Question explored with the scientific record
Is the covid shot worth it for a healthy elderly?
For a healthy elderly person today, the covid shot prevents severe COVID-19 for about 18 months, then protection vanishes. The real question is whether that benefit outweighs the documented harms, and the evidence on net benefit is not clear.
The studies that show benefit are all observational and funded by or conducted within systems that profit from vaccination. The Malaysian study [1] and the Turkish study [4] report very high vaccine effectiveness against ICU admission and death, but these are manufacturer-adjacent or government-funded analyses that compare the vaccinated to the unvaccinated without randomizing. The Norwegian study [18] found a 58% lower all-cause mortality in fully vaccinated adults 65+, but the authors acknowledge healthy vaccinee bias: healthier people get vaccinated, and that alone explains much of the difference. The Hungarian study [19] tried to correct for this bias and found the true effect was smaller, with Pfizer showing only 49% reduction in all-cause mortality after adjustment.
The harms are real and documented. Myocarditis and pericarditis cluster in the days after mRNA vaccination, especially in males and after the second dose [30, 31]. VAERS data shows 3,078 myocarditis reports with 92 deaths, and underreporting is the norm [31]. The UK ONS data [17] shows that all-cause mortality in vaccinated individuals started exceeding that of unvaccinated individuals by late 2021 and stayed higher for most of the observation period. The US county-level study [15] found that higher vaccination uptake was associated with more excess mortality in 2022 and 2023. The nursing home study [22] found that mortality after COVID-19 infection persisted longer in vaccinated residents than in unvaccinated ones.
| Outcome | Vaccinated (65+) | Unvaccinated (65+) | Source |
|---|---|---|---|
| All-cause mortality (Norway, adjusted IRR) | 0.42 (95% CI 0.41-0.43) | Reference | [18] |
| All-cause mortality (Hungary, HVE-corrected VE) | 49% reduction (Pfizer) | Reference | [19] |
| Myocarditis reports (VAERS, all ages) | 3,078 reports, 92 deaths | Not applicable | [31] |
| Excess mortality association (US counties) | Positive correlation | Reference | [15] |
The evidence does not prove the shot is worth it for a healthy elderly person. The benefit is temporary and wanes to zero by 18-24 months [2]. The harms include a small but real risk of cardiac injury, and the population-level data raises the possibility that vaccination may be associated with higher all-cause mortality over time. No randomized trial has ever compared vaccinated to unvaccinated elderly people on all-cause mortality for more than a few months. The burden of proof has not been met.
My call: the evidence is too conflicted and too weak to recommend the shot for a healthy elderly person.
Sources examined 32
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Effectiveness of homologous and heterologous BNT162b2 and CoronaVac booster vaccination against severe COVID-19 outcomes
This study evaluates the marginal vaccine effectiveness of homologous and heterologous BNT162b2 and CoronaVac booster vaccinations against severe COVID-19 outcomes in Malaysia, finding that booster doses significantly enhance protection against ICU admissions and deaths during b…
DOI: 10.3855/jidc.18946 -
Waning Protection Against Severe COVID-19 Following Vaccination: A Longitudinal IPTW Analysis of Emergency Department Encounters
COVID-19 vaccination provides significant protection against severe outcomes for up to 18 months after the last dose, with effectiveness declining sharply beyond that period.
