Estimating the early impact of vaccination against COVID-19 on deaths among elderly people in Brazil: Analyses of routinely-collected data on vaccine coverage and mortality

Prof Cesar Victora; Prof Marcia C Castro; Susie Gurzenda; Arnaldo C Medeiros; Giovanny V A França; Prof Aluisio J D Barros

doi:10.1016/j.eclinm.2021.101036

Estimating the early impact of vaccination against COVID-19 on deaths among elderly people in Brazil: Analyses of routinely-collected data on vaccine coverage and mortality

EClinicalMedicine. 2021 Aug:38:101036. doi: 10.1016/j.eclinm.2021.101036. Epub 2021 Jul 16.

Authors

Prof Cesar Victora^{1

2}, Prof Marcia C Castro², Susie Gurzenda², Arnaldo C Medeiros³, Giovanny V A França³, Prof Aluisio J D Barros¹

Affiliations

¹ International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.
² Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
³ Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasilia, DF, Brazil.

Abstract

Background: Vaccination against COVID-19 in Brazil started in January 2021, with health workers and the elderly as the priority groups. We assessed whether there was an impact of vaccinations on the mortality of elderly individuals in a context of wide transmission of the SARS-CoV-2 gamma (P.1) variant. Methods: By May 15, 2021, 238,414 COVID-19 deaths had been reported to the Brazilian Mortality Information System. Denominators for mortality rates were calculated by correcting population estimates for all-cause deaths reported in 2020. Proportionate mortality at ages 70-79 and 80+ years relative to deaths at all ages were calculated for deaths due to COVID-19 and to other causes, as were COVID-19 mortality rate ratios relative to individuals aged 0-69 years. Vaccine coverage data were obtained from the Ministry of Health. All results were tabulated by epidemiological weeks 1-19, 2021. Findings: The proportion of all COVID-19 deaths at ages 80+ years was over 25% in weeks 1-6 and declined rapidly to 12.4% in week 19, whereas proportionate COVID-19 mortality for individuals aged 70-79 years started to decline by week 15. Trends in proportionate mortality due to other causes remained stable. Mortality rates were over 13 times higher in the 80+ years age group compared to that of 0-69 year olds up to week 6, and declined to 5.0 times in week 19. Vaccination coverage (first dose) of 90% was reached by week 9 for individuals aged 80+ years and by week 13 for those aged 70-79 years. Coronavac accounted for 65.4% and AstraZeneca for 29.8% of all doses administered in weeks 1-4, compared to 36.5% and 53.3% in weeks 15-19, respectively. Interpretation: Rapid scaling up of vaccination coverage among elderly Brazilians was associated with important declines in relative mortality compared to younger individuals, in a setting where the gamma variant predominates. Had mortality rates among the elderly remained proportionate to what was observed up to week 6, an estimated additional 43,802 COVID-related deaths would have been expected up to week 19. Funding: CGV and AJDB are funded by the Todos pela Saúde (São Paulo, Brazil) initiative.

Keywords: Brazil; COVID-19; Immunization; Mortality.