Covid-19 undervaccination led to thousands of deaths in UK, research shows

16th January 2024

People not having all their recommended doses of the Covid-19 vaccine led to thousands of unnecessary deaths and severe outcomes, researchers have found.

Over 7,000 hospitalisations and deaths might have been avoided in summer 2022 if there had been ‘full’ Covid-19 vaccination coverage across the UK, according to a new study published in The Lancet,

Using health record data from participants over four years old, researchers found that between a third and a half of the populations of the four UK nations had not received the recommended number of Covid-19 vaccinations by summer 2022.

Over the period between the start of June and the end of September that year, they used a ‘counterfactual scenario’ in which everyone in the UK was fully vaccinated in order to estimate the potential reduction in ‘severe Covid-19 outcomes’.

The study concluded that there would have been 7,180 fewer hospitalisations or deaths across all age groups, down from the 40,393 that actually took place, indicating that ‘higher vaccination coverage would have been associated with considerable reduction in severe Covid-19 outcomes’. 

Among the undervaccinated, the researchers estimated there would have been a 50% reduction in these events.

They also found that younger, more deprived or non-white people, or those with a lower number of comorbidities, were less likely to be fully vaccinated. 

The study defined ‘undervaccination’ as having received fewer than the recommended number of vaccine doses.

Rates of ‘undervaccination’ against Covid-19 across the UK as of 1 June 2022 were:

• England – 45.8% (26,985,570 of 58,967,360)
• Northern Ireland – 49.8% (938,420 of 1,885,670)
• Scotland – 34.2% (1,709,786 of 4,992,498)
• Wales – 32.8% (773,850 of 2,358,740)

‘The effect of being undervaccinated on severe Covid-19 outcomes was notably larger than the effect of ethnicity or socioeconomic status,’ the researchers concluded. 

They also said health policy and public health interventions need to be formulated with the aim of improving coverage among the ‘undervaccinated’ demographics.

‘This could, for example, include the need to tackle vaccine misinformation in a more direct fashion, and to continue to diversify the use of champions to support public messaging and the range of community-based centres offering vaccinations,’ the study said.

Dr Andrew Freedman, consultant in infectious diseases and vaccine clinical trials at Cardiff University School of Medicine, said the study ‘clearly demonstrates how effective Covid vaccines were at reducing the risk of severe outcomes’ from the disease during summer 2022.

He said: ‘As the authors point out, these findings will help identify which groups should in future be specifically targeted to maximise uptake of vaccines for Covid and other infections. This will be particularly crucial in the event of another pandemic.’

Dr Freedman also noted that the study’s inclusion of data from the whole UK population – the first of its kind – is a ‘remarkable achievement’. 

A version of this article was originally published by our sister publication Pulse.

Male hypogonadism an independent risk factor COVID-19 hospitalisation

12th September 2022

Male hypogonadism is associated with an increased risk of hospitalisation in COVID-19 and which is independent of other known risk factors

Male hypogonadism is independently associated with a greater risk of being hospitalised after infection with COVID-19 according to the results of a retrospective study by US researchers.

A 2020 meta-analysis of over 3 million cases demonstrated that, whilst there was no difference in the proportion of males and females with confirmed COVID-19, male patients had an almost three times higher odds of requiring intensive treatment and a higher risk of death compared to women.

The implication of these findings was that a man’s testosterone level was a likely risk factor for worse outcomes after infection with the virus. Nevertheless, testosterone levels in men vary are influenced by several factors. For example, the presence of type 2 diabetes and chronic kidney disease, lead to subnormal free T concentrations and hypogonadism in men with chronic obstructive pulmonary disease ranges from 22 to 69% and is associated with several other systemic manifestations including osteoporosis, depression, and muscle weakness.

Furthermore, testosterone levels tend to be lower as men age and given that the presence of co-morbidities and advancing age are risk factors for worse outcomes in COVID-19, whether testosterone levels per se represents an independent risk factor is unclear.

For the present study, the researchers hypothesised that it was actually male hypogonadism, i.e., low testosterone levels that was responsible for the worse outcomes in COVID-19.

In trying to test out their theory, the team retrospectively analysed electronic health records for men with hypogonadism, those receiving testosterone therapy (TTh) for at least 6 months and men with eugonadism (i.e., normal testosterone levels) and then compared the rates of hospitalisation between the three groups.

The researchers also collated demographic and co-morbidity data and which were adjusted for in the final analysis. The primary outcome of interest was hospitalisation due to COVID-19.

Male hypogonadism and COVID-19 hospitalisation

A total of 723 participants with a mean age of 55 years, 116 who were hypogonadal, 427 with eugonadism and 180 in receipt of TTh were included in the analysis.

A testosterone level was made in 73% of patients and the median time between testosterone measurement and infection with COVID-19 was 7 months. The median testosterone level in men with hypogonadism was 131 ng/dL and which was significantly different to eugonadal men (381 ng/dL) and those receiving TTh (396 ng/dL).

In total, 134 men were hospitalised due to COVID-19 and this was significantly more common among those with hypogonadism compared to eugonadism after adjustment for know risk factors such as increasing age, co-morbidities and immunosuppression (adjusted odds ratio, aOR = 2.4, 95% CI 1.4 – 4.4, p < 0.003). Men receiving TTh had a similar risk to those with eugonadism (aOR = 1.3, 95% CI 0.7 – 2.3, p = 0.35).

The authors concluded that male hypogonadism was an independent risk factor for hospitalisation due to COVID-19. They suggested that screening and appropriate therapy for hypogonadism need to be evaluated as a strategy to prevent severe disease after infection with the virus.

Citation
Dhindsa S et al. Association of Male Hypogonadism With Risk of Hospitalization for COVID-19 JAMA Netw Open 2022