Better in their words…

Professor Christof Kuhbandner, at the University of Regensburg in Germany, and Professor Matthias Reitzner, at Osnabrück University in Germany, published “Regional patterns of excess mortality in Germany during the COVID-19 pandemic: a state-level analysis” in Royal Society Open Science in September.

Using actuarial life-table methods and population-adjusted expected-death modeling, the authors examined excess mortality across Germany’s 16 federal states from April 2020 to March 2023 to determine which factors — COVID-19 infections, deaths, vaccination rates, demographics or policy — best explain mortality patterns.

Their most controversial finding: in the third pandemic year, excess mortality rose sharply while COVID-19 deaths declined, creating a statistical decoupling that correlated positively with vaccination rates, even after adjusting for prior-year mortality.

While no causation is established, the correlations are nonetheless troubling.

Study design: State-level excess mortality across three ‘pandemic years’

This observational modeling study analyzed mortality data for three periods:

• P1: April 2020-March 2021
• P2: April 2021-March 2022
• P3: April 2022-March 2023

Researchers computed expected deaths using 2017-2019 life tables, applied federal-state mortality correction factors and correlated excess mortality with: COVID-19 deaths, PCR-confirmed cases, vaccination rates (double and triple), age structure, poverty, GDP, trust in institutions and policy stringency.

The authors also used change-score models and ANCOVA to control for time-invariant confounders and prior-year excess mortality.

Findings: Early COVID death correlation, later decoupling and a vaccine paradox

1. First two years: Excess mortality correlated strongly with COVID-19 deaths (r = 0.96 and r = 0.89). Yet COVID-19 deaths greatly exceeded excess deaths (e.g., 78,185 COVID-19 deaths vs. 22,405 excess deaths in P1). The study suggests misclassification or pandemic-measure effects as possible explanations.
2. Third year: A “new driver” emerged. COVID-19 deaths dropped, infections fell, but excess mortality jumped from ~26,973 to ~78,493. Correlations with COVID-19 outcomes dissolved (r = 0.32, ns).
3. Vaccination correlation:
   1. In P3, higher vaccination rates correlated with higher excess mortality (r = 0.65, p = 0.006).
   2. Change-score analysis for P2→P3 yielded r = 0.93, p < 0.001, even after adjusting for prior mortality.
   3. Higher vaccination states also saw smaller declines in COVID-19 deaths and case fatality rates.

The authors repeatedly caution that correlation does not equal causation and that hidden confounders remain possible. But statistically, vaccination was the only consistent predictor of increased excess mortality in the third year.

Bias & interpretation: Where the study pushes — and where it pulls back

Strengths

• Transparent methodology, fully sourced from federal statistics.
• Rigorously addresses time-invariant confounders using actuarial modeling and ANCOVA.

Potential bias signals (TSN bias meter)

• Framing tilt: Although the authors stop short of asserting causality, the paper heavily emphasizes the paradoxical positive vaccine correlation while giving less weight to alternative hypotheses for year-three mortality (e.g., delayed medical care, healthcare strain, climate extremes, sequencing biases).
• Selective contextualization: The discussion foregrounds randomized-trial all-cause mortality data critical of mRNA vaccines and cites mortality analyses contested in mainstream epidemiology.
• Under-discussed denominators: PCR-confirmed “infection rates” and administrative COVID-19 death counts are known to shift in validity post-2022, yet the authors treat them as stable comparative metrics.

So, did the authors examine a link between vaccination and excess mortality?

Yes — directly, extensively and repeatedly.

The paper explicitly analyzes vaccination rates as a predictor of excess mortality, finds statistically significant positive associations in the third year, and concludes that the pattern “underscores the need for urgent investigation into potential unintended effects of vaccination or other previously neglected mortality drivers.”

Conclusion

This study provides moderate-strength evidence of an unexpected, statistically robust association between vaccination rates and excess mortality in Germany’s third pandemic year — without establishing causality.

Its most important contribution is methodological: it highlights a decoupling between COVID-19 deaths and excess deaths after 2022, demanding new lines of inquiry.

Its greatest limitation is interpretive: correlation patterns are not explanations, and the framing leans toward vaccine-centered hypotheses while only partially exploring alternative drivers.

In summary, the study raises legitimate concerns — but does not settle them — and calls for deeper, multidisciplinary investigation into Germany’s 2022–2023 excess mortality spike.

TrialSite Evidence Strength Indicator 2.0:

• Methodological rigor: 7/10; Strong actuarial modeling; ecological correlations limit causal inference.
• Consistency & effect size: 6/10; Large effect sizes in P3 but inconsistent across years.
• External validity: 5/10; State-level ecological data; generalizability uncertain.
• Human consequence index: 8/10; High stakes; findings could affect vaccine-safety policy.
• Pluralism index: 5/10; Limited exploration of non-vaccine explanations for P3 mortality.
• Transparency & disclosure: 9/10; Full open data, clear methodology, AI disclosure.
• Summary (weighted): 6.5/10 (~65%); Important signals; causality unproven; further investigation required.

Originally published by TrialSite News.