Waning Immunity and Partial Vaccination Coverage Lead to Transitions in the Source of Daily Incidence

Vaccine-acquired immunity plays an important role in controlling the spread of many infectious diseases; however, vaccine efficacy can diminish over time. This work uses a mathematical model to study the effects of waning vaccination-acquired immunity on infection incidence. With an SEIR-type compartmental model that considers both vaccinated and unvaccinated populations (and their mixing), we present mathematical conditions under which vaccinated individuals drive ongoing growth in infections, i.e., over half of the daily incidence arises from vaccinated individuals. Analysis of a mathematical model of COVID-19 spread in the state of Colorado suggests how and for what duration vaccinated individuals could have sustained such growth. Importantly, our model demonstrates that, despite potential for brief vaccinated-driven periods of growth in infections, which occur among unvaccinated-driven periods of growth in infections, increased vaccination coverage always reduces total cases and total hospitalizations. This work provides insight into how waning immunity in vaccinated populations can contribute to ongoing infection incidence and demonstrates the value of complementary interventions to prevent disease spread in vaccinated populations.