The issue is that "background rates" in these studies often don't account for the age and health status of the vaccinated population, which is typically more monitored and possibly healthier than the general population.

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The point about background rates not accounting for health status is valid, but the fact that the ratio is still below one after adjustments suggests the effect is robust.

The fact that the ratio remains below one even after adjustments suggests the finding is not just a statistical artifact, but could point to a real effect — though the interpretation of "background rates" still matters.