Last month Office for National Statistics published the first statistics on the number of fully vaccinated people who had subsequently died from COVID-19. They showed the risk of death involving COVID-19 was consistently lower for people who had received two vaccinations compared to one or no vaccination. However, there has also been some inaccurate speculation about the number of people who have died as a result of an adverse reaction to one of the vaccines.
There are two main sources for obtaining the number of deaths where the vaccine played a part; these are the Yellow Card Scheme by the Medicines and Healthcare products Regulatory Agency (MHRA) and death registrations analysis produced by the Office for National Statistics (ONS), National Records of Scotland (NRS) and Northern Ireland Statistics and Research Agency (NISRA).
Both sets of statistics are important but they have different purposes and use different sources.
What is the Yellow Card Scheme?
MHRA’s role is to continually monitor the safety of any medicine or vaccine once they are approved for use. Yellow Card is a website where any member of the public or health professional can report any suspected side effect. This includes deaths, which are reported by others on behalf of the deceased person. As the information is self-reported, it means that the suspected side effects are not always proven and some of the side effects may have occurred regardless of the vaccine.
The usefulness of the Yellow Card Scheme is that anyone can report their symptoms and the information can be provided quickly as it is based on notifications, meaning that people can provide information on a possible side effect as soon as it occurs. A summary of reports about COVID-19 vaccines from the Yellow Card scheme is provided weekly where they further explain the scheme and note the importance that the information is not interpreted as proven side effects.
The COVID-19 vaccination programme led to a very large number of people receiving vaccinations in a relatively short period. Some people will, sadly, die by chance shortly after receiving a vaccine, so the death can be mistakenly attributed to the COVID-19 vaccination by a family member or carer. In the course of such a large-scale programme, this could add up to a large number.
What are death registrations data?
When a death is registered the information, including causes involved in the death, is sent to the different statistical agencies across the UK (ONS, NRS and NISRA).
Doctors are required by law to certify the cause of death ‘to the best of their knowledge and belief’.
That means they use their medical expertise to decide the cause based on symptoms, physical examination, hospital records, laboratory tests, and all the other information available. If the death is certified by a coroner (as it needs further investigation), the Coroner’s Court follows legal rules of evidence when deciding the causes of death. This is slightly different in Scotland where it is investigated by the Procurator Fiscal.
For the vaccine to be mentioned on the death certificate the medical professional certifying the death must have believed, to the best of their knowledge, that the vaccine was part of the events that led to the death.
This information will take longer to come through because deaths that go to a coroner for investigation tend to take longer to be registered. Deaths can take several months to be registered if they are investigated by a coroner.
In Scotland deaths are referred to the Procurator Fiscal rather than a coroner and in these cases the death and a provisional cause must be registered within 8 days and may be updated later after the investigation is complete.
For this reason, we would expect the number of registered deaths to increase, especially for England, Wales and Northern Ireland where there is a lag between when a death occurs and when it is registered. Although this information takes longer to come through, it is the best way to know if the vaccine was part of the chain of events that led to the death.
What numbers are currently available?
The Yellow Card reporting scheme has reported that between 9 December 2020 and 8 September 2021 there were 1,645 deaths where the person died shortly after receiving one of the coronavirus vaccines. This is the number of deaths reported as possibly linked to a vaccine, however they will not have been fully investigated at the time of reporting and a report is not proof of causation. So, the numbers are likely to be a big overestimate. The MHRA follow up all such reports and use other sources of evidence such as the numbers of individuals who would be expected to experience different events irrespective of vaccination.
In contrast, the different statistical agencies have reported that to August 2021 (June 2021 in Northern Ireland) there were 4 deaths in England, 0 deaths in Wales, 4 deaths in Scotland and 1 in Northern Ireland. Of these, 4 in Scotland and 1 in Northern Ireland had the vaccine as the underlying cause of death. This meant that there were 9 deaths in the UK that involved the vaccine (meaning the vaccine contributed to the death), of which 5 had the vaccine as the underlying cause (meaning the vaccine initiated the chain of events directly leading to the death). For these deaths, there was evidence to suggest that the vaccine played a part in the chain of events that led to the death.
Which figures should I use?
The deaths registrations figures published by ONS show the official figures for when a death involved the COVID-19 vaccination, and when the vaccination was the underlying cause. This means it was recorded as such by a doctor or coroner. There is a time lag, for the reasons described here, so the most recent data relate to deaths registered up to the end of August 2021. This time lag should be borne in mind when using these figures.
The Yellow Card Scheme data, by contrast, give an important early warning about possible deaths relating to COVID-19 vaccinations, and form a basis for further investigations. However, the numbers don’t show confirmed cases of deaths linked to the vaccines and should not be used for this purpose. Many of these deaths will actually have had other causes, which explains why these numbers are so much higher than the deaths registrations.
The deaths registrations numbers are likely to rise, as numbers feed through following delays, but they can be expected to remain far lower than those shown in the Yellow Card data.
Sarah Caul, Head of Mortality Analysis at ONS