Abstract
BACKGROUND: COVID-19 dynamics are driven by a complex interplay of factors including population behaviour, new variants, vaccination and immunity from prior infections. We quantify drivers of SARS-CoV-2 transmission in the Dominican Republic, an upper-middle income country of 10.8 million people. We then assess the impact of the vaccination campaign implemented in February 2021, primarily using CoronaVac, in saving lives and averting hospitalisations. METHODS: We fit an age-structured, multi-variant transmission dynamic model to reported deaths, hospital bed occupancy, and seroprevalence data until December 2021, and simulate epidemic trajectories under different counterfactual scenarios. FINDINGS: We estimate that vaccination averted 7210 hospital admissions (95% credible interval, CrI: 6830-7600), 2180 intensive care unit admissions (95% CrI: 2080-2280) and 766 deaths (95% CrI: 694-859) in the first 6 months of the campaign. If no vaccination had occurred, we estimate that an additional decrease of 10-20% in population mobility would have been required to maintain equivalent death and hospitalisation outcomes. We also found that early vaccination with CoronaVac was preferable to delayed vaccination using a product with higher efficacy. INTERPRETATION: SARS-CoV-2 transmission dynamics in the Dominican Republic were driven by a substantial accumulation of immunity during the first two years of the pandemic but, despite this, vaccination was essential in enabling a return to pre-pandemic mobility levels without considerable additional morbidity and mortality. FUNDING: Medical Research Council, Wellcome Trust, Royal Society, US CDC and Australian National Health and Medical Research Council.