Does COVID-19 vaccination cause excess deaths?

After fighting against the coronavirus disease 2019 (COVID-19) for more than 1 year,^1,2 Taiwan started to implement COVID-19 vaccination on March 22, 2021. In 3 months, 1 681 936 doses of COVID-19 vaccines had been administered to 1 652 232 persons in Taiwan, with a coverage rate of 7%.³ Since the vaccination extended to residents of long-term care facilities, hemodialysis patients and the elderly over 75 years, deaths after vaccination had been increasingly reported: totally 144 deaths (71 women and 73 men) until June 22, 2021. Of them, 112 (77.8%) were in the group of elderly people aged 75 years or older and occurred within 7 days after vaccination.³ Most of the deceased had multiple chronic or cardiovascular diseases with a higher natural mortality rate. Vaccination and deaths were only chronologically related, not necessarily with causal relationships. While the number of deaths from the COVID-19 declined with the epidemic control on one side and the number of reported deaths after vaccination increased on the other side, fear triggered by news media seemed to slow down the speed of vaccination in Taiwan.

How was the situation in the United States? From the Vaccine Adverse Event Reporting System co-managed by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration, we obtained the number of deaths within 7 days after COVID-19 vaccination in the United States from December 2020 to May 2021.⁴ The demographic structure of the United States was available from CDC Wonder online database,⁵ and the COVID-19 vaccine coverage rate from CDC Morbidity and Mortality Weekly Report.⁶ These data were used to calculate the proportion of deaths within 7 days after receiving COVID-19 vaccination per 100 1000 vaccinated persons, stratified by gender and age group. It was found that the mortality rate within 7 days after COVID-19 vaccination was higher for males than females and increased with age. But it was still much lower than the background mortality rate (the 7-day mortality rate in the US population) in 2019 (Table 1).

Table 1 - Mortality rates within 7 days after COVID vaccination compared to background mortality rate in the United States and Taiwan, stratified by sex and age group

Deaths within 7 d after COVID-19 vaccination per 100 000 persons
	United States				Taiwan
	50–59 y	60–64 y	65–79 y	80+ y	75+ y
Female	0.80	1.17	2.15	7.44	NA
Male	1.06	2.20	3.44	11.09	NA
Total	0.92	1.65	2.76	8.90	19.83
Background deaths per 7 d per 100 000 persons
	United States				Taiwan
	50–59 y	60–64 y	65–79 y	80+ y	75+ y
Female	8.76	15.37	33.76	95.13	108.75
Male	14.52	25.53	50.23	128.17	152.10
Total	11.58	21.33	41.38	109.14	127.39

COVID = coronavirus disease; NA = not available.

In Taiwan, one-third of vaccines had been so far administered to people aged 75 years or older or frail institutionalized people. If we divided the 112 postvaccination deaths in the elderly over 75 years by the number of vaccinated people in this age group, the mortality rate within 7 days after COVID-19 vaccination would be about 19.8 per 100 000, higher than that in the United States. But a direct comparison was not feasible because the average life expectancy in Taiwan was higher than that in the United States and vaccination strategies differed. Nevertheless, the mortality rate within 7 days after COVID-19 vaccination in Taiwan was still much lower than the background mortality rate in the same age group (Table 1).⁷

The issue of excess deaths from COVID-19 vaccination is a scientifically difficult question, conditioned by the type of vaccines and the composition of vaccinated people in age and health.⁸ Although deaths following COVID-19 vaccination had been recorded worldwide, their rates were still much lower than the mortality rates following an outbreak. Vaccination remains the most effective way to prevent severe cases and deaths from COVID-19. Unblocking to resume normal life can only be facilitated by herd immunity with a high coverage of vaccination.