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Which States Saw the Most COVID Deaths in 2021? America's Least Vaccinated

States with the highest COVID death rates tended to have the lowest vaccination rates and fewer social and economic restrictions.

This article was updated on Jan. 12, 2022, at 1:38 p.m. ET with year-end totals from Johns Hopkins University and the CDC.

States with the U.S.’s lowest vaccination rates lost residents to COVID at a rate two to five times higher than states with high vaccination rates in 2021, according to an analysis of the country’s 473,795 COVID-related deaths and nearly 500 million vaccines administered this year.

The states with the worst COVID death rates in 2021, according to Johns Hopkins University, were Oklahoma and Alabama, whose national vaccination rates rank 37th and 48th, respectively. Oklahoma lost one of every 399 residents to COVID this past year, while Alabama lost one of every 432 residents.

Among the 15 states with highest COVID death rates in 2021, 11 ranked among the 15 lowest for vaccination rates, according to the CDC.

“This has been a year where the majority of people have gotten exposed, either to the virus or to the vaccine,” said epidemiologist Dr. David Dowdy from the Johns Hopkins Bloomberg School of Public Health. “But we know the virus is something that can kill you and the vaccine is not.”

“One of the downsides of a herd immunity policy, or we can call it an infection policy, is more people die.”

Dowdy called the 2021 calendar year “a reasonable barometer” to examine the effect of the vaccines, since the first shots in America were administered a few days before the start of the year. More than 500 million Pfizer, Moderna and Johnson & Johnson vaccines were administered this year in the United States, with fewer than a dozen deaths attributed to adverse vaccine reactions (all from the Johnson & Johnson shot).

“Certainly you can attribute a substantial number of COVID deaths to a mistrust of public health measures, and you could probably attribute a certain amount of that to political and social trends that have happened over the past decade or more,” Dowdy said. “So I think it's fair to say that those trends have killed people.”

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COVID Deaths and Other Public Health Measures

The high 2021 COVID death rates in some states also seem to correlate with looser attitudes regarding social distancing, mask mandates and restrictions on activities.

In states where mask and business restrictions were met with opposition, such as Florida (190 deaths per 100,000 residents) and Texas (164 deaths per 100,000 residents), death rates were considerably higher than the national average of 144 deaths per 100,000 residents.

Only the country’s most populous state, California, suffered more total COVID- related fatalities in 2021 (50,757) than Texas (47,678) or Florida (40,831). However, its rate of 128 deaths per 100,000 residents was well below the national average.

“It is absolutely true that many (COVID) restrictions have a cost,” Dowdy said. “They have an economic cost, they have a psychological cost, and they have a cost on people's well-being. ... It's unfair for us to only look at the health side ... but it would also be unfair to ignore the death and other negative health consequences that many people have faced.”

2021’s COVID numbers also reflect how state’s leaders balanced health measures with social and economic interests.

While studies have found in-person college learning, sports celebrations on campus and birthday parties can lead to significant COVID spread, the absence of such social gatherings can also be harmful.

“I think we should be looking back on certain strategies like closing schools as having a very serious price, and in some cases, be willing to say, ‘Look, we were wrong about that,’” Dowdy said. “But I think we can look back on other things, such as vaccination — and at least some level of restrictions in the midst of a major wave — and say, ‘We were probably right.’”

He pointed out that if Florida’s 2021 death rate had matched the national average of 144 deaths per 100,000 residents, 10,000 fewer Floridians would have died from COVID this year. Similarly, 5,708 Texans and 5,084 Georgians might still be alive today had their states also matched the national average death rates.

Vaccines and Long COVID

Dowdy said there's a lot of nuance not visible in 2021’s death rates, including immunity that may've been built up in some pockets of the country from 2020’s COVID cases. But the most consequential impact not represented in COVID statistics is the millions of Americans who have suffered from long COVID symptoms, which generally aren’t tracked in the United States.

“COVID can make people very sick and cause long-term health complications,” Dowdy said. “(But) getting vaccinated … reduces the severity of illness and long-term health consequences."

“(Vaccination) is not just about saving lives. It's about making lives better, and vaccines – and other health measures – have done that well.”

States with highest COVID death rates in 2021

1. Oklahoma (251 per 100,000)

2. Alabama (231)

3. West Virginia (223)

4. Arizona (215)

5. Kentucky (211)

States with lowest COVID death rates in 2021

1. Vermont (52)

2. Hawaii (55)

3. Puerto Rico (55) 

4. Utah (77)

5. Washington (83)

Noah Pransky is NBCLX’s National Political Editor. He covers Washington and state politics for NBCLX, and his investigative work has been honored with national Murrow, Polk, duPont and Cronkite awards. You can contact him confidentially at noah.pransky@nbcuni.com or on Facebook, Instagram or Twitter.