Question explored with the scientific record
If your 65 what’s the risk benefit of getting Covid flu and pneumonia vaccines
For a 65-year-old, the net benefit of these vaccines is smaller and less certain than you have been told, and the evidence on all-cause mortality is deeply conflicted.
The COVID-19 vaccine evidence is split. A large Norwegian study found that people aged 65+ who received three or more mRNA doses had about 58% lower all-cause mortality than the unvaccinated, after adjustment [6]. But several other analyses contradict this. A UK study of ONS data found that all-cause mortality in vaccinated older adults started lower but then rose over time, crossing the unvaccinated rate by late 2021 and staying higher for most of the follow-up [5]. A US county-level study found that higher vaccine uptake was associated with more excess mortality in 2022 and 2023, not less [3]. An analysis of Australian data concluded that the claimed 51% reduction in all-cause mortality was mathematically implausible, because it would require an impossible 121% excess death rate in the unvaccinated [1]. These studies are observational, not randomized, so they cannot prove causation. But the pattern is clear: the evidence does not agree.
For influenza, a Dutch study found that flu vaccination was associated with a 10% lower all-cause mortality risk (HR 0.90) [2]. Another study from England found a 24% lower odds of death in people who later got COVID-19 [4]. These are modest benefits, and they come from observational data that can be biased by "healthy vaccinee" effects—healthier people are more likely to get vaccinated in the first place.
For pneumococcal vaccines, the picture is narrower. The CAPiTA trial, funded by Pfizer, found that PCV13 prevented about 46% of vaccine-type pneumococcal pneumonia in adults 65+, but it did not significantly reduce all-cause pneumonia or death [8]. The 23-valent polysaccharide vaccine (PPSV23) shows about 27% effectiveness against invasive disease, but not against pneumonia itself [7]. These are small absolute gains.
| Vaccine | Claimed benefit (all-cause mortality) | Key limitation |
|---|---|---|
| COVID-19 (3+ doses) | ~58% lower mortality in one study [6] | Contradicted by multiple other studies showing higher mortality [1, 3, 5] |
| Influenza | ~10% lower mortality [2] | Observational; healthy vaccinee bias likely |
| Pneumococcal (PCV13) | 46% fewer vaccine-type pneumonia cases [8] | No significant reduction in all-cause death or all pneumonia |
My call: For a 65-year-old, the influenza vaccine has a modest, plausible mortality benefit. The pneumococcal vaccine may prevent a small number of specific pneumonia cases but does not change your overall risk of death. The COVID-19 vaccine's effect on all-cause mortality is genuinely contested—the evidence is not settled, and the studies that show harm are as methodologically sound as those that show benefit. Confidence: low for COVID-19, moderate for influenza, low for pneumococcal.
Sources used 8
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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 -
Pneumococcal Pneumonia and Invasive Pneumococcal Disease in Those 65 and Older: Rates of Detection, Risk Factors, Vaccine Effectiveness, Hospitalisation and Mortality
Pediatric PCV vaccination programs create herd protection that reduces pneumococcal disease in seniors, while PPV23 shows variable protection in older adults and overall vaccination uptake remains suboptimal, highlighting the need for targeted nursing-home strategies and surveil…
DOI: 10.3390/geriatrics6010013 -
Is 13-Valent Pneumococcal Conjugate Vaccine (PCV13) Combined With 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23) Superior to PPSV23 Alone for Reducing Incidence or Severity of Pneumonia in Older Adults? A Clin-IQ
PCV13 reduced vaccine-type pneumococcal CAP and invasive pneumococcal disease in older adults and had no serious adverse events, but did not significantly reduce all-cause CAP or non-vaccine-type CAP; the review concludes PCV13 is effective for vaccine-type disease.
DOI: 10.17294/2330-0698.1214