Version 1
: Received: 18 February 2023 / Approved: 21 February 2023 / Online: 21 February 2023 (03:49:52 CET)
How to cite:
Aarstad, J.; Kvitastein, O.A. Is there a Link between the 2021 COVID-19 Vaccination Uptake in Europe and 2022 Excess All-Cause Mortality?. Preprints.org2023, 2023020350. https://doi.org/10.20944/preprints202302.0350.v1
Aarstad, J.; Kvitastein, O.A. Is there a Link between the 2021 COVID-19 Vaccination Uptake in Europe and 2022 Excess All-Cause Mortality?. Preprints.org 2023, 2023020350. https://doi.org/10.20944/preprints202302.0350.v1
Cite as:
Aarstad, J.; Kvitastein, O.A. Is there a Link between the 2021 COVID-19 Vaccination Uptake in Europe and 2022 Excess All-Cause Mortality?. Preprints.org2023, 2023020350. https://doi.org/10.20944/preprints202302.0350.v1
Aarstad, J.; Kvitastein, O.A. Is there a Link between the 2021 COVID-19 Vaccination Uptake in Europe and 2022 Excess All-Cause Mortality?. Preprints.org 2023, 2023020350. https://doi.org/10.20944/preprints202302.0350.v1
Abstract
We primarily study a possible link between 2021 COVID-19 vaccination uptake in Europe and monthly 2022 excess all-cause mortality, i.e., mortality higher than before the pandemic. Analyses of 31 countries weighted by population size show that all-cause mortality during the first nine months of 2022 increased more the higher the 2021 vaccination uptake; a one percentage point increase in 2021 vaccination uptake was associated with a monthly mortality increase in 2022 by 0.105 percent (95% CI, 0.075-0.134). When controlling for alternative explanations, the association remained robust, and we discuss the result emphasizing causality as well as potential ecological fallacy. Also, the study shows that 2021 all-cause mortality was lower the higher the vaccination uptake, but this association became non-significant when controlling for alternative explanations.
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received:
22 February 2023
Commenter:
Per Stangeland
The commenter has declared there is no conflict of interests.
Comment:
An interesting and very controversial article. As you mention, the correlation should be analysed by age cohorts. A possible explaining hypothesis could be that countries with high vaccination rates (Denmark) have vaccinated a younger strata of the population, including more young adults and children. Countries with lower rates (Bulgaria) vaccinated only the high risk population, the elderly. If negative side effects of the vaccines are more extended among the young, the vaccines might indeed have caused higher mortality.
The commenter has declared there is no conflict of interests.
Comment:
Thanks for the constructive comment.
Response 2 to
Comment 1
Received:
22 March 2023
Commenter:
Ewin Barnett
The commenter has declared there is no conflict of interests.
Comment:
I am very interested in what changes in correlation are associated with 1) comorbidities and 2) 25-hydroxy vitamin D serum levels. Neither of these stratifications are commonly considered, yet an early CDC study of hospital admissions showed a 17X (!!) increase in severe outcomes for 4 or more comorbidities. This implies a very non-linear severity curve.
Response 3 to
Comment 1
Received:
25 March 2023
The commenter has declared there is no conflict of interests.
Comment:
An interesting and thought-provoking article.
I recall at that time and worsening today, the struggle to acquire solid data on infection rates.
I believe filling and attempting to account for this hole in data must come before this type of paper is written since you cannot even attempt to reliably account for one of the largest variables behind it.
The alternative explanations and such that you account for in this paper could be easily outweighed by its p-value. Like the expectation that after a year of high mortality, mortality would decrease. Could that not be outweighed by the population growth rate of given nations?
Response 4 to
Comment 1
Received:
29 March 2023
Commenter:
Damian T. Rafal
The commenter has declared there is no conflict of interests.
Comment:
Covid-19 has not been a danger meaningfully worse than the common flu (y-o-y fluctuations in the number of lethal flu victims were bigger in the 2009-2019 period than a potential net increase caused by Covid-19), so experiments on humans should not be applied. There could not exist benefits (counted as deaths +/-) due to Covid-19 vaccines (unless in manipulated bogus data of CDC), till they have important side effects. https://zenodo.org/record/7372672
Comment 2
Received:
2 March 2023
Commenter:
Herve Seligmann
The commenter has declared there is no conflict of interests.
Comment:
Please have a look at the following manuscript from 2021, which analyses all cause mortalities for age cohorts in the USA and in Europe, in relation to COVID19 injections. The analyses of the european data also indicate the dynamics of deaths in relation to duration since the 1st injection. https://www.researchgate.net/publication/355581860_COVID_vaccination_and_age-stratified_all-cause_mortality_risk
More updates of these data are also available at my Researchgate profile.
