Vaccinating the oldest against COVID-19 saves both the most lives and most years of life

Proc Natl Acad Sci U S A. 2021 Mar 16;118(11):e2026322118. doi: 10.1073/pnas.2026322118.


Many competing criteria are under consideration for prioritizing COVID-19 vaccination. Two criteria based on age are demographic: lives saved and years of future life saved. Vaccinating the very old against COVID-19 saves the most lives, but, since older age is accompanied by falling life expectancy, it is widely supposed that these two goals are in conflict. We show this to be mistaken. The age patterns of COVID-19 mortality are such that vaccinating the oldest first saves the most lives and, surprisingly, also maximizes years of remaining life expectancy. We demonstrate this relationship empirically in the United States, Germany, and South Korea and with mathematical analysis of life tables. Our age-risk results, under usual conditions, also apply to health risks.

Keywords: COVID-19; age; demography; vaccine; years of life lost.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • COVID-19 / mortality
  • COVID-19 / prevention & control*
  • COVID-19 Vaccines / administration & dosage*
  • Female
  • Humans
  • Life Expectancy*
  • Male
  • Models, Biological*
  • Risk Factors
  • SARS-CoV-2*
  • Vaccination*


  • COVID-19 Vaccines