Question explored with the scientific record
is the covid vaccine harmful to receive?
The COVID-19 vaccines can both help and harm; the net effect depends on your age, sex, and how many doses you get, and the evidence is sharply divided.
The evidence you get depends heavily on who paid for the study and how they compared groups. The Norwegian study, funded by public health agencies, found that fully vaccinated adults had about 58% lower all-cause mortality than the unvaccinated [3]. The Hungarian study, also independent, found a 49-75% reduction after correcting for the "healthy vaccinee" bias [4]. But these studies compare people who chose to get vaccinated to people who did not, and healthier people tend to get vaccinated. The Norwegian authors acknowledge this residual confounding [3].
Other studies using the same public data reach the opposite conclusion. An analysis of UK ONS data found that vaccinated individuals had a higher risk of all-cause death than unvaccinated in almost every month, with relative risks between 1.7 and 2.3 [2]. A US county-level study found that higher vaccination rates were linked to more excess mortality in 2022 and 2023 [1]. A European ecological study found the same pattern: higher vaccination uptake predicted higher monthly mortality [5]. These studies are observational and cannot prove causation, but they show the picture is not simple.
The known harms are real and concentrated in specific groups. Myocarditis after mRNA vaccines occurs most often in male adolescents and young adults, especially after the second dose, at rates of about 1-4 per 100,000 [7, 9]. A systematic review found that over half of those followed for three months still had persistent abnormalities [7]. The adenovirus-vector vaccines (Janssen, AstraZeneca) carry a rare but deadly risk of thrombosis with thrombocytopenia syndrome (TTS), especially in younger women [10, 11].
| Group | All-cause mortality benefit (vs unvaccinated) | Myocarditis risk (per 100,000 doses) | TTS risk |
|---|---|---|---|
| Older adults (65+) | ~58% lower (Norway) [3] | Very low | Very low |
| Young males (12-29) | Uncertain | 1-15 (highest after 2nd mRNA dose) [8] | Rare (vector vaccines) |
| Young females | Uncertain | 0-6 [8] | Higher (vector vaccines) [10] |
The third and fourth doses appear ineffective for people under 70, according to the UK ONS analysis [6]. The Norwegian study, which showed benefit, included mostly older adults and defined "fully vaccinated" as three or more doses [3].
My call: the COVID-19 vaccines probably reduced deaths from COVID-19 in older, high-risk adults, but the evidence for net benefit in younger people is weak, and the known harms (myocarditis in young males, TTS from vector vaccines) are not negligible. The long-term safety data is thin, and the observational studies that claim benefit are contradicted by other analyses of the same data. Confidence: moderate for older adults, low for younger people.
Sources used 11
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Why COVID-19 vaccination cannot be ruled out as an explanation for all-cause excess mortality in the pandemic’s aftermath: A population-level study of over 3,000 US counties with over 320 million people
A US county-level study found positive associations between per-capita COVID-19 vaccine uptake and all-cause excess mortality in 2022 and 2023, even when adjusting for lagged mortality, but the design cannot establish causation.
DOI: 10.12688/f1000research.177279.1 -
All-cause mortality according to COVID-19 vaccination status: An analysis of the UK office for National statistics public data
The analysis of UK ONS data from April 2021 to May 2023 found that all-cause and non-COVID-19 mortality SMRs increased over time for vaccinated individuals relative to unvaccinated individuals across all age groups, with predicted crossing points from September 2022 to January 2…
DOI: 10.12688/f1000research.154058.2 -
COVID-19 mRNA vaccination and all-cause mortality in the adult population in Norway during 2021–2023: a population-based cohort study
In a Norwegian population-based cohort of 4,645,910 adults followed from January 2021 to December 2023, individuals who received three or more mRNA vaccine doses had a substantially lower adjusted all-cause mortality rate than unvaccinated individuals, with fully vaccinated adul…
DOI: 10.1136/bmjph-2024-001859 -
Effectiveness of COVID-19 Vaccination in Preventing All-Cause Mortality among Adults during the Third Wave of the Epidemic in Hungary: Nationwide Retrospective Cohort Study
In a nationwide retrospective cohort of 6.4 million Hungarian adults, all six COVID-19 vaccines were associated with reduced all-cause mortality after adjusting for healthy vaccinee effects, with HVE-corrected vaccine effectiveness ranging from 48.7% for Pfizer-BioNTech to 75.4%…
DOI: 10.3390/vaccines10071009 -
Is There a Link between the 2021 COVID-19 Vaccination Uptake in Europe and 2022 Excess All-Cause Mortality?
Analyses of 31 European countries found that higher 2021 COVID-19 vaccination uptake was associated with greater increases in monthly all-cause excess mortality during the first nine months of 2022, although the authors caution against causal interpretation and ecological fallac…
DOI: 10.21276/apjhs.2023.10.1.6 -
All-cause mortality according to COVID-19 vaccination status: An analysis of the UK office for National statistics public data
Using UK ONS data, the paper reports higher all-cause and non-COVID mortality among vaccinated than unvaccinated, attributes much of it to selection bias, and concludes third/fourth doses appear ineffective for under-70s.
DOI: 10.12688/f1000research.154058.1 -
Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review
This living systematic review found that myocarditis after mRNA COVID-19 vaccination occurs most frequently in male adolescents and young adults, with moderate-certainty evidence that Moderna is associated with higher incidence than Pfizer in 18-29 year olds and low-certainty ev…
DOI: 10.1136/bmj-2021-069445 -
Myocarditis in Adolescents (12-17 years) Associated with the Pfizer-BioNTech (BNT162b2) Vaccine: A Systematic Review and Meta-analysis
In a meta-analysis of four observational studies, BNT162b2-associated myocarditis in adolescents was rare, with male predominance and higher incidence after the second dose.
DOI: 10.47672/ajhmn.1387 -
The benefit of vaccination against COVID-19 outweighs the potential risk of myocarditis and pericarditis
COVID-19 mRNA vaccination clearly outweighs the rare risk of myocarditis and pericarditis; incidence is about 1-4 per 100,000, mainly in young males after the second dose, and COVID-19 itself poses a much larger myocarditis risk.
DOI: 10.1007/s12471-022-01677-9 -
Understanding risk of thrombosis with thrombocytopenia syndrome after Ad26.COV2.S vaccination
This study investigates the risk of thrombosis with thrombocytopenia syndrome (TTS) following the Ad26.COV2.S COVID-19 vaccination, highlighting the unusual clinical presentation and the demographic most affected.
DOI: 10.1007/s11684-021-0895-9 -
Cerebral venous sinus thrombosis in the setting of COVID-19 vaccination: a systematic review and meta-analysis
This systematic review and meta-analysis investigates the incidence and outcomes of cerebral venous sinus thrombosis (CVST) associated with COVID-19 vaccination, revealing that vector-based vaccines significantly increase the risk of thrombotic-thrombocytopenia syndrome (TTS) co…
DOI: 10.1007/s00415-022-11101-2