The study, published on June 3rd, in one of the world’s leading medical journals, the British Medical Journal, is titled “Excess mortality across countries in the Western World since the COVID-19 pandemic: ‘Our World in Data’ estimates of January 2020 to December 2022”. Its end — its closing third — is useful for the general public who want to know why there is increasing concern in the research-medical community regarding whether vaccines against covid-19 increased instead of decreased death-rates. The report recognizes that the purpose of a vaccine isn’t merely to reduce death-rates from a particular disease (in this case covid-19) but to reduce all-cause death-rates (“excess mortality”), which includes deaths from the given disease but is not limited to that. This study focused on the effect that the covid-19 vaccines had on all-cause death-rates, not on their effect on merely covid-19 death-rates.
Here is the study’s closing third:
A recent analysis of seroprevalence studies in this prevaccination era [prior to covid-19] illustrates that the Infection Fatality Rate estimates in non-elderly populations were even lower than prior calculations suggested.37 At a global level, the prevaccination Infection Fatality Rate [the death-rates prior to 2020] was 0.03% for people aged <60 years and 0.07% for people aged <70 years.38 For children aged 0–19 years, the Infection Fatality Rate was set at 0.0003%.38 This implies that children are rarely harmed by the COVID-19 virus.19 38 During 2021, when not only containment measures but also COVID-19 vaccines were used to tackle virus spread and infection, the highest number of excess deaths [in the “47 countries of the Western World”] was recorded: 1,256,942 excess deaths (P-score 13.8%).26 37 Scientific consensus regarding the effectiveness of non-pharmaceutical interventions in reducing viral transmission is currently lacking.75 76 During 2022, when most mitigation measures were negated and COVID-19 vaccines were sustained, preliminary available data count 808 392 excess deaths (P-score 8.8%).39 The percentage difference between the documented and projected number of deaths was highest in 28% of countries during 2020, in 46% of countries during 2021, and in 26% of countries during 2022.
This insight into the overall all-cause excess mortality since the start of the COVID-19 pandemic is an important first step for future health crisis policy decision-making.1–4 The next step concerns distinguishing between the various potential contributors to excess mortality, including COVID-19 infection, indirect effects of containment measures and COVID-19 vaccination programmes. Differentiating between the various causes is challenging.16 National mortality registries not only vary in quality and thoroughness but may also not accurately document the cause of death.1 19 The usage of different models to investigate cause-specific excess mortality within certain countries or subregions during variable phases of the pandemic complicates elaborate cross-country comparative analysis.1 2 16 Not all countries provide mortality reports categorised per age group.2 12 Also testing policies for COVID-19 infection differ between countries.1 2 Interpretation of a positive COVID-19 test can be intricate.77 Consensus is lacking in the medical community regarding when a deceased infected with COVID-19 should be registered as a COVID-19 death.1 77 Indirect effects of containment measures have likely altered the scale and nature of disease burden for numerous causes of death since the pandemic. However, deaths caused by restricted healthcare utilisation and socioeconomic turmoil are difficult to prove.1 78–81 A study assessing excess mortality in the USA observed a substantial increase in excess mortality attributed to non-COVID causes during the first 2 years of the pandemic. The highest number of excess deaths was caused by heart disease, 6% above baseline during both years. Diabetes mortality was 17% over baseline during the first year and 13% above it during the second year. Alzheimer’s disease mortality was 19% higher in year 1 and 15% higher in year 2. In terms of percentage, large increases were recorded for alcohol-related fatalities (28% over baseline during the first year and 33% during the second year) and drug-related fatalities (33% above baseline in year 1 and 54% in year 2).82 Previous research confirmed profound under-reporting of adverse events, including deaths, after immunisation.83 84 Consensus is also lacking in the medical community regarding concerns that mRNA vaccines might cause more harm than initially forecasted.85 French studies suggest that COVID-19 mRNA vaccines are gene therapy products requiring long-term stringent adverse events monitoring.85 86 Although the desired immunisation through vaccination occurs in immune cells, some studies report a broad biodistribution and persistence of mRNA in many organs for weeks.85 87–90 Batch-dependent heterogeneity in the toxicity of mRNA vaccines was found in Denmark.48 Simultaneous onset of excess mortality and COVID-19 vaccination in Germany provides a safety signal warranting further investigation.91 Despite these concerns, clinical trial data required to further investigate these associations are not shared with the public.92 Autopsies to confirm actual death causes are seldom done.58 60 90 93–95 Governments may be unable to release their death data with detailed stratification by cause, although this information could help indicate whether COVID-19 infection, indirect effects of containment measures, COVID-19 vaccines or other overlooked factors play an underpinning role.1 8–14 20–25 39–60 68 90 This absence of detailed cause-of-death data for certain Western nations derives from the time-consuming procedure involved, which entails assembling death certificates, coding diagnoses and adjudicating the underlying origin of death. Consequently, some nations with restricted resources assigned to this procedure may encounter delays in rendering prompt and punctual cause-of-death data. This situation existed even prior to the outbreak of the pandemic.1 5
