Aim To evaluate the effect of vaccination/booster administration dynamics on the reduction of excess mortality during COVID-19 infection waves in European countries.

Methods We selected twenty-nine countries from the OurWorldInData project database according to their population size of more than one million and the availability of information on dominant SARS-CoV-2 variants during COVID-19 infection waves. After selection, we categorized countries according to their “faster” or “slower” vaccination rates. The first category included countries that reached 60% of vaccinated residents by October 2021 and 70% by January 2022. The second or “slower” category included all other countries. In the first or “faster” category, two groups, “boosters faster’’ and “boosters slower” were created. Pearson correlation analysis, linear regression, and chi-square test for categorical data were used to identify the association between vaccination rate and excess mortality. We chose time intervals corresponding to the dominance of viral variants: Wuhan, Alpha, Delta, and Omicron BA.1/2.

Results The “faster” countries, as opposed to the “slower” ones, did better in protecting their residents from mortality during all periods of the SARS-CoV-2 pandemic and even before vaccination. Perhaps higher GDP per capita contributed to their better performance throughout the pandemic. During mass vaccination, when the Delta variant prevailed, the contrast in mortality rates between the “faster” and “slower” categories was strongest. The average excess mortality in the “slower” countries was nearly 5 times higher than in the “faster” countries, and the odds ratio (OR) was 4.9 (95% CI 4.4 to 5.4). Slower booster rates were associated with significantly higher mortality during periods dominated by Omicron BA.1 and BA.2, with an OR of 2.6 (CI 95%. 2.1 to 3.3). Among the European countries we analyzed, Denmark, Norway, and Ireland did best, with a pandemic mortality rate of 0.1% of the population or less. By comparison, Bulgaria, Serbia, and Russia had a much higher mortality rate of up to 1% of the population. Thus, slow vaccination and booster administration was a major factor contributing to an order of magnitude higher excess mortality in “slower” European countries compared to more rapidly immunized countries.

The authors have declared no competing interest.

This work was supported by the Intramural Research Program of the National Library of Medicine, National Institutes of Health (SAS).

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OurWorldinData public data depository. https://ourworldindata.org/coronavirus World bank open data https://data.worldbank.org/

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