Intended for healthcare professionals

Rapid response to:


Routine vaccination during covid-19 pandemic response

BMJ 2020; 369 doi: (Published 16 June 2020) Cite this as: BMJ 2020;369:m2392

Read our latest coverage of the coronavirus pandemic

Rapid Response:

Fewer American infants are dying during the Covid-19 lockdown. Why?

With few words and typical understatement Noel Thomas calls our attention to an important paper. (BMJ rr, 6/19/20) It is by Becker and Blaxill and reports a striking decline in mortality in US children after the declaration of a national Covid-19 emergency on March 13. ( ) It is relevant to your editorial about vaccinations during the Covid-19 pandemic response. (Saxena et al, BMJ, 6/16/20) I have looked at their data sources and provide the following update:

During the first 11 weeks of 2020 (through March 14) there were 209 fewer deaths in US children <18 compared to the same period in 2019 (7024 vs 7233). During the 11 week period following the emergency declaration (through May 30) there were 1465 fewer deaths in US children compared to 2019 (5923 vs 7388). ( ) The difference is statistically highly significant…..Becker and Blaxill emphasized that the most pronounced mortality decline occurred in infants <1 year. This is confirmed by reviewing the most recent data. (

There was a substantial and highly significant decline from 2020 weeks 5 through 11 to weeks 12 through 22 (367 to 309 infant deaths per week). There were 2567 and 3396 infant deaths during weeks 5 to 11 and weeks 12 to 22, respectively. For children 1-17 years the comparable figures were 1848 and 2527. I could not find weekly infant mortality data before 2020.

Becker and Blaxill provided no information about specific causes of infant deaths in 2020, and I could find none. They did convey anecdotes from emergency room physicians who reported seeing fewer SIDS cases since the beginning of the pandemic and associated lockdowns. Along with this, Becker and Blaxill ask whether the substantial decline in vaccine uptake after the emergency declaration could be relevant. ( )

The suggestion that vaccinations could be one factor in the causation of SIDS is not new. ( American pediatric officials have steadfastly dismissed any role for vaccines in the causation of SIDS, based on a selection of observational studies. Nevertheless, until properly controlled trials are done we will be unable to confirm or exclude a causal role for vaccines.

There have been a number of reports from around the world that social distancing and lockdowns reduced the duration and severity of the recent flu season, including fewer hospitalizations for respiratory infections in children. This, and other factors, could relate to any decline in infant mortality. Becker and Blaxill have made potentially important observations. They suggest that the question of vaccinations and SIDS urgently needs answering. I agree. Vaccinations have been lifesavers, as your editorial fervently explains, but the foregoing observations should give us pause. More study is required and, in time, perhaps changes in the immunization schedule.


Competing interests: No competing interests

22 June 2020
Allan S. Cunningham
Retired pediatrician
Cooperstown NY 13326, USA <>