To compare and analyze COVID-19 control outcomes, including case severity, vaccination, and excess mortality, across 6 nations (USA, UK, China, Russia, Japan, and South Africa) from January 2020 to December 2022.

This study utilized data from the “Our World in Data” dataset to characterize the epidemiological features of COVID-19 across 6 countries. Generalized linear models (GLMs) were employed to examine the associations between Stringency Index (SI), vaccination coverage, and epidemiological outcomes.

The USA had the highest median cases per million and the UK the highest deaths per million, while China reported the lowest for both. Hospitalization and ICU rates were highest in the UK and the USA, respectively, and lowest in Japan. Vaccination coverage was highest in China and lowest in South Africa. Excess mortality was highest in Russia and lowest in Japan. Generalized linear models indicated a negative association between the SI and cases in China (β = −40, P = 0.015), which became stronger after adjusting for vaccination (β = −311, P < 0.001), but positive associations were observed in the USA, UK, and South Africa. SI was negatively associated with excess mortality in most countries.

Effective pandemic control is highly context-dependent. The relationships among vaccination, variant prevalence, and health care burden were complex, shaped by implementation context, public compliance, and health care capacity.