I’ll start off this week with data not from the latest UKHSA Vaccine Surveillance Report, nor even from the U.K. – the first chart for today shows the excess deaths in Israel since 2017 for those aged 65 or over. Just something to think about and I’ll come back to it at the end.
In this week’s UKHSA report the story is much the same as prior weeks – infection rates are still highest in the triple vaccinated except for individuals aged under 18 or over 80; the data for those aged under 18 continue to shift towards decreasing vaccine protection, while there’s not much change in vaccine performance for those aged over 80. At least infection rates are declining across the board as this January’s Omicron wave recedes into history.
Using the rates data above to estimate vaccine effectiveness against infection again shows the vaccines to be performing poorly, with all vaccinated bar those under 18 now showing substantially increased risk of infection (and thus also onwards transmission). Strikingly, the triple vaccinated aged 18-70 have around triple the risk of infection compared to the unvaccinated.
Plotting vaccine effectiveness against infection by time shows that while the vaccine effectiveness for one or two doses is broadly flat, albeit mostly negative, across all age ranges, the protection offered by three doses continues to drop relentlessly. This now appears to be more serious than a simple waning of vaccine protection; the data instead appear to be more characteristic of a dose-effect, with the more doses given resulting in increased risk. Time will tell if this is indeed the case.
Protection against hospitalisation shows a similar picture to last week’s data, with a continued drift downwards in the protection offered by three doses. The protection offered by three doses appears to be better in those aged over 50; it isn’t clear why this should be the case, although I note that the immune system does change with age, and particularly for those aged over 65-70 – it might be that the vaccines offer more benefit for those suffering from age related immune dysfunction. The situation with one or two doses appears to be drifting downwards with two doses increasing risk of hospitalisation slightly (slightly negative protection) and one dose being associated with substantially increased risk of hospitalisation risk.
The protection offered by the vaccines against death perhaps shows the most worrying trend, with a rather significant downwards slope deeper into negative territory for one or two doses of vaccine, and a lower but nevertheless prominent slide in vaccine effectiveness for those triple jabbed. It is important to add that while these data do show that while a triple dose of vaccine does appear to reduce the risk of death from Covid, they don’t offer any information whatsoever about any side-effect/complication risk of the Covid vaccines.
The above graphs show vaccine effectiveness and thus don’t really indicate the impact of the vaccines on the progression of each Covid wave – I think it might be instructive to show a little data on how the vaccines appear to have impacted on Covid rates since the start of the year. I’ll focus on one age group – those aged 40 to 50 – as this will keep the graphs relatively simple, but note that similar trends are seen across all age groups. I’ll also lump all vaccinated together into one group called ‘any vaccine’.
The changes in case rates are perhaps what you’d expect if you’d been following the UKHSA publications over the weeks – rates are higher in those that are vaccinated, but in both the vaccinated and unvaccinated case rates were highest at the start of the year and have been declining at a relatively similar pace since.
The data for hospitalisations, however, shows a different pattern. While the hospitalisation rate in the unvaccinated has declined significantly since the start of the year, the data for those having taken any vaccine shows a much more subdued reduction, with signs of a slight peak in hospitalisations around the latter part of January. Note how the hospitalisation data ends with there being little difference in hospitalisation rates between the unvaccinated and those having taken any vaccine.
But it is the deaths (within 60 days of a positive test) data that shows the most worrying trend. The vaccines still appear to offer protection against death. However, while the death rate in the unvaccinated has been in a strong trend downwards since the start of the year, the death rate in the vaccinated has been trending upwards.
These data are very concerning as they suggest that serious Covid disease is now behaving differently in the vaccinated than in the unvaccinated; since the start of the year hospitalisations have reduced markedly in both the vaccinated and unvaccinated, but while deaths have decreased in the unvaccinated, they have increased in the vaccinated and remain relatively high. It isn’t clear why this should be the case, but several potential reasons jump out:
- The curve above could reflect the change in death rates as the Omicron variant replaced Delta. In this case the data would suggest that the net impact of Omicron is of increased mortality rates in the vaccinated; the increased numbers of cases and increased vaccine escape in Omicron result in an increase in deaths despite the indications that the mortality rate of Omicron is lower than that of Delta per infection. However, the curve in the graph above doesn’t match the rapid switch to Omicron variant seen at the end of last year. In addition, the mismatch between the curves for hospitalisations and deaths in the vaccinated suggests that there is more to it.
- The change in mortality rates indicated in the figure above does better match the spread of Omicron BA.1.1 variant in the U.K. However, this variant is not very different from variant BA.1 and there are no other indications that it has any substantial impact on the severity of disease.
- It might be that Omicron variant BA.2 is more deadly than we think to the vaccinated. In this case the slow climb upwards in the deaths data for the vaccinated would reflect the slow increase in BA.2 variant in the U.K., despite the dramatic reduction in cases of the BA.1 variant. BA.2 is still only present in relatively small numbers in the UK (about 25% according to the UKHSA’s Technical Briefing 37) and thus would need to be much more deadly in the vaccinated to get the change in mortality rates of the magnitude seen.
- The mortality rate data seen above could arise due to differences in the time course of infection in the vaccinated versus unvaccinated. The unvaccinated appear to be following the known progression of Covid disease, with those few that succumb to Covid doing so about two to three weeks after infection. The vaccinated, however, appear to be having a more protracted disease progression and dying sometime later. Quite how much later is not clear – looking at the chart suggests that the period of increased mortality isn’t over yet.
A simple examination of the relative trends of the vaccinated and unvaccinated mortality rates suggests that the two curves will cross over some time between the UKHSA week 10 Vaccine Surveillance Report and the report for week 11, although I note that the data shown in the graph above are for deaths within 60 days; if it is due to a slower disease progression in the vaccinated then the data could well be curtailed as the 60 day point after infection is reached. Any Covid deaths that occur after the 60 day point will be regarded in the data as connected with neither vaccination nor Covid – they’ll be relegated into the realms of ‘short illness’ and ‘sudden death’ that fills too many news reports in recent times.
These data indicating that deaths in the vaccinated aren’t declining as expected after the January Covid wave are very concerning, whatever the reason. Under normal times there would be an urgent investigation into what exactly was occurring and why, and what mitigating actions were required. But these aren’t normal times and I imagine we’ll get the same action as has occurred when other ‘inconvenient’ data have emerged about the vaccines – i.e., nothing will be done.
And that brings me right back to where I started, with that graph of excess deaths in what is probably the most vaccinated country in greater Europe. Something has occurred in Israel to give a significant rise in deaths in the last few weeks, far above what might be expected at this time of year – they’ve now got their highest death rate in those aged over 65 since Covid began two years ago. I note that while Israel and the U.K. began vaccinating at about the same time, in Israel they gave the second dose approximately 30 days after the first, while in the UK we waited approximately 90 days – this has resulted in Israel being about 60 days ahead of the UK in terms of the impact of vaccination on their population…
Amanuensis is an ex-academic and senior Government scientist. He blogs at Bartram’s Folly.