Is there a Link between the 2021 COVID-19 Vaccination Uptake in Europe and 2022 Excess All-Cause Mortality? https://www.preprints.org/manuscript/202302.0350/v1 (Western Norway University of Applied Sciences). Conflict of interest statement The authors declare no conflict of interest. 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, Jan to September, 2022 31 EU member states, plus Norway, Iceland, Liechtenstein, Switzerland All-cause mortality, increased more the higher the 2021 vaccination uptake Countries with more covid vaccines in 2021 had higher excess mortality in first 9 months of 2022 Positive correlation between vaccination in 2021 and excess deaths in 2022 A one percentage point increase in 2021 vaccination uptake, was associated with a monthly mortality increase in 2022 by 0.105% (95% CI, 0.075-0.134). When controlling for alternative explanations The association remained robust 2021 all-cause mortality Was lower the higher the vaccination uptake Inverse correlation between previous covid vaccination and all-cause mortality in 2021 (this association became non-significant when controlling for alternative explanations) Eurostat https://ec.europa.eu/eurostat/databrowser/view/demo_mexrt/default/table?lang=en. EU experienced excess all-cause mortality in the first nine months of 2022 COVID-19 vaccination has prevented SARS- CoV-2-related hospital admission and deaths Lancet (5th May 2021) https://pubmed.ncbi.nlm.nih.gov/33964222/ BMJ (13th May 2021) https://pubmed.ncbi.nlm.nih.gov/33985964/ COVID-19 vaccination has side effects such as myocarditis and pericarditis JAMA Cardiology (1st June 2022) https://pubmed.ncbi.nlm.nih.gov/35442390/ JAMA (25th Jan 2022) https://pubmed.ncbi.nlm.nih.gov/35076665/ A recent study falsified a suspected association between the two diagnoses and COVID-19 virus infection Journal of Clinical Medicine (15th April 2022) https://pubmed.ncbi.nlm.nih.gov/35456309/ Post COVID-19 infection was not associated with either myocarditis or pericarditis Vaccination uptake is the percentage of the total population that has received a “primary course” by week 52, 2021. The interaction between vaccination up- take and time passed in months since the beginning of 2022 is strongly significant and implies that the mortality increases the higher the vaccination uptake. Potential reverse causality Could the excess mortality have caused the increase in vaccinations? Concerning alternative explanations We controlled for average all-cause mortality in 2020 and 2021, divided by the average between 2016 and 2019 Relatively low mortality at one period is followed by relatively high mortality later, and vice versa. We still observed a significant association between 2021 vaccination uptake and the 2022 monthly increase in all-cause mortality. Concerning ecological fallacy We are cautious about making individual-level inferences from our nation-level findings. Excess mortality, delayed diagnosis or medical treatment We cannot see that the issues have been more prevalent in high-vaccination vs. low-vaccination countries. I.e., we do not expect delayed diagnosis or medical treatment during COVID-19 to substantially have induced omitted variable bias.

• published: 22 Mar 2023
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