Norway’s elderly Covid-19 vaccine deaths aren’t what they seem

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When reports emerged from Norway about a handful of deaths amongst people who had received the Covid-19 vaccine, vocal vaccine deniers were quick to pounce on the news.
On January 14, the Norwegian Medicines Agency (Noma) reported that 23 people had died after receiving their first dose of the Pfizer/BioNTech vaccine. Those who died were described as having severe underlying health conditions and were all aged 75 or over. (The number of deaths has since risen to 33, out of about 55,000 people who have received the first dose of the vaccine in the country.)

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The deaths made international headlines, raising alarm that the (typically mild) side effects of the vaccine could cause the elderly who receive it to die. Fox News commentator Jan Morgan posted the news story to Facebook with the caption: “23 die within hours of taking COVID vaccine. … I’ve never taken a flu shot and I’m certainly NOT letting anyone inject this garbage in to my body.” (The deaths actually happened within six days of the vaccine, according to a statement from the Norwegian Institute of Public Health.)
In Noma’s statement, Sigurd Hortemo, the agency’s chief physician, said that “we cannot rule out that common adverse reactions, such as fever and nausea, may contribute to a more serious course and fatal outcome in some frail patients with severe underlying diseases.” But on January 19, the Norwegian Institute of Public Health released a statement saying that no link had been established between Pfizer/BioNTech’s vaccine and any post-vaccination deaths in the country. The World Health Organisation (WHO) echoed the sentiment in a statement on January 22, saying that it saw no evidence that the vaccine had contributed to the deaths. In yet another statement, Pfizer told The British Medical Journal that it is working with Noma to investigate the deaths, but that “the number of incidents so far is not alarming, and in line with expectations”.
Determining whether the Norwegian deaths are truly a cause for concern means putting these seemingly scary numbers into context. In Norway, an estimated 45 people die in nursing homes or similar institutions every week. The country also has a low threshold for reporting adverse vaccination reactions, encouraging healthcare providers to report possible reactions even when any causal relationship is very unclear. “It is not a given that [the number of deaths] represents any excess mortality or that there is a causal connection,” said Camilla Stoltenberg, head of the Norwegian Institute of Public Health, at a press conference on January 18.
“We absolutely shouldn’t confuse the very normal and natural deaths that will happen to older and more frail people with the consequences of the vaccine,” cautions Stuart McDonald, a fellow of the Institute of and Faculty Actuaries and co-founder of the Covid-19 Actuaries Response Group.

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If you put the Norwegian deaths in perspective, a very different picture begins to emerge. The UK, for example, has a very large number of people aged 80 and over, and as a result that group makes up a sizeable chunk of total deaths in the country.
“In the next twelve months, I would expect around 335,000 deaths of people 80-plus, and I’d also expect around 30,000 deaths in care homes [of people aged under 80],” McDonald adds. “So, if we look just at the top two priority groups [for the vaccine] and expect around 365,000 deaths in the next year – which is about 1,000 a day – now that’s actually about six out of ten UK deaths. And it’s more than one in ten of the people that were vaccinated.” In short: we can expect to see a high number of deaths in this age group in the next few months, regardless of whether they’ve had the vaccine or not – and we should be careful not to draw cause and effect.
Although these deaths in severely ill elderly people weren’t unexpected, it doesn’t mean that all older people are necessarily at the end of their lives. The life expectancy in the UK for males aged 85 is about six years; seven years for females. Approximately one in ten will actually live for about 12 to 13 more years. Age has also been shown to be the biggest factor in an individual’s likelihood of dying from Covid-19. The greatest risk for severe illness from the disease falls onto those in this exact age bracket, particularly those in aged care facilities.
More than one in three deaths from Covid-19 in the UK have been people aged over 85, despite people in that group making up just over two per cent of the population. The skewed profile of Covid-19 mean that the benefits still far outweigh the risks of the vaccine – although some people will sadly die soon after their vaccinations, many others stand to gain years of healthy life.

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“What they’ve presented out of Norway appears to be consistent with normal life, and not with vaccine-induced issues,” says Helen Keipp Talbot, associate professor of medicine at Vanderbilt University, who studies vaccines in older adults and advises the Centers for Disease Control and Prevention on vaccine use. “I think it’s really a matter of being aware that death is common in a nursing home.”
Talbot was the sole vote against making long-term care residents near the top of the list for the vaccine in the US. Not because she actually objected to the vaccine, but because this population normally has a high rate of medical events anyway, and that any deaths that would most likely occur, vaccine or not, could potentially compromise trust in the vaccines.
She says it’s inevitable that we will see more news stories like this one in the coming months, and transparency about any mortality after vaccination will be the best approach to ensure that people do not latch onto these stories and to use them as ammunition against the vaccine. “We need to be prepared to talk about death,” Talbot says.
Whether this part of the population should even be receiving the vaccine in the first place is another question that this story has raised. “Personally, I was a bit surprised they even gave them the vaccine,” says Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, because if an individual is very sick or has extreme allergies, then the advice cautions against vaccinating them. “And now, we have clear evidence that if you’ve got a terminally ill or near death person that you’re considering vaccinating, it’s probably not recommended.”
Larson too expects to see more and more stories like this in the future. “I think there’s probably going to be more cases of coincidental issues that turn out to be unrelated to the vaccine, just because of the sheer numbers of people we’re vaccinating.”
Grace Browne is a science writer at WIRED. She tweets from @gracefbrowne
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