Rapid communication Open Access
Like 0


We estimate the potential remaining COVID-19 hospitalisation and death burdens in 19 European countries by estimating the proportion of each country’s population that has acquired immunity to severe disease through infection or vaccination. Our results suggest many European countries could still face high burdens of hospitalisations and deaths, particularly those with lower vaccination coverage, less historical transmission and/or older populations. Continued non-pharmaceutical interventions and efforts to achieve high vaccination coverage are required in these countries to limit severe COVID-19 outcomes.


Article metrics loading...

Loading full text...

Full text loading...



  1. Flaxman S, Mishra S, Gandy A, Unwin HJT, Mellan TA, Coupland H, et al. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature. 2020;584(7820):257-61.  https://doi.org/10.1038/s41586-020-2405-7  PMID: 32512579 
  2. Gostic KM, McGough L, Baskerville EB, Abbott S, Joshi K, Tedijanto C, et al. Practical considerations for measuring the effective reproductive number, Rt. PLOS Comput Biol. 2020;16(12):e1008409.  https://doi.org/10.1371/journal.pcbi.1008409  PMID: 33301457 
  3. Riffe T, Acosta E, Acosta EJ, Manuel Aburto D, Alburez-Gutierrez A, Altová A, et al. Data resource profile: COVerAGE-DB: a global demographic database of COVID-19 cases and deaths. Int J Epidemiol. 2021;50(2):390-390f.  https://doi.org/10.1093/ije/dyab027 
  4. Riffe T, Acosta E, Schöley J, Donzowa J, Kniffka MS. COVerAGE-DB: A database of COVID-19 cases and deaths by age. Charlottesville: Center for Open Science. [Accessed: 20 Oct 2021]. Available from: https://osf.io/mpwjq
  5. Institut National D’Études Démographiques (INED). The demography of COVID-19 deaths. Paris: INED. [Accessed: 21 Oct 2021]. Available from: https://dc-covid.site.ined.fr/en
  6. European Centre for Disease Prevention and Control (ECDC). Data on COVID-19 vaccination in the EU/EEA. Stockholm: ECDC. [Accessed: 20 Oct 2021]. Available from: https://www.ecdc.europa.eu/en/publications-data/data-covid-19-vaccination-eu-eea
  7. UK Coronavirus Dashboard. London: UK Health Security Agency. [Accessed: 30 Nov 2021]. Available from: https://coronavirus.data.gov.uk/details/download
  8. Krause PR, Fleming TR, Peto R, Longini IM, Figueroa JP, Sterne JAC, et al. Considerations in boosting COVID-19 vaccine immune responses. Lancet. 2021;398(10308):1377-80.  https://doi.org/10.1016/S0140-6736(21)02046-8  PMID: 34534516 
  9. Pouwels KB, Pritchard E, Matthews PC, Stoesser N, Eyre DW, Vihta K-D, et al. Effect of Delta variant on viral burden and vaccine effectiveness against new SARS-CoV-2 infections in the UK. Nat Med. 2021;27(12):2127-35.  https://doi.org/10.1038/s41591-021-01548-7  PMID: 34650248 
  10. United Nations (UN), Department of Economic and Social Affairs, Population Division. World population prospects 2019. New York: UN. [Accessed: 21 Oct 2021]. Available from: https://population.un.org/wpp/Download/Standard/Interpolated
  11. Miller AC, Hannah L, Futoma J, Foti NJ, Fox EB, D’Amour A, et al. Statistical deconvolution for inference of infection time series. medRxiv.2020.10.16.20212753. Preprint.
  12. Miller A, Hannah L, Foti N, Futoma J. Apple Inc. incidental R package version 0.1. New York: Comprehensive R Archive Network; 2020. Available from: https://CRAN.R-project.org/package=incidental
  13. Andrews N, Tessier E, Stowe J, Gower C, Kirsebom F, Simmons R, et al. Vaccine effectiveness and duration of protection of Comirnaty, Vaxzevria and Spikevax against mild and severe COVID-19 in the UK. medRxiv. 2021.09.15.21263583. Preprint. https://doi.org/10.1101/2021.09.15.21263583
  14. Pereira E, Giji S, Gabb V. Coronavirus (COVID-19) infection survey technical article: analysis of reinfections of COVID-19. Newport: Office for National Statistics; 2021. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19infectionsurveytechnicalarticleanalysisofreinfectionsofcovid19/june2021
  15. Cevik M, Grubaugh ND, Iwasaki A, Openshaw P. COVID-19 vaccines: Keeping pace with SARS-CoV-2 variants. Cell. 2021;184(20):5077-81.  https://doi.org/10.1016/j.cell.2021.09.010  PMID: 34534444 
  16. Keeling MJ, Rohani P. Modeling infectious diseases in humans and animals. Princeton: Princeton University Press; 2008.  https://doi.org/10.1515/9781400841035  https://doi.org/10.1515/9781400841035 
  17. O’Driscoll M, Ribeiro Dos Santos G, Wang L, Cummings DAT, Azman AS, Paireau J, et al. Age-specific mortality and immunity patterns of SARS-CoV-2. Nature. 2021;590(7844):140-5.  https://doi.org/10.1038/s41586-020-2918-0  PMID: 33137809 
  18. Salje H, Tran Kiem C, Lefrancq N, Courtejoie N, Bosetti P, Paireau J, et al. Estimating the burden of SARS-CoV-2 in France. Science. 2020;369(6500):208-11.  https://doi.org/10.1126/science.abc3517  PMID: 32404476 
  19. Demonbreun AR, Sancilio A, Vaught LA, Reiser NL, Pesce L, McNally EM, et al. Antibody titers before and after booster doses of SARS-CoV-2 mRNA vaccines in healthy adults. medRxiv.2021.11.19.21266555. Preprint.
  20. Falsey AR, Frenck RW Jr, Walsh EE, Kitchin N, Absalon J, Gurtman A, et al. SARS-CoV-2 neutralization with BNT162b2 vaccine dose 3. N Engl J Med. 2021;385(17):1627-9.  https://doi.org/10.1056/NEJMc2113468  PMID: 34525276 
  21. Andrews N, Stowe J, Kirsebom F, Gower C, Ramsay M, Bernal JL. Effectiveness of BNT162b2 (Comirnaty, Pfizer-BioNTech) COVID-19 booster vaccine against covid-19 related symptoms in England: test negative case-control study. medRxiv.2021.11.15.21266341. Preprint.
  22. Cele S, Jackson L, Khoury DS, Khan K, Moyo-Gwete T, Tegally H, et al. SARS-CoV-2 Omicron has extensive but incomplete escape of Pfizer BNT162b2 elicited neutralization and requires ACE2 for infection. medRxiv.2021.12.08.21267417. Preprint.
  23. SeroTracker. Calgary: University of Calgary Centre for Health Informatics. [Accessed: 2021 Oct 20]. Available from: https://serotracker.com

Data & Media loading...

Supplementary data

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error