Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan.
Research Center for Epidemic Prevention, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Glob Health. 2021 Jul 17;11:05019. doi: 10.7189/jogh.11.05019. eCollection 2021.
Scientists have demonstrated the efficacy of vaccines against severe acute respiratory syndrome coronavirus 2 in randomized controlled trials. However, the extent to which reductions in COVID-19 case fatality ratio (CFR) are attributable to mass vaccination in the real world remains unclear. This study evaluated the association of COVID-19 vaccine coverage with CFR on a global scale.
The sample was a longitudinal data set of 90 countries over 25 weeks, from the first week of November 2020 to the third week of April 2021. CFR was measured in deaths per 100 COVID-19 confirmed cases; vaccine coverage was defined as the number of people who received at least one vaccine dose per 10 people in the total population. Data were retrieved from open-access databases, including Our World in Data and the Oxford COVID-19 Government Response Tracker. A country-level random effects model was used; a comprehensive set of variables for country characteristics and nonpharmaceutical interventions were included.
A 10% increase in vaccine coverage was associated with a 7.6% reduction in the CFR (95% confidence interval (CI = -12.6 to -2.7%, = 0.002). This association was stronger in countries with more effective governments (-8.3%; 95% CI = -13.6 to -3.1%, = 0.002) and higher transport infrastructure quality (-8.1%; 95% CI = -13.3 to -2.9%, = 0.002). Moreover, the vaccine coverage was associated with a reduced CFR in a dose-dependent manner. When vaccine coverage achieved 0.8 to 1.6, 1.6 to 3.2 and ≥3.2 per 10 people, the CFR reduced by 12.7% (95 CI = -21.8 to -3.6%, = 0.006), 21.2% (95 CI = -33.9 to -8.5%, = 0.001) and 31.3% (95 CI = -51.5 to -11.0%, = 0.002), respectively as compared with no vaccination.
Our results provide supporting evidence that vaccination is critical to preventing deaths among infected people. Vaccination programmes have yielded significant health benefits in certain countries. However, globally, a large gap remains between observed and achievable fatality reductions. Continuous improvement in vaccine coverage will be critical to transforming efficacious vaccines into desired health outcomes.
科学家在随机对照试验中证明了疫苗对严重急性呼吸综合征冠状病毒 2 的功效。然而，在现实世界中，大规模疫苗接种对 COVID-19 病死率（CFR）降低的贡献程度仍不清楚。本研究评估了 COVID-19 疫苗覆盖率与全球范围内 CFR 的相关性。
样本为 2020 年 11 月第一周到 2021 年 4 月第三周期间的 90 个国家 25 周的纵向数据集。CFR 以每 100 例 COVID-19 确诊病例中的死亡人数衡量；疫苗覆盖率定义为每 10 人总人口中至少接种一剂疫苗的人数。数据从开放获取数据库中检索，包括 Our World in Data 和牛津 COVID-19 政府反应追踪器。使用了国家层面的随机效应模型；纳入了一整套国家特征和非药物干预措施的变量。
疫苗覆盖率每增加 10%，CFR 降低 7.6%（95%置信区间（CI）=-12.6 至-2.7%，=0.002）。在政府效能更高（-8.3%；95% CI=-13.6 至-3.1%，=0.002）和交通基础设施质量更高（-8.1%；95% CI=-13.3 至-2.9%，=0.002）的国家，这种关联更强。此外，疫苗覆盖率与 CFR 呈剂量依赖性降低。当疫苗覆盖率达到每 10 人 0.8 至 1.6、1.6 至 3.2 和≥3.2 时，CFR 分别降低 12.7%（95% CI=-21.8 至-3.6%，=0.006）、21.2%（95% CI=-33.9 至-8.5%，=0.001）和 31.3%（95% CI=-51.5 至-11.0%，=0.002）。
我们的研究结果提供了有力的证据表明，接种疫苗对于防止感染人群死亡至关重要。疫苗接种计划在某些国家带来了显著的健康益处。然而，在全球范围内，实际死亡率降低与预期目标之间仍存在巨大差距。持续提高疫苗覆盖率对于将有效疫苗转化为预期的健康结果至关重要。
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