COVID-19 vaccine uptake in the Peach State is among the lowest in the country, with just 54% of Georgians having received two doses, and less than 1 in 5 having received a booster. The impact is shown in the cost of the unvaccinated becoming hospitalized: nearly half a billion dollars in preventable hospitalization costs alone since June. The full bill still hasn’t come due and it is sure to be larger, especially if vaccination rates remain low. 

According to CDC data this week, Georgia ranks 45th out of 50 states for vaccination.

State Affairs tried answering the question: what is the measurable cost of nearly half of Georgia’s residents choosing not to be vaccinated? 

Since June, when vaccines were widely available, that figure likely exceeds $460 million in the direct cost of preventable hospitalizations. 

It’s a figure State Affairs calculated from a study by the Kaiser Family Foundation (KFF) and the Peterson Institute which found that nationally preventable COVID-19 hospitalizations directly cost individuals, hospitals and taxpayers about $13.8 billion from June through November of 2021. 

It’s also a figure that experts say is just the tip of the iceberg of what citizens and society as a whole will end up paying in preventable direct and indirect costs associated with COVID-19. It also does not even begin to address the cost of those who died preventable deaths.

The tip of the iceberg

What do $460 million in preventable hospitalization costs mean?

It means there were roughly 23,000 preventable COVID-19 hospitalizations from June 1, 2021, through Jan. 11, 2022, State Affairs found by applying the metrics of the KFF-Peterson study to statewide hospitalization figures. 

“That’s an entire small town that could have been prevented from going to a hospital… many of our counties don’t have 23,000 residents,” said Laura Colbert, the executive director of Georgians for a Healthy Future, a public health advocacy group.

According to the study, the national average cost of a COVID-19 hospitalization is $20,000, which, given 23,000 preventable hospitalizations, translates to $460 million in preventable direct hospitalization costs.

The true costs may in fact be higher. This estimate doesn’t consider the much higher costs associated with ICU patients, outpatient care and patients who may have long-term side effects from the disease such as lung damage or neurological issues requiring continued care. What’s more, the indirect costs caused by hospitalizations such as disruptions for families, economic activity and business are inestimably large, and will likely be studied by economists for years to come. 

“There’s also profound indirect costs,” Dr. Harry Heiman, a medical doctor and clinical associate professor at Georgia State University’s School of Public Health. “I mean, every person in the workplace, who gets sick, and can’t work, can’t both produce for their families in terms of their income, but also impacts on the productivity of us as a society.” 

State Affairs checked the $460 million figure with several experts including at KFF, Georgia State University, and the University of Georgia (UGA), who found it to be sound and the estimate for Georgia to be reasonable but noted that state-specific cost figures and other rates may differ from the national average figures, and so to treat the cost as a rough estimate. 

“This cost estimate will give the public and policy-makers an impression about the medical expenses we could potentially save if everyone in Georgia had been vaccinated or had received at least one dose of the COVID-19 vaccine since (June 1, 2021),” said Stacy Zhang, an associate professor at UGA’s College of Public Health. 

What’s more, it’s a cost that isn’t just felt by hospitalized individuals and their families. All of us will feel it, experts said.

“It increases Medicare spending that is largely funded through tax dollars, and will indirectly pass on (costs) to patients who are insured through raised insurance premiums within the insurance plans that use community rating systems in the following year,” Zhang noted.  

Colbert said that not just the costs, but the fact that 23,000 people, which is likely an undercount, could have avoided hospitalization, is an “incredible” statistic. 

“Having that many people go to a hospital for a cause that is completely preventable, or almost completely preventable, prior to or during the Omicron wave,” Colbert said. “It’s a big missed opportunity. And we just could have done a lot better.”

How will we feel it?

Some effects are already clear. As society tries to return to “normal” without a sufficiently inoculated population, we felt supply chain disruptions and flight cancellations, and while some of those issues are structural, there’s little doubt they were made worse by outbreaks of COVID-19.

