How fast is Denmark vaccinating its population compared to other European countries?

The pace of Europe's vaccination campaigns against Covid-19 is steadily improving but in some countries more than others. We take a look at how countries in Europe compare in the race to inoculate their population.

How fast is Denmark vaccinating its population compared to other European countries?
A mass vaccination centre in an exhibition hall in Nice, France Photo: Valery Hache/AFP

European countries’ vaccination campaigns started at a snail’s pace and have come in for huge criticism domestically and from abroad but the pace is certainly picking up.

Germany on Wednesday administered a record 656,000 doses, according to the Robert Koch Institute (RKI), not too far off the UK’s daily record of 844,000 injections. On Thursday Germany topped 700,000 jabs.

Then France on Thursday announced that it had met its target of giving at least one Covid vaccine injection to 10 million people, one week ahead of schedule, while also setting a daily record of 437,000 vaccinations. 

Vaccination efforts have also picked up in Spain. The country’s health authorities beat the record for daily administered doses with 336,846 on Wednesday April 7th and then 456,682 the following day. But there have been problems in Italy, where targets have been missed.

March and April have also seen other countries covered by The Local’s network catch up with Denmark — by far the fastest European Union country off the block in January and February — as constraints in vaccine supply became a more important limiting factor than efficiency in administering doses. 

READ ALSO: What does Denmark’s continued AstraZeneca pause mean for Covid-19 vaccination programme?

By the start of April, the nine countries covered by The Local were closely bunched together in terms of the number of doses administered by 100 people, with the leader Denmark on 19.77, and the laggard, Sweden, on 16.55. 

As of April 8th, Well over 60m people in the European Union have now at least one dose of a vaccine: 12.2m in Germany, or 14.6 percent of the population, 10.2m in France (15.2%), 8.4m ( 13.8%) in Italy, 6.8m (14.5%) in Spain, 1.4m (15.5) in Austria, and 1.3m (13.0) in Sweden. 

The chart below shows the total number of doses administered, adding up both first and second jabs.

According to Denmark’s infectious diseases agency SSI, 835, 271 people had received at least one dose on April 8th (14.3%), while according to the Norwegian Institute of Public Health, 835,970 people (15.7 percent) had been. 

In this chart, you can see how other countries have steadily caught up with the lead set by Denmark, except perhaps Sweden.

What’s behind the increased speed of vaccination? 

This week around 35,000 GP surgeries in Germany have started vaccinating patients across the states, helping to increase the speed of the inoculation campaign. This boost will increase in the week of April 26th when the number of doses available to GPs will more than triple to three million a week. 

READ ALSO: Why is Italy missing its Covid vaccination targets?

France, meanwhile, has recently opened around 30 giant mass-vaccination centres or “vaccinodromes” in exhibition halls, stadiums, and other large venues,  with the Groupama stadium in Lyon carrying out 10,000 vaccinations over the Easter weekend alone. 

Otherwise, the faster pace largely reflects increased vaccine deliveries as well as the fact that governments have opened vaccination programmes up to wider age groups after priority groups such as care home residents were almost all vaccinated.

Mind the gap: how long are countries leaving between doses? 

France’s decision to allow a relatively long 12-week gap between doses for the AstraZeneca vaccine, and 3-6 weeks between doses for Pfizer and Moderna, has enabled it to overtake Denmark when it comes to the share of the population. Germany’s Permanent Vaccination Commission on March 4th recommended extending the gap between the first and second AstraZeneca dose to a maximum of 12 weeks. 

Austria has also pulled ahead, with close to 15 percent of the population having received at least one dose, thanks in part to a March 24th recommendation from the National Vaccination Board to extend the gap between doses for both the Pfizer/BioNtech and Moderna vaccine by “two to three weeks”, so that the second dose is given at six-week intervals. 

But when it comes to the share of the population who are fully vaccinated (two doses), Denmark is still comfortably ahead. Switzerland, the country in the Local’s network where the lowest share of the population has received at least one dose, is second only to Denmark in the share of the population who are fully vaccinated. 

France, meanwhile, has by far the lowest proportion of its population fully vaccinated of any country in The Local’s network. 

How significant an impact has the pause in administering AstraZeneca jabs had? 

The effects of the temporary suspension of AstraZeneca vaccines is clear if you look at a chart of the seven-day average of daily doses given per 100,000 people between March 11th, when Denmark suspended use of the AstraZeneca jab, and April 8th, when Denmark and Norway are the only countries in The Local’s network yet to resume using it. 

Austria, which only temporarily suspended the use of one suspect batch of the vaccine, surged ahead from March 12th, while Denmark dropped from its leading position to temporarily become the slowest vaccinating country covered by The Local.

After Germany, France, Italy, and Spain resume AstraZeneca vaccinations on March 19th, they started to pull ahead of Denmark, Sweden and Norway, which kept the suspension in place while health authorities further studied the evidence. Last week, Norway and Denmark, administered the lowest number of doses of any country covered by The Local. 

Switzerland, meanwhile, whose medicines agency has yet to approve the AstraZeneca vaccine, continued along the same lacklustre trajectory. 

Who has done the best at protecting the most vulnerable risk groups? 

Of all the country’s in The Local’s network, Italy has prioritised health workers the most, with over 90 percent of health workers having had at least one dose of a vaccine, compared to less than 60 percent of those over the age of 80. 

Most other countries have prioritised the over-80s.

According to data released on April 8th by Spain’s health ministry, 87.4 percent of those over the age of 80 have received at least one dose of a vaccine in Spain, but just 9.1 percent of 70-79 years olds, and 20.8 percent of 60-69 year olds. 

According to France’s VaccinTracker website, 63 percent of those over the age of 75 have had at least one dose of a vaccine, of whom 34 percent have had both doses. 

Germany’s vaccination dashboard on March 31st stopped updating data on what share of vaccines had been given to health workers and which to elderly. But at that point 48.8 percent of the total doses had been to people prioritised due to age, of whom 12.7 percent were care home residents, and 39.9 percent to health staff. 

According to the vaccination data site of Denmark’s SSI infectious diseases institute, 93 percent of men over the age of 90 and 92 percent of women have had at least one dose, while 86.4 percent and 84.9 percent had had two. Of those between the ages of 80 and 89, 86.3 percent of men and 86.2 percent of women have had at least one dose, while 45.9 percent and 49.3 percent have had both. Only 29.8 percent of men and 27.8 percent of women between the ages of 70 and 79 have had their first dose, while only 13.1 percent and 12 percent have had both. 

According to the Swedish Public Health Agency’s vaccination data site, 88 percent over over-90s have received at least one dose, and 68 percent two doses, 84.6 percent of 80 to 89-year-olds have received at least one dose and