less than 10%.

Evidence of cross-protection for unvaccinated

While noting studies that found reduced SARS-CoV-2 viral loads among vaccinated people, the researchers said that vaccination could also lead to undesirable behaviors such as failure to quarantine after exposure to the virus or to continue keeping a distance from others in the community. 

Furthermore, they said, because the number of people infected by another person varies by socio-behavioral and environmental factors, even in communities without vaccine availability and because global infection rates take into account both vaccinated and unvaccinated people, determining the effect of vaccination on community-level SARS-CoV-2 spread has been difficult.

While the study results didn’t address the possibility of natural immunity, the researchers said the results provide observational evidence that vaccination not only protects individuals who have been vaccinated but also provides cross-protection to unvaccinated individuals in the community (herd/population/community immunity), which is crucial for putting an end to this pandemic.


Dr. Melvin Sanicas (@Vaccinologist) is a physician-scientist specializing in vaccines, infectious diseases, and global health. 

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