Covid-19 mRNA Vaccination and 4-Year All-Cause Mortality

Study findings and framing

• Participants highlight key results: among ~22.7M vaccinated vs ~5.9M unvaccinated adults (18–59), vaccination was associated with ~74% lower risk of death from severe COVID-19 and ~25% lower all-cause mortality over ~45 months, with no signal of excess overall deaths.
• Some find the abstract wording “no increased risk of all-cause mortality” misleading because the paper later shows a clear decrease; others note the authors are foregrounding safety (no harm) rather than efficacy.

Confounding, methodology, and interpretation

• Multiple commenters stress this is an observational cohort, not an RCT, so only confounder-adjusted associations are possible.
• Strong “healthy-vaccinee” effects are noted: vaccinated participants had lower mortality in almost every cause category (e.g., accidents, drownings, circulatory disease, cancer), which likely reflects differences in health behaviors, healthcare engagement, socioeconomics, and risk-taking, not vaccine effects on those causes.
• Some are uneasy that the paper does not show a transparent causal diagram; others reply that this is standard for large epidemiologic studies and that efficacy was already demonstrated in randomized trials.
• There is specific concern about immortal-time bias handling: follow-up starts 6 months after index date, so very-early post-vaccination deaths would not appear here; defenders point out these early risks are studied separately via trials and short-term safety designs.

Exposure definition and timing

• Criticism focuses on defining “unvaccinated” as no mRNA dose by Nov 1, 2021 and restricting “exposed” to first doses between May–Oct 2021.
• Some argue this misclassifies people vaccinated later; others counter that by late 2021 in France, most who intended to vaccinate had already done so, making the split reasonable for long-term comparison.

Broader vaccine safety, mandates, and trust

• Many comments pivot to politics: compressed development timelines, changing public messaging (“won’t get COVID” vs “reduces severity”), and mandates or employment pressure are cited as major drivers of skepticism.
• Others argue that communications naturally evolved with new data and that refusing a strongly beneficial intervention while working in healthcare is unprofessional.
• Adverse events like myocarditis, menstrual changes, and lymph node swelling are acknowledged; several note that COVID itself also increases these risks, often more than vaccination.
• A recurrent theme: hard-core skeptics treat any study as propaganda, while another group of initially cautious or health-conscious people see long-term cohort data like this as exactly what they were waiting for to update their risk assessment.

Communication quality and public understanding

• Commenters criticize biomedical papers for dense language and inconsistent uses of terms like “all-cause mortality,” arguing that poor readability and overcautious phrasing hinder public trust.
• Others suggest the solution is not dumbing down primary literature but building better translation layers—clear, honest summaries that highlight both benefits and limitations (e.g., strong safety signal here, but efficacy estimates are heavily confounded).