Six years after its emergence, SARS-CoV-2 continues to have a substantial burden, however, the impact of vaccination and the optimal timing of its rollout remain uncertain. To explore these uncertainties, the US Scenario Modeling Hub convened its 19th round of ensemble projections for COVID-19 hospitalizations and deaths in the United States. Eight teams provided outcomes for each US state and nationally from April 2025 to April 2026 under five scenarios regarding vaccine recommendations and timing. We assessed recommendations with two eligibility scenarios (high-risk individuals only and all-eligible) and two timing scenarios (classic start: mid-August, earlier start: late June). These were crossed to create four scenarios and were compared against a counterfactual scenario with no vaccination. We found that compared to no vaccination, our ensemble projections estimated 90,000 (95% PI 53,000-126,000) hospitalizations averted in the high-risk and classic timing scenario across the US. Expanding coverage averted an additional 26,000 (95% PI 14,000-39,000) hospitalizations, which when coupled with earlier vaccination timing further reduced national hospitalizations by 15,000 (95% PI −3,000-33,000). These findings estimate significant benefits from a broad all-eligible vaccination recommendation, and suggest an additional benefit is likely to be gained from an earlier vaccination campaign.
