Patterns of protection, infection, and detection: Country-level effectiveness of COVID 19 vaccination in reducing mortality worldwide

Rughinis, Cosima and Dima, Mihai and Vulpe, Simona Nicoleta and Rughinis, Razvan and Vasile, Sorina (2022): Patterns of protection, infection, and detection: Country-level effectiveness of COVID 19 vaccination in reducing mortality worldwide.

Abstract

We investigated the negative relationship between mortality and COVID 19 vaccination at ecological level, which has been established through clinical trials and other investigations at the individual level. We conducted an exploratory, correlational, country-level analysis of open data centralized by Our World in Data concerning the cumulative COVID 19 mortality for the winter wave (October 2021–March 2022) of the pandemic as function of the vaccination rate in October 2021. At country level, patterns of vaccine protection have not been clearly differentiated from patterns of COVID-19 infection and detection. In order to disentangle the protective relationship from confounding processes, we controlled variables that capture country-level social development and level of testing. We also deployed three segmentation tactics, distinguishing among countries based on their level of COVID 19 testing, age structure, and types of vaccines used. Controlling for confounding factors did not highlight a statistically significant global relationship between vaccination and cumulative mortality in the total country sample. As suggested by previous estimates at country level, a strong, significant, negative relationship between cumulative mortality (log scale) and vaccination was highlighted through segmentation analysis for countries positioned at the higher end of the social development spectrum. The strongest estimate for vaccine effectiveness at ecological level was obtained for countries that use Western-only vaccines. This may partly reflect the higher effectiveness of Western vaccines in comparison with the average of all vaccines in use; it may also derive from the lower social heterogeneity of countries included in this segment, which minimizes confounding influences. COVID-19 testing (log scale) has a significant and positive relationship with cumulative mortality for all subsamples, consistent with patterns of under- and overreporting of COVID-19 deaths at country level, partly driven by testing. This indicates that testing intensity should be controlled as a potential confounder in future ecological analyses of COVID-19 mortality.

• Item Type: MPRA Paper
• Language: English
• Keywords: COVID-19 vaccine; vaccine effectiveness; mortality; COVID-19 testing; ecological study
• Subjects: I - Health, Education, and Welfare > I0 - General > I00 - General

References

[1] Shahbazi F, Khazaei S. Socio-economic inequality in global incidence and mortality rates from coronavirus disease 2019: an ecological study. New Microbes and New Infections 2020;38:100762. https://doi.org/10.1016/J.NMNI.2020.100762.

[2] Mohammed I, Nauman A, Paul P, Ganesan S, Chen KH, Jalil SMS, et al. The efficacy and effectiveness of the COVID-19 vaccines in reducing infection, severity, hospitalization, and mortality: a systematic review. Hum Vaccin Immunother 2022;18. https://doi.org/10.1080/21645515.2022.2027160.

[3] Mathieu E, Roser M. How do death rates from COVID-19 differ between people who are vaccinated and those who are not? OurWordInDataOrg 2021. https://ourworldindata.org/covid-deaths-by-vaccination (accessed February 6, 2022).

[4] Noor R, Shareen S, Billah M. COVID-19 vaccines: their effectiveness against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its emerging variants. Bulletin of the National Research Centre 2022 46:1 2022;46:1–12. https://doi.org/10.1186/S42269-022-00787-Z.

[5] Zhou L, Puthenkalam JJ, Zhou L, Puthenkalam JJ. Effects of the Human Development Index on COVID-19 Mortality Rates in High-Income Countries. European Journal of Development Studies 2022;2:26–31. https://doi.org/10.24018/EJDEVELOP.2022.2.3.104.

[6] Jabłońska K, Aballéa S, Toumi M. The real-life impact of vaccination on COVID-19 mortality in Europe and Israel. Public Health 2021;198:230–7. https://doi.org/10.1016/J.PUHE.2021.07.037.

[7] Papadopoulos VP, Emmanouilidou A, Yerou M, Panagaris S, Souleiman C, Varela D, et al. SARS-CoV-2 Vaccination Coverage and Key Public Health Indicators May Explain Disparities in COVID-19 Country-Specific Case Fatality Rate Within European Economic Area. Cureus 2022;14. https://doi.org/10.7759/CUREUS.22989.

[8] Ziakas PD, Kourbeti IS, Mylonakis E. Comparative Analysis of Mortality From Coronavirus Disease 2019 Across the European Union Countries and the Effects of Vaccine Coverage. Open Forum Infectious Diseases 2022;9. https://doi.org/10.1093/OFID/OFAC006.

[9] Ylli A, Burazeri G, Wu YY, Sentell T. COVID-19 excess death rate in Eastern European countries associated with weaker regulation implementation and lower vaccination coverage. MedRxiv 2022:2022.02.06.22270549. https://doi.org/10.1101/2022.02.06.22270549.

[10] Ning C, Wang H, Wu J, Chen Q, Pei H, Gao H. The COVID-19 Vaccination and Vaccine Inequity Worldwide: An Empirical Study Based on Global Data. International Journal of Environmental Research and Public Health 2022, Vol 19, Page 5267 2022;19:5267. https://doi.org/10.3390/IJERPH19095267.

[11] Liang LL, Kuo HS, Ho HJ, Wu CY. COVID-19 vaccinations are associated with reduced fatality rates: Evidence from cross-county quasi-experiments. Journal of Global Health 2021;11:1–9. https://doi.org/10.7189/JOGH.11.05019.

[12] Huang C, Yang L, Pan J, Xu X, Peng R. Correlation between vaccine coverage and the COVID-19 pandemic throughout the world: Based on real-world data. Journal of Medical Virology 2022;94:2181–7. https://doi.org/10.1002/JMV.27609.

[13] Udoakang A, Oboh M, Henry-Ajala A, Anyigba C, Omoleke S, Amambua-Ngwa A, et al. Low COVID-19 impact in Africa: The multifactorial Nexus. Open Research Africa 2021;4:47. https://doi.org/10.12688/AASOPENRES.13261.1.

[14] Marziali ME, Hogg RS, Oduwole OA, Card KG. Predictors of COVID-19 testing rates: A cross-country comparison. International Journal of Infectious Diseases 2021;104:370–2. https://doi.org/10.1016/J.IJID.2020.12.083.

[15] Ioannidis JPA. Over- and under-estimation of COVID-19 deaths. European Journal of Epidemiology 2021;36:581–8. https://doi.org/10.1007/S10654-021-00787-9/FIGURES/2.

[16] Cao Y, Hiyoshi A, Montgomery S. COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data. BMJ Open 2020;10:e043560. https://doi.org/10.1136/BMJOPEN-2020-043560.

[17] Liang LL, Tseng CH, Ho HJ, Wu CY. Covid-19 mortality is negatively associated with test number and government effectiveness. Scientific Reports 2020 10:1 2020;10:1–7. https://doi.org/10.1038/s41598-020-68862-x.

[18] Wei C, Lee CC, Hsu TC, Hsu WT, Chan CC, Chen SC, et al. Correlation of population mortality of COVID-19 and testing coverage: a comparison among 36 OECD countries. Epidemiology & Infection 2021;149. https://doi.org/10.1017/S0950268820003076.

[19] Hasell J, Mathieu E, Beltekian D, Macdonald B, Giattino C, Ortiz-Ospina E, et al. Per capita: COVID-19 tests vs. Confirmed deaths n.d. https://ourworldindata.org/grapher/covid-19-tests-deaths-scatter-with-comparisons (accessed April 19, 2022).

[20] Hasell J, Mathieu E, Beltekian D, Macdonald B, Giattino C, Ortiz-Ospina E, et al. A cross-country database of COVID-19 testing. Scientific Data 2020;7. https://doi.org/10.1038/S41597-020-00688-8.

[21] Hasell J, Mathieu E, Beltekian D, Macdonald B, Giattino C, Ortiz-Ospina E, et al. Coronavirus (COVID-19) Testing - Our World in Data. Our World in Data 2022. https://ourworldindata.org/coronavirus-testing (accessed April 19, 2022).

[22] Iwata K, Miyakoshi C. Is COVID-19 mortality associated with test number? Journal of Family Medicine and Primary Care 2022;11:1842. https://doi.org/10.4103/JFMPC.JFMPC_1633_21.

[23] Mesas AE, Cavero-Redondo I, Álvarez-Bueno C, Cabrera MAS, de Andrade SM, Sequí-Dominguez I, et al. Predictors of in-hospital COVID-19 mortality: A comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions. PLOS ONE 2020;15:e0241742. https://doi.org/10.1371/JOURNAL.PONE.0241742.

[24] Hoffmann C, Wolf E. Older age groups and country-specific case fatality rates of COVID-19 in Europe, USA and Canada. Infection 2021;49:111–6. https://doi.org/10.1007/S15010-020-01538-W.

[25] Ritchie H, Mathieu E, Rodés-Guirao L, Appel C, Giattino C, Ortiz-Ospina E, et al. Coronavirus Pandemic (COVID-19). OurWordInDataOrg 2020.

[26] UNDP - United Nations Development Program. Human Development Reports 2020. https://hdr.undp.org/ (accessed April 18, 2022).

[27] Hernán MA, Clayton D, Keiding N. The Simpson’s paradox unraveled. International Journal of Epidemiology 2011;40:780–5. https://doi.org/10.1093/IJE/DYR041.