Best,
Herve Seligmann
The commenter has declared there is no conflict of interests.
Comment:
Thanks for notifying me.
Comment 3
Received:
22 March 2023
Commenter:
Dr Avinash kinikar
The commenter has declared there is no conflict of interests.
Comment:
How is it possible to relate mortality to vaccines, as history of vaccinations is readily available but past history of covid is not reliable as asymptomatic undetected undiagnosed covid will be missed out. After 2021, almost more than 85 percent population had covid, either asymptomatic undetected undiagnosed covid or symptomatic covid.
Antibodies to N antibodies have short half life and they disappear faster but T cell immunity persists.
Unless TCell immunity studies are done in all population, it is not possible to rule out past covid only from N antibodies studies..
How do we know about side effects of
vaccines or something to do with side effects of covid itself .
Received:
23 March 2023
Commenter:
Soteris Christodoulou
The commenter has declared there is no conflict of interests.
Comment:
Interesting question. Let us think of some possibilities.
First: The excess mortality is indeed related to a set of (late) complications to COVID disease. If this is the case we would expect countries with higher vaccine uptake to have lower prevalence of COVID infections and as a result of that we would expect in turn to have less complications as well. In this case the relationship between vaccine uptake in 2021 and excess mortality in 2022 would have been negative, i.e. higher vaccine uptake = lower all-cause ex. mortality.
Second: As you already mentioned the great majority of people have been exposed to the virus. Is there a reason to believe that countries with higher vaccine uptake would have higher percentage of people infected? I would expect that all countries during all this time have all very high percentage of people infected. Either vaccine or natural immunity are short lived and with this widespread infectious disease virtually everyone would have been exposed. If there is any difference in all-cause mortality between different countries is observed this would hardly be associated with differences in prevalence of past COVID infections.
Third: There is indeed a statistical positive association between the excess mortality and vaccine uptake.
Response 2 to
Comment 3
Received:
26 March 2023
Commenter:
Paul J Sims
The commenter has declared there is no conflict of interests.
Comment:
You cannot categorically have a respiratory virus such as covid19 and NOT have any symptoms . Its impossible perhaps pre symptomatic. Do you have peer reviewed data on asymptomatic covid 19
Response 3 to
Comment 3
Received:
26 March 2023
Commenter:
Stathis Vass
The commenter has declared there is no conflict of interests.
Comment:
Because low Vaccination country's don't have excess mortality above normal average only high vaccinated country's have excess deaths
Response 4 to
Comment 3
Received:
26 March 2023
Commenter:
Informed Nonmedic
The commenter has declared there is no conflict of interests.
Comment:
There is no such thing as "asymptomatic undetected undiagnosed covid".
Covid-19 is a disease (=a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms), so being asymptomatic means being... healthy.
The correct thing to say is asymptomatic infection.
The commenter has declared there is no conflict of interests.
Comment:
Dear authors,
I performed a very simple reanalysis:
Plotted using using Excel scatter graph your vax uptake values versus excess deaths p scores (via https://ourworldindata.org/)
The result was clear correlation: higher the vaccination uptake the lower the excess deaths at end of 2022. Apparently the opposite to your finding.
Received:
23 March 2023
Commenter:
KUCHIR S.
The commenter has declared there is no conflict of interests.
Comment:
I would like to encourage you to conduct an analysis using the data made available by the UK's ONS agency and the recently shared data from Australia and New Zealand.
It should be noted that Our World in Data cannot be considered a neutral source of data.
Best regards,
KUCHIR S.
Response 2 to
Comment 4
Received:
23 March 2023
Commenter:
Simon Fauckner
The commenter has declared there is no conflict of interests.
Comment:
You made an error by using using cumulative p scores from https://ourworldindata.org/ because those scores include death that occurred prior to the vaccination (from 1/1/2020 to end of 2022). Post vaccination period excess deaths (deaths in 2022) is unquestionably the lowest in low vaccinated countries (both according to eurostat and ourworldindata.org - look at p scores for 2022 alone not cumulative p scores since Jan 2020) https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Excess_mortality_-_statistics
https://ourworldindata.org/grapher/excess-mortality-p-scores-average-baseline?tab=table
Response 3 to
Comment 4
Received:
28 March 2023
The commenter has declared there is no conflict of interests.
Comment:
KUCHIR S:
The paper itself uses Our World In Data as a source. Does that bother you?
Response 4 to
Comment 4
Received:
29 March 2023
Commenter:
HB
The commenter has declared there is no conflict of interests.
