On March 11, 2020, World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus first publicly characterized COVID-19 as a pandemic. In the United States the night before, Joe Biden won primaries in Idaho, Michigan, Mississippi, and Missouri as he began to lock down the Democratic nomination. And Dr. Anthony Fauci testified to Congress, warning its members and the public about the impending crisis. 

“Is the worst yet to come, Dr. Fauci?” asked Representative Carolyn Maloney, who chaired the U.S. House Committee on Oversight and Reform. 

“Yes, it is,” Fauci replied. 

For the past three years, the worst has come in the United States and has continued to come. The country experienced among the highest rates of COVID-19 mortality at the beginning of the pandemic, and its relative performance changed little since then. That is despite record-setting levels of public investment in the speedy development of effective vaccines, an ample supply of doses, a robust vaccine rollout program, and the election of a new U.S. president.  

The United States has consistently had among the highest COVID-19 mortality rates in the world, ranking among the top twenty-five countries globally where COVID was deadliest in 2020, 2021, and 2022.  

At the beginning of the pandemic, high-income countries generally experienced higher rates of COVID-19 mortality relative to lower- and middle-income countries due in part to their demographics, which skew toward older adults. Exceptions aside — for example, Peru, which reported by far the highest mortality rate in 2020 — many of the leading countries were in Europe, including Belgium, Spain, and the United Kingdom, which were all among the ten nations with the highest mortality rates in 2020.  

Starting in 2021, those three countries managed to improve their rankings dramatically by vaccinating people against COVID-19. The United Kingdom has now improved to twenty-third, Belgium now ranks twenty-eighth, and Spain now ranks thirty-second.  

The United States improved its ranking in 2021 in part because it was among the first countries to roll out the highly effective mRNA COVID-19 vaccines; billions of people in low- and middle-income countries were forced to wait. By June 2021, the United States had fully vaccinated 50 percent of its population, whereas half the countries in the world had fully vaccinated fewer than 10 percent of their populations. 

But by 2022 the United States had fallen further behind. Despite its promising vaccine campaign, that year it was just one of three high-income countries — alongside Chile and Greece — that ranked among the top twenty countries with the highest rates of deaths from COVID-19. This might be related in part to fully vaccinating a smaller percentage of people relative to other high-income countries. At the end of 2022, it ranked fifty-two out of 175 countries in reported vaccine coverage.  

Other high-income countries better protected their people. Canada, Denmark, and Germany ranked fiftieth or lower in terms of COVID-19 mortality rankings all three years. Although the United States was a global leader in advancing COVID-19 vaccine technology through Operation Warp Speed, when it came to protecting the lives of its people, it fell short relative to its peers.

Acknowledgments: The authors would like to thank Dr. Robert Reiner for providing feedback and Rebecca Sirull for fact-checking the article.  

EDITOR’S NOTE: Katherine Leach-Kemon is employed by the University of Washington’s Institute for Health Metrics and Evaluation (IHME), which leads the COVID-19 research described in this article. IHME collaborates with the Council on Foreign Relations on Think Global Health. All statements and views expressed in this article are solely those of the individual authors and are not necessarily shared by their institution.