# The Impact of Limited Vaccine Access on COVID-19 Mortality—Descriptive Study of COVID-19 Vaccination and Mortality Due to COVID-19 in Montenegro, July 2020–February 2022

## TL;DR

This study examines how delayed and limited vaccine access in Montenegro affected COVID-19 mortality rates from 2020 to 2022.

## Contribution

The study highlights disparities in vaccine distribution and effectiveness in Montenegro, linking them to higher mortality rates.

## Key findings

- Unvaccinated individuals had nearly four times higher mortality rates compared to those with at least one vaccine dose.
- Inactivated vaccines were mainly given to those aged 60 and over, while RNA vaccines were given to younger people.
- Vector vaccines showed a longer interval between vaccination and death compared to inactivated vaccines.

## Abstract

Introduction: The Delta variant of SARS-CoV-2 dominated Montenegro from July 2020 until early 2022, when Omicron took over. COVID-19 vaccination began on 20 February 2021, two months later than in the EU. The study aimed to investigate the impact of vaccination on mortality rates in Montenegro during Delta’s predominance. Methods: A descriptive study was conducted using data from the Montenegrin Institute of Public Health COVID-19 database, the Population Electronic Immunization Register, which provides data for all administrated COVID-19 vaccines in Montenegro, and EUROSTAT mortality data. Results: COVID-19 accounted for 17.8% of total deaths in Montenegro during the period of study. Crude mortality rate among unvaccinated was almost four times higher compared to those who received at least one vaccine dose. Inactivated vaccines were predominantly administered to those aged 60 and over, while RNA vaccines were mainly given to those under 60. The median interval between the last vaccine dose and death was significantly higher for vector vaccines compared to inactivated vaccines. Discussion: The delayed start of vaccination and limited vaccine choices in Montenegro likely contributed to prolonged high mortality due to COVID-19. Our findings reveal disparities in vaccine distribution and effectiveness, highlighting the need for timely and equitable access to effective vaccines, especially for vulnerable populations. Conclusions: The study underscores the importance of prompt vaccine distribution and the option to choose vaccine types in building public trust and reducing mortality rates. It emphasizes the need for strengthening global mechanisms COVAX and continuing educational activities to address vaccine hesitancy and ensure equitable access to effective vaccines.