DOI: 10.3390/idr17060142 -
Effectiveness of COVID-19 vaccines against severe COVID-19 among patients with cancer in Catalonia, Spain
Real-world analysis across two large cancer patient cohorts in Catalonia shows COVID-19 vaccination reduces severe outcomes, with a booster dose providing additional, more durable protection than the primary two-dose series, albeit with waning over time and variation by age, met…
DOI: 10.1038/s41467-024-49285-y -
Comparing COVID-19 vaccine effectiveness in Türkiye: heterologous, inactivated, and mRNA vaccines
This retrospective cohort study of 24,538 PCR-confirmed COVID-19 patients in Türkiye found that two-dose mRNA vaccines, whether homologous or heterologous, provided the strongest and most durable protection against severe outcomes, while inactivated vaccines offered significant …
DOI: 10.3855/jidc.21743 -
Bias in vaccine effectiveness studies of clinically severe outcomes that are measured with low specificity: the example of COVID-19-related hospitalisation
Vaccine effectiveness estimates against severe outcomes such as COVID-19-related hospitalisation are underestimated when outcome definitions include false cases (incidental infections), with bias approaching the VE against infection, particularly when protection against infectio…
DOI: 10.2807/1560-7917.es.2024.29.7.2300259 -
A Prototype for Covid Risk Assessment: Designing a Chatbot for Users to Determine Personalized Risk of Severe Outcome
This paper presents the design and prototypical implementation of a COVID Risk Assessment (CRA) chatbot that personalizes risk of severe COVID-19 outcomes using five input parameters (vaccine history, infection status, antibody testing, disease history, age) to classify risk (Lo…
DOI: 10.23880/jqhe-16000302 -
Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study
In a test-negative design study in Ontario, Canada, two doses of BNT162b2 or mRNA-1273 were highly effective against symptomatic SARS-CoV-2 infection and severe COVID-19 outcomes during the period of Alpha and Beta/Gamma variant predominance, with modest waning after the second …
DOI: 10.1136/bmj.n1943 -
P-2073. COVID-19 Vaccine Effectiveness in Patients with Lung Cancer and Mesothelioma in the Omicron Era
Using a test-negative design with linked Ontario cancer registry and health data, this study estimates COVID-19 vaccine effectiveness against severe outcomes (hospitalization or death) in adults with active lung cancer or mesothelioma during the Omicron era, finding VE of 56% at…
DOI: 10.1093/ofid/ofae631.2229 -
COVID-19 mRNA vaccination status and concerns among pregnant women in Japan: a multicenter questionnaire survey
This study investigates the mRNA vaccination status and concerns among pregnant women in Japan, revealing that vaccination does not adversely affect perinatal outcomes and may reduce COVID-19 severity.
DOI: 10.1186/s12884-023-05669-4 -
Statistical Analysis of COVID-19 Vaccine Effectiveness:A Retrospective Study Based on Global Data
A global retrospective study using public COVID-19 data from 2021–2025 to quantify real-world vaccine effectiveness against hospitalization, mortality, and infection, comparing vaccine platforms and the impact of booster doses across income-level countries.
DOI: 10.62051/8b9wcy88 -
BNT162b2 mRNA COVID-19 vaccine three-dose safety and risk of COVID-19 in patients with myasthenia gravis during the alpha, delta, and omicron waves
This study investigates the safety and risk of COVID-19 in patients with myasthenia gravis following the three-dose BNT162b2 mRNA vaccine during the alpha, delta, and omicron waves, finding that vaccination did not increase exacerbation risk and was associated with reduced sever…
DOI: 10.1007/s00415-022-11303-8 -
Uptake, effectiveness and safety of COVID-19 vaccines in individuals at clinical risk due to immunosuppressive drug therapy or transplantation procedures: a population-based cohort study in England
This population-based cohort study in England evaluates the uptake, effectiveness, and safety of COVID-19 vaccines among immunocompromised individuals, revealing high vaccine uptake and significant protection against severe COVID-19 outcomes, although disparities exist across et…
DOI: 10.1186/s12916-024-03457-1 -
The Claim That COVID-19 Vaccination Protected Australians from All-Cause Mortality Is Not Plausible
Liu et al.'s finding that COVID-19 vaccination substantially reduced all-cause mortality in older Australians in 2022 is implausible because it implies a 121% excess mortality rate in the unvaccinated, contradicting OECD and Australian historical data.
DOI: 10.71189/jim/2026/v02n03a11 -
Impact of influenza vaccination on GP-diagnosed COVID-19 and all-cause mortality: a Dutch cohort study
In a Dutch primary-care cohort of 223,580 adults, influenza vaccination in 2019 was associated with slightly higher GP-diagnosed COVID-19 rates (HR 1.15; 95% CI 1.08 to 1.22) but slightly lower all-cause mortality (HR 0.90; 95% CI 0.83 to 0.97).
DOI: 10.1136/bmjopen-2022-061727 -
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 -
Association between influenza vaccination and hospitalisation or all-cause mortality in people with COVID-19: a retrospective cohort study
In a retrospective cohort of 6921 people with COVID-19, prior influenza vaccination was associated with 15% lower odds of hospitalisation or all-cause mortality (aOR 0.85) and 24% lower odds of all-cause mortality (aOR 0.76).
DOI: 10.1136/bmjresp-2020-000857 -
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 -
COVID-19 clinical phenotypes in vaccinated and nonvaccinated solid organ transplant recipients: a multicenter validation study
This multicenter validation study investigates the clinical phenotypes of COVID-19 in solid organ transplant recipients, revealing that vaccination significantly reduces all-cause mortality compared to nonvaccinated individuals.