A critical challenge in excess mortality research is choosing an appropriate statistical method for calculating the projected baseline of expected deaths to which the observed deaths are compared.96 Although the analyses and estimates in general are similar, the method can vary, for instance, per length of the investigated period, nature of available data, scale of geographic area, inclusion or exclusion of past influenza outbreaks, accounting for changes in population ageing and size and modelling trend over years or not.7 96 Our analysis of excess mortality using the linear regression model of Karlinsky and Kobak varies thus to some extent from previous attempts to estimate excess deaths. For example, Islam et al conducted an age- and sex-disaggregated time series analysis of weekly mortality data in 29 high-income countries during 2020.97 They used a more elaborate statistical approach, an overdispersed Poisson regression model, for estimating the baseline of expected deaths on historical death data from 2016 to 2019. In contrast to the model of Karlinsky and Kobak, their baseline is weighing down prior influenza outbreaks so that every novel outbreak evolves in positive excess mortality.7 97 Islam’s study found that age-standardised excess death rates were higher in men than in women in nearly all nations.97 Alicandro et al investigated sex- and age-specific excess total mortality in Italy during 2020 and 2021, using an overdispersed Poisson regression model that accounts for temporal trends and seasonal variability. Historical death data from 2011 to 2019 were used for the projected baseline. When comparing 2020 and 2021, an increased share of the total excess mortality was attributed to the working-age population in 2021. Excess deaths were higher in men than in women during both periods.98 Msemburi et al provided WHO estimates of the global excess mortality for its 194 member states during 2020 and 2021. For most countries, the historical period 2015–2019 was used to determine the expected baseline of excess deaths. In locations missing comprehensive data, the all-cause deaths were forecasted employing an overdispersed Poisson framework that uses Bayesian inference techniques to measure incertitude. This study describes huge differences in excess mortality between the six WHO regions.99 Paglino et al used a Bayesian hierarchical model trained on historical death data from 2015 to 2019 and provided spatially and temporally granular estimates of monthly excess mortality across counties in the USA during the first 2 years of the pandemic. The authors found that excess mortality decreased in large metropolitan counties but increased in non-metropolitan counties.100 Ruhm examined the appropriateness of reported excess death estimates in the USA by four previous studies and concluded that these investigations have likely understated the projected baseline of excess deaths and therewith overestimated excess mortality and its attribution to non-COVID causes. Ruhm explains that the overstatement of excess deaths may partially be explained by the fact that the studies did not adequately take population growth and age structure into account.96 101–104 Although all the above-mentioned studies used more elaborate statistical approaches for estimating baseline mortality, Karlinsky and Kobak argue that their method is a trade-off between suppleness and chasteness.7 It is the simplest method to captivate seasonal fluctuation and annual trends and more transparent than extensive approaches.7
This study has various significant limitations. Death reports may be incomplete due to delays. It may take weeks, months or years before a death is registered.5 Four nations still lack all-cause mortality reports for 1–4 months. Some nations issue complete data with profound arrears, whereas other nations publish prompt, yet incomplete data.5 7 The presented data, especially for 2022, are thus preliminary and subject to backward revisions. The more recent data are usually more incomplete and therefore can undergo upward revisions over time. This implies that several of the reported excess mortality estimates can be underestimations.7 The completeness and reliability of death registration data can also differ per nation for other reasons. The recorded number of deaths may not depict all deaths accurately, as the resources, infrastructure and registration capacity may be limited in some nations.5 7 Most countries report per week, but some per month. Weekly reports generally provide the date of death, whereas monthly reports often provide the date of registration. Weekly and monthly reports may not be entirely comparable.5 7 Our data are collected at a country level and provide no detailed stratification for sociodemographic characteristics, such as age or gender.5 7
In conclusion, excess mortality has remained high in the Western World for three consecutive years, despite the implementation of COVID-19 containment measures and COVID-19 vaccines. This is unprecedented and raises serious concerns. During the pandemic, it was emphasised by politicians and the media on a daily basis that every COVID-19 death mattered and every life deserved protection through containment measures and COVID-19 vaccines. In the aftermath of the pandemic, the same morale should apply. Every death needs to be acknowledged and accounted for, irrespective of its origin. Transparency towards potential lethal drivers is warranted. Cause-specific mortality data therefore need to be made available to allow more detailed, direct and robust analyses to determine the underlying contributors. Postmortem examinations need to be facilitated to allot the exact reason for death. Government leaders and policymakers need to thoroughly investigate underlying causes of persistent excess mortality and evaluate their health crisis policies.
Dissemination to participants and related patient and public communities
We will disseminate findings through a press release on publication and contact government leaders and policymakers to raise awareness about the need to investigate the underlying causes of persistent excess mortality.
This study isn’t saying that in the U.S. and other Western countries, covid-19 vaccination definitely caused more deaths than they prevented, but that the evidence thus far is that it is likelier than not, and that data-collection must be greatly improved in order to become able scientifically to answer such a question.
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