Comment:
Regarding the comment by Simon Fauckner: the data is available for the dates of January 5, 2020, but appears to be cumulated by year; Mr Coombs also used the data only for 2021 and 2022. If it were truly cumulative, you would not see lower figures in 2022 vs. 2021 for any countries (you do).
Additionally, the entire paper is flawed because you cannot look only at the p values for excessive deaths and vaccination rates without considering (and removing) other confounding variables. Comparing different countries at such a broad level is also problematic, as each one has different locales, governments, COVID-19 protocols, populations, vaccination plans, comorbidities, etc. It also doesn’t take into consideration any/all excess deaths resulting from healthcare facilities being overwhelmed and not able to treat non-COVID-19 related illnesses and injuries.
Comment 5
Received:
22 March 2023
The commenter has declared there is no conflict of interests.
Comment:
An interesting article that shouldn't be controversial.
It will be interesting to remove certain causes of mortality that are likely to be not directly due to vaccination, e.g. road accidents and crime. Although these data may not be readily available for all the countries included in the analysis.
Received:
27 March 2023
The commenter has declared there is no conflict of interests.
Comment:
Indeed, but some road accidents are hard to rule out as vaccine-related. A driver who suffers a sudden cardiac arrest and crashes is an example.
Comment 6
Received:
22 March 2023
Commenter:
Philip Jones
The commenter has declared there is no conflict of interests.
Comment:
I am not a statistician, but surely, if, for whatever reason, there is a year (2021) with lower than average excess deaths, we have a following year/years where there has to be a catchup.
If 2022 is that year, is it surprising that the excess deaths take a jump, or am I mis-reading something?
Received:
24 March 2023
Commenter:
Rune Ydstebo
The commenter has declared there is no conflict of interests.
Comment:
Yes 2022 mortality is much higher than 2021, and 2020. so they compared it to average 2016-2019. That way you eliminate Covid influence completely. Truth is that 14-21% increased mortality throughout Europe is so alarming that one could wonder what government and medie is thinking hiding this ? Let's remind us the medie storm during 2020-2021 ? there was million articles on how bad this was. We all going to die ? Let's shut down. Let's create A class people (vaccinated) and B class (unvaccinated) and lets take away basic privileges lie travelling, jobs, visit restaurants for the B class. Let's convince them to vaccinate and then we stop the Covid pandemic ? Well that didnt happen.... Vaccinated infected others just as much as unvaccinated .... And now we know that after 3 months .... 2, 3 or 4 doses... there is no benefit for beeing serious ill or die... And now this study ? IF , just IF there was a small percentage chance that its true, that there is a correlation between vaccine and increased death in a population from other causes than Covid... The Government should demand a full stop and hearings and find the truth.. not like Norwegian health department does... They swipe it under the rug, hoping it will go away :-(
Comment 7
Received:
23 March 2023
Commenter:
Damian T. Rafal
The commenter has declared there is no conflict of interests.
Comment:
Hi
When you aim at discovering that of Covid-19 role it can be done directly by the original mathematical method. It shows the role can be only a minimal one, and a very vast majority of excess deaths must be due to not Covid-19 causes, including vaccines, like in the U.S. (or in the U.K) in 2020 >90% of "Covid-19 deaths" were wrongly attributed to Covid-19. ...It is new place from October is the major based in Switzerland preprint (as blocked, without any excuse, by the U.S ones, including journals): https://zenodo.org/record/7372672
To some people it seems so difficult that they give up.
Received:
25 March 2023
The commenter has declared there is no conflict of interests.
Comment:
On authors observations that increase in covid19 vaccine intake in 2021 being correlated with increases in all-cause mortality: Which period are you comparing with? How was the all-cause mortality trend at pre- and during covid-19 pandemic? If the trend in pre-pandemic years was going up, couldn't reasons other than vaccination be at play? Perhaps burden of covid-19 infection being the driver behind increases in all-cause mortality etc. Another important observation is that countries tended to boost up vaccination efforts with increases in covid-19 infection waves. Countries that saw less of the infections tended to be slower in ramping up the covid-19 vaccinations. Couldn't this partially or wholly explain higher all-cause mortality with increases in vaccination? I.e more to do with correlation and not causality.
Received:
28 March 2023
Commenter:
Damian t. Rafal
The commenter has declared there is no conflict of interests.
Comment:
A little higher you have the answers already: https://zenodo.org/record/7372672
Covid-19 was a petty threat; but could have become worse from 2021 due to the vaccines producing mutations and disrupting the immune system.
