Change in age distribution of COVID-19 deaths with the introduction of COVID-19 vaccination

OBJECTIVES: Most countries initially deployed COVID-19 vaccines preferentially in elderly populations. We aimed to evaluate whether population-level vaccine effectiveness is heralded by an increase in the relative proportion of deaths among non-elderly populations that were less covered by vaccination programs. ELIGIBLE DATA: We collected data from 40 countries on age-stratified COVID-19 deaths during the vaccination period (1/14/2021–5/31/2021) and two control periods (entire pre-vaccination period and excluding the first wave). MAIN OUTCOME MEASURES: We meta-analyzed the proportion of deaths in different age groups in vaccination versus control periods in (1) countries with low vaccination rates; (2) countries with age-independent vaccination policies; and (3) countries with standard age-dependent vaccination policies. RESULTS: Countries that prioritized vaccination among older people saw an increasing share of deaths among 0–69 year old people in the vaccination versus the two control periods (summary proportion ratio 1.32 [95 CI% 1.24–1.41] and 1.35 [95 CI% 1.26–1.44)]. No such change was seen on average in countries with age-independent vaccination policies (1.05 [95 CI% 0.78–1.41 and 0.97 [95 CI% 0.95–1.00], respectively) and limited vaccination (0.93 [95 CI% 0.85–1.01] and 0.95 [95 CI% 0.87–1.03], respectively). Proportion ratios were associated with the difference of vaccination rates in elderly versus non-elderly people. No significant changes occurred in the share of deaths in age 0–49 among all 0–69 deaths in the vaccination versus pre-vaccination periods. CONCLUSIONS: The substantial shift in the age distribution of COVID-19 deaths in countries that rapidly implemented vaccination predominantly among elderly provides evidence for the population level-effectiveness of COVID-19 vaccination and a favorable evolution of the pandemic towards endemicity with fewer elderly deaths.