“All you have to do is open the newspaper and look at articles about grocery shelves being low… Some of that is supply-chain challenges, that are more structural, but a lot of that is a result of people being sick, and unable to work or exposed and unable to work,” said Heiman. 

Experts like Heiman say the full bill will be “staggering” compared to just the direct hospitalization costs estimated by the KFF-Peterson study.

“Think about people that as a result of COVID, now have a chronic neurologic problem or chronic lung problem, a chronic kidney problem, and are going to require ongoing treatment for the rest of their lives… they may be much more reliant upon support and assistance through public programs that we all pay for through our taxes,” he said. “The human and the financial costs of this pandemic are staggering.”

Monty Veazey, president of the Georgia Alliance of Community Hospitals, a group that represents the non-profit hospitals across the state, reviewed the $460 million figure State Affairs calculated from the KFF-Peterson study and estimated that the bulk of that cost – as much as 70% – would be passed onto the general public directly or indirectly. 

“What we do see in the hospitals, is that many of those unvaccinated (COVID-19 patients), a lot of them are poor, have no insurance,” he said. 

As a result, he said, while the federal government is still assisting in covering such costs, those costs will ultimately fall on the paying patients and insured patients. So long as a federal state of emergency exists for COVID-19, the U.S. government will continue to assist. 

When it comes to Medicaid patients, Veazey said, hospitals get reimbursed for 83 cents on the dollar. The remaining 17 cents will need to be covered somewhere. 

“We are being squeezed. Our governor has provided bonds to help us hire nurses, contract nurses, and he has let us have the National Guard at certain hospitals, which has helped out because of our huge shortage not just of nurses, but of health care workers,” he said.

State Affairs requested cost figures last week associated with the national guard deployments to hospitals from the Georgia Department of Defense but received no reply by publication time. 

“We’re having a tough time. And we’re spending a hell of a lot more money at the hospital level,” Veazey said.

What can the state do?

A vaccine mandate in Georgia seems highly unlikely, given that Gov. Brian Kemp has been fighting those in workplaces handed down by President Joe Biden’s administration. Even so, the governor has also encouraged Georgians to get the jab and reminds the public often that both he and his family are fully vaccinated. 

Kemp, speaking to reporters amid the Omicron surge just before the New Year, again said he is both vaccinated and boosted. 

“I want to continue to urge all Georgians to talk to their doctor about the benefits of getting the life-saving vaccine or receiving their booster shot. We’re encouraged by the data demonstrating that when you’re vaccinated and boosted, you have great protection against the virus,” he said.  

Asked by a reporter what the state can do more to incentivize vaccination, Kemp said, “I think at this point I’m trusting people to do what’s best for them,” before criticizing “badgering from the government” and the Biden administration for enacting mandates which Kemp previously labeled “dangerous” and “illegal.”

“At this point, people have been so confused by the government, the last thing I think we need is government politicians and leaders, especially in Washington, confusing them even more or trying to convince people. My message has been very consistent,” he said.

While Colbert acknowledged that the governor has been consistent in encouraging Georgians to be vaccinated by relating his own experience, the messaging, especially on the ground level, could have been better. 

“If the governor and the attorney general truly believe that vaccines are our way out of this pandemic, then I would offer that they should not be investing public time and resources in battling an effective public policy to get more people vaccinated,” said Colbert, a public-health policy advocate. 

Earlier in the pandemic, Colbert said, the state could have invested more in the workforce and infrastructure to reach out to rural communities and communities of color.  “These communities, of course, have been hit disproportionately hard by COVID-19 and they often don’t have the trust in the state government or in other institutions, that is needed to get them to take some difficult steps like getting a vaccine,” she said. 

Communication and outreach, Heiman agreed, are crucial. “We have done a really poor job, both at the state level and at the local level of reaching out to communities, particularly those communities that are the most vaccine-hesitant,” he said. It’s an approach that works in other states, but in Georgia, he said, the workforce infrastructure isn’t there.

What do you think about the cost that not being vaccinated incurs on society? Who is responsible, who should pay for it and what can the state do? Share your thoughts: [email protected].