Comment 11
Received:
27 March 2023
Commenter:
Richard Glynn Owens
The commenter has declared there is no conflict of interests.
Comment:
Just a brief note - the concept of "borderline significance" has no meaning within the logic of Fisherian or Neyman-Pearson significance testing. It makes as much sense as being "borderline pregnant". Perhaps a Bayesian analysis might be more helpful?
Received:
28 March 2023
The commenter has declared there is no conflict of interests.
Comment:
There is absolutely *zero* reason to weight the independent variables by population size. All-cause mortality is already a proportional measure. I look forward to seeing a peer-reviewed version of this paper.
The commenter has declared there is no conflict of interests.
Comment:
I read the paper with interest - thank you for making it public. I didn't see any discussion of the variance year-to-year in excess mortality and whether 2022 fell within 'normal' bounds - that would be an essential, I think - and whether normalising by a wider range of years changed any outcomes (I recognise the tension between longer normalising intervals and the desire to deal with a stationary population). Related to that, it would also be interesting to know if, in your base data set, there was any increasing trend in mortality that would make excess mortality more likely and how that varied between countries (I am sorry but I have not looked up your references for the data). It would also be interesting to see if there was any correlation between month of the year and mortality - in general - and excess or deficient mortality - in particular- in other years. Mostly, I was surprised that vaccination at any time in 2021 was somehow related to a progressive increase in excess mortality over 2022. Is that a correct interpretation - that you took the all year vaccination as opposed to the monthly vaccination rates? I did not see any discussion of lag rates so imagine that must be your method.
Received:
30 March 2023
The commenter has declared there is no conflict of interests.
Comment:
These results are entirely compatible with being a statistical artefact.
Both vaccination rate and excess death rate have the popuation in the denominator and weighting by the population does not remove the artefact.
Just try generating random numbers of vaccinations, random numbers of excess deaths and using the population values to compute the rates of vaccination and excess deaths by dividing by the population and then regress excess deaths on vaccination rate and you will find a highly significant relation.
With y as a random number, x as a random number and with some fixed d (denominator), y/d will have a positive relation with x/d.
Received:
30 May 2023
Commenter:
Roger Willcocks
The commenter has declared there is no conflict of interests.
Comment:
1. The excess mortality is compared to **before COVID started**.
2. You don't bother to check for correlation between vaccination rates and COVID infection rates.
3. You don't bother to remove COVID deaths from the excess mortality.
Commenter: Per Stangeland
The commenter has declared there is no conflict of interests.
Commenter:
The commenter has declared there is no conflict of interests.
Commenter: Ewin Barnett
The commenter has declared there is no conflict of interests.
The commenter has declared there is no conflict of interests.
I recall at that time and worsening today, the struggle to acquire solid data on infection rates.
I believe filling and attempting to account for this hole in data must come before this type of paper is written since you cannot even attempt to reliably account for one of the largest variables behind it.
The alternative explanations and such that you account for in this paper could be easily outweighed by its p-value. Like the expectation that after a year of high mortality, mortality would decrease. Could that not be outweighed by the population growth rate of given nations?
Commenter: Damian T. Rafal
The commenter has declared there is no conflict of interests.
https://zenodo.org/record/7372672
Commenter: Herve Seligmann
The commenter has declared there is no conflict of interests.
https://www.researchgate.net/publication/355581860_COVID_vaccination_and_age-stratified_all-cause_mortality_risk
More updates of these data are also available at my Researchgate profile.
Best,
Herve Seligmann
Commenter:
The commenter has declared there is no conflict of interests.
Commenter: Dr Avinash kinikar
The commenter has declared there is no conflict of interests.
Antibodies to N antibodies have short half life and they disappear faster but T cell immunity persists.
Unless TCell immunity studies are done in all population, it is not possible to rule out past covid only from N antibodies studies..
How do we know about side effects of
vaccines or something to do with side effects of covid itself .
Commenter: Soteris Christodoulou
The commenter has declared there is no conflict of interests.
First: The excess mortality is indeed related to a set of (late) complications to COVID disease. If this is the case we would expect countries with higher vaccine uptake to have lower prevalence of COVID infections and as a result of that we would expect in turn to have less complications as well. In this case the relationship between vaccine uptake in 2021 and excess mortality in 2022 would have been negative, i.e. higher vaccine uptake = lower all-cause ex. mortality.
Second: As you already mentioned the great majority of people have been exposed to the virus. Is there a reason to believe that countries with higher vaccine uptake would have higher percentage of people infected? I would expect that all countries during all this time have all very high percentage of people infected. Either vaccine or natural immunity are short lived and with this widespread infectious disease virtually everyone would have been exposed. If there is any difference in all-cause mortality between different countries is observed this would hardly be associated with differences in prevalence of past COVID infections.
Third: There is indeed a statistical positive association between the excess mortality and vaccine uptake.
Commenter: Paul J Sims
The commenter has declared there is no conflict of interests.
Commenter: Stathis Vass
The commenter has declared there is no conflict of interests.
Commenter: Informed Nonmedic
The commenter has declared there is no conflict of interests.
Covid-19 is a disease (=a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms), so being asymptomatic means being... healthy.
The correct thing to say is asymptomatic infection.
Commenter:
The commenter has declared there is no conflict of interests.
I performed a very simple reanalysis:
Plotted using using Excel scatter graph your vax uptake values versus excess deaths p scores (via https://ourworldindata.org/)
The result was clear correlation: higher the vaccination uptake the lower the excess deaths at end of 2022. Apparently the opposite to your finding.
https://twitter.com/Paul_A_Coombes/status/1638562850976288770?s=20
Regards,
Paul Coombes
Commenter: KUCHIR S.
The commenter has declared there is no conflict of interests.
It should be noted that Our World in Data cannot be considered a neutral source of data.
Best regards,
KUCHIR S.
Commenter: Simon Fauckner
The commenter has declared there is no conflict of interests.
https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Excess_mortality_-_statistics https://ourworldindata.org/grapher/excess-mortality-p-scores-average-baseline?tab=table
The commenter has declared there is no conflict of interests.
The paper itself uses Our World In Data as a source. Does that bother you?
Commenter: HB
The commenter has declared there is no conflict of interests.
Additionally, the entire paper is flawed because you cannot look only at the p values for excessive deaths and vaccination rates without considering (and removing) other confounding variables. Comparing different countries at such a broad level is also problematic, as each one has different locales, governments, COVID-19 protocols, populations, vaccination plans, comorbidities, etc. It also doesn’t take into consideration any/all excess deaths resulting from healthcare facilities being overwhelmed and not able to treat non-COVID-19 related illnesses and injuries.
The commenter has declared there is no conflict of interests.
It will be interesting to remove certain causes of mortality that are likely to be not directly due to vaccination, e.g. road accidents and crime. Although these data may not be readily available for all the countries included in the analysis.
The commenter has declared there is no conflict of interests.
Commenter: Philip Jones
The commenter has declared there is no conflict of interests.
If 2022 is that year, is it surprising that the excess deaths take a jump, or am I mis-reading something?
Commenter: Rune Ydstebo
The commenter has declared there is no conflict of interests.
Commenter: Damian T. Rafal
The commenter has declared there is no conflict of interests.
When you aim at discovering that of Covid-19 role it can be done directly by the original mathematical method. It shows the role can be only a minimal one, and a very vast majority of excess deaths must be due to not Covid-19 causes, including vaccines, like in the U.S. (or in the U.K) in 2020 >90% of "Covid-19 deaths" were wrongly attributed to Covid-19. ...It is new place from October is the major based in Switzerland preprint (as blocked, without any excuse, by the U.S ones, including journals):
https://zenodo.org/record/7372672 To some people it seems so difficult that they give up.
The commenter has declared there is no conflict of interests.
Commenter:
The commenter has declared there is no conflict of interests.
https://www.preprints.org/manuscript/202301.0204/v7
The commenter has declared there is no conflict of interests.
Commenter: Damian t. Rafal
The commenter has declared there is no conflict of interests.
https://zenodo.org/record/7372672 Covid-19 was a petty threat; but could have become worse from 2021 due to the vaccines producing mutations and disrupting the immune system.
Commenter: Richard Glynn Owens
The commenter has declared there is no conflict of interests.
The commenter has declared there is no conflict of interests.
Commenter:
The commenter has declared there is no conflict of interests.
The commenter has declared there is no conflict of interests.
Both vaccination rate and excess death rate have the popuation in the denominator and weighting by the population does not remove the artefact.
Just try generating random numbers of vaccinations, random numbers of excess deaths and using the population values to compute the rates of vaccination and excess deaths by dividing by the population and then regress excess deaths on vaccination rate and you will find a highly significant relation.
With y as a random number, x as a random number and with some fixed d (denominator), y/d will have a positive relation with x/d.
Commenter: Roger Willcocks
The commenter has declared there is no conflict of interests.
2. You don't bother to check for correlation between vaccination rates and COVID infection rates.
3. You don't bother to remove COVID deaths from the excess mortality.
Given #1, you should at least check #2 and #3.