Keele Research Repository

Objectives We compared the global reported cumulative case-fatality ratio (rCFR) and excess mortality between top-20 countries with COVID-19 vaccination rates, the rest of the world and Sub-Saharan Africa (SSA) before and after commencement of vaccination programmes. Methods We performed time series model to understand the trend of rCFR over time and performed generalized linear mixed model to understand role of vaccination on rCFR. Results By 31 December 2022, on average 260.3 doses of COVID-19 vaccines per 100 people had been administered in the top-20 vaccinated countries, compared to 152.1 doses in the rest of the world, and 51.2 in SSA. The mean rCFR of COVID-19 had dropped by 69.0% in the top in the top-20 vaccinated countries, 26.5% in the rest of the world and 7.6% in SSA. The excess mortality had dropped by 48.7% in top vaccinated countries compared to 62.5% in the rest of the world and 60.7% in SSA. In a generalized linear mixed model, reported number of vaccine doses administered doses (/100 population) (Odds ratio:0.64) was associated with a steeper reduction of the country's COVID-19 rCFR. Conclusions Vaccine equity and faster roll-out across the world is critically important in reducing COVID-19 transmission and CFR.