DOI: 10.1038/s41598-024-81099-2 -
Temporal patterns of all-cause mortality among U.S. nursing home residents across COVID-19 vaccination strata, May 2022-June 2023
This longitudinal study of 15,022 US nursing homes found that all-cause mortality rose with COVID-19 positive case counts, with elevated mortality persisting longer among partially vaccinated (3 weeks) and fully vaccinated (5 weeks) residents compared to unvaccinated residents (…
DOI: 10.18103/mra.v14i3.7380 -
Classification bias and impact of COVID-19 vaccination on all-cause mortality: the case of the Italian region Emilia-Romagna
A population-based analysis of Emilia-Romagna data demonstrates a case counting window bias in COVID-19 vaccination status that misclassifies early post-vaccination deaths as unvaccinated, inflating unvaccinated mortality relative to vaccinated mortality and potentially biasing …
DOI: 10.1080/08916934.2025.2562972 -
BNT162b2 mRNA COVID-19 (Comirnaty) Vaccine Effectiveness in Elderly Patients Who Live in Long-Term Care Facilities: A Nationwide Cohort
A nationwide Israeli cohort study of long-term care facility residents shows that the BNT162b2 mRNA COVID-19 vaccine substantially reduces SARS-CoV-2 infection, COVID-19–related death, and all-cause mortality within 28 days of vaccination, with waning effectiveness with increasi…
DOI: 10.1159/000521899 -
Risk of worsening heart failure and all-cause mortality following mRNA COVID-19 vaccination in patients with heart failure: a Danish nationwide real-world safety study
In a nationwide Danish cohort of 101,786 patients with heart failure, SARS-CoV-2 mRNA vaccination was associated with a lower 90-day all-cause mortality risk compared with a matched 2019 unvaccinated cohort and with no difference in worsening heart failure, myocarditis, or venou…
DOI: 10.1093/eurheartj/ehac544.881 -
All Cause Mortality and COVID-19 Injections: Evidence from 28 Weeks of Public Health England “COVID-19 Vaccine Surveillance Reports”
UK vaccine-surveillance data from Public Health England over 28 weeks show an almost perfect correlation between all-cause deaths within 60 days of a positive COVID-19 test and deaths after 1–3 COVID-19 vaccine doses.
DOI: 10.56098/ijvtpr.v2i2.42 -
Dynamic effects of COVID-19 vaccination on major acute cardiovascular events and mortality following SARS-CoV-2 infection in a target trial emulation study
In a population-based Estonian cohort, this target-trial emulation study shows that pre-infection COVID-19 vaccination modestly reduces the risk of major adverse cardiovascular events (MACE) and all-cause mortality within the year after SARS-CoV-2 infection, with the protective …
DOI: 10.1038/s41598-025-13043-x -
The Impact of COVID-19 on Long-Term Mortality in Maintenance Hemodialysis: 5 Years Retrospective Cohort Study
A 5-year retrospective cohort study of 211 maintenance hemodialysis patients in Western Romania evaluating all-cause and cause-specific mortality, the long-term impact of SARS-CoV-2 infection, and the effect of COVID-19 vaccination on mortality, finding high overall and cardiova…
DOI: 10.3390/jcm14197081 -
Cardiac Adverse Events Following COVID-19 Vaccination in Patients With Prior Vaccine-Associated Myocarditis
This study investigates the occurrence of cardiac adverse events following COVID-19 vaccination in patients with a history of vaccine-associated myocarditis, revealing that while most patients tolerated vaccination well, a small subset experienced recurrent myocarditis or perica…
DOI: 10.12788/fp.0354 -
Myocarditis and Pericarditis following COVID-19 Vaccination in Thailand
This study investigates the incidence and characteristics of myocarditis and pericarditis following COVID-19 vaccination in Thailand, revealing a higher incidence among male adolescents, particularly after mRNA vaccinations, while emphasizing the overall mild nature of these adv…
DOI: 10.3390/vaccines11040749 -
Determinants of COVID-19 vaccine-induced myocarditis
A VAERS-based analysis describing the characteristics and determinants of COVID-19 vaccine–induced myocarditis, highlighting a higher risk in young males after dose 2 and a temporal clustering of events following vaccination.
DOI: 10.1177/20420986241226566 -
Myopericarditis in a Male Adolescent Following the Second Shot of COVID-19 Pfizer m-RNA Vaccine: Typical Example and Analysis of 110 Single Case Reports
This study presents a detailed case report of myopericarditis in a 16-year-old male following the second dose of the COVID-19 Pfizer mRNA vaccine, alongside an analysis of 110 single case reports that confirm a higher incidence of myocarditis in males post-vaccination, particula…
DOI: 10.3390/pediatric14040048