Heterologous vaccination interventions to reduce pandemic morbidity and mortality: Modeling the US winter 2020 COVID-19 wave

Significance Control of the COVID-19 pandemic has been impeded by the slow global uptake of targeted vaccines, emergence of more transmissible variants, and resistance to continuation of nonpharmaceutical interventions. Commonly used vaccines can have nonspecific immune effects, and several have been shown to have beneficial heterologous effects against SARS-CoV-2 infection. However, there is no science-based guidance on effective implementation of such heterologous vaccine interventions (HVIs) to counter the current or future pandemics. We modeled the effect of different HVI strategies on the winter 2020 COVID-19 wave in the United States, finding that targeting both elderly and nonelderly populations and intervening during pandemic growth phases (i.e., effective reproduction number > 1) led to the greatest reduction in morbidity and mortality.