evidence: Using previous methodology, we compared the US overall, the 10 most- and least-vaccinated states, and the 20 OECD countries with 2021 population exceeding 5 million and greater than $25 000 per capita gross domestic product (Supplement 1).1 US COVID-19 mortality, all-cause mortality, and vaccination data were obtained from the US Centers for Disease Control and Prevention.2 For other countries, COVID-19 mortality data were obtained from the World Health Organization, all-cause mortality data from OECD databases, and vaccination data from Our World in Data (Supplement 1).3-5 Some mortality data from 2021 and 2022 were provisional. [...] The US continued to experience significantly higher COVID-19 and excess all-cause mortality compared with peer countries during 2021 and early 2022, a difference accounting for 150 000 to 470 000 deaths. This difference was muted in the 10 states with highest vaccination coverage; remaining gaps may be explained by greater vaccination uptake in peer countries, better vaccination targeting to older age groups, and differences in health and social infrastructure. [...] These findings highlight that the US continued to lag peer countries in COVID-19 and excess all-cause mortality, albeit with lower mortality in highly vaccinated states.