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Characteristics and risk of COVID-19-related death in fully vaccinated people in Scotland

October 2021: A research letter published in The Lancet looks at people in Scotland who have died of COVID-19 after two vaccine doses, and what the risks and causes might be.

Characteristics and risk of COVID-19-related death in fully vaccinated people in Scotland

Grange, Z., Buelo, A., Sullivan, C., et al.

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Published Online October 28, 2021

Available via The Lancet (online): https://doi.org/10.1016/S0140-6736(21)02316-3

Summary in Plain English

By 18 August 2021 in Scotland, over 3.2 million people had been double vaccinated with the Oxford-AstraZeneca (ChAdOx1), Pfizer-BioNTech (BNT162b2) or Moderna (mRNA-1273) vaccine.

Evidence shows that the vaccines are very effective at preventing hospital admissions and deaths from COVID-19. Unfortunately, however, there have been several reports of people dying from COVID-19 after being vaccinated with two doses.

Why did we carry out this research?

We wanted to understand which groups of double vaccinated people might still be at risk of dying from COVID-19. This information helps patients, healthcare staff and policy-makers make more informed decisions about what precautions to take in the future.

To do this, we looked at personal circumstances like age, sex, health history and where people live or tested positive for COVID-19.

What data did we use?

We compared information on vaccination type, health history, hospital and intensive care admissions, and causes of death for double vaccinated and unvaccinated adults in Scotland. These routinely collected data are held in the EAVE II platform. EAVE II securely links together healthcare data with personal identifiable data removed.

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We defined double vaccinated COVID-19 deaths as anyone who tested positive more than two weeks after their second dose, who then died with COVID-19 listed as a cause of death on their death certificate.

There have been no deaths in the smaller group of people vaccinated more recently with Moderna, so we didn’t include people who received this vaccine in our analysis.

What were the results?

There were 236 deaths in double vaccinated people in the time period studied, or 7 deaths in every 100,000 people who have had two vaccine doses. People in this group were typically around 80 years of age, and 62% of deaths were in men.

We looked at how many deaths would happen per 10,000 people in each age group, over the course of a year

Age (years) Unvaccinated deaths Double vaccinated deaths
18-64 3 0-1
65-79 65 4
80+ 420 14

This shows that the highest difference in death rates was between double vaccinated and unvaccinated adults aged 80 or older.

Almost all the group (97%) had at least one other cause of death listed on their death certificate. The most common non-COVID-19 causes of death were long-term heart or kidney disease, diabetes, chronic obstructive pulmonary disease (COPD), and fast or irregular heart beat (atrial fibrillation). COPD is a group of lung conditions that cause breathing difficulties.

We found that the main predictors of death in double vaccinated people were being male, having a larger number of underlying health conditions, and testing positive when admitted to hospital rather than in the community. Over half the group studied tested positive in hospital, suggesting they did not have treatment for COVID-19 beforehand.

What is next?

These results show that COVID-19 deaths were extremely uncommon in people who tested positive 14 days or more after their second dose of the Pfizer-BioNTech or Oxford-AstraZeneca vaccine.

The risk profiles also suggest that older adults, and particularly men, with multiple long term health conditions should continue to be cautious.

As the pandemic progresses, we will continue to monitor the number of COVID-19 infections, hospital admissions and deaths in Scotland. This will include looking at Moderna and newer vaccines, younger populations, and how much protection the vaccines offer over time.


This plain English summary was created with the support and feedback of the EAVE II Public Advisory Group (PAG). This particular summary was reviewed by PAG members Sandra J and Eve S.

To learn more about the PAG, see: Our EAVE II Public Advisory Group (PAG) | The University of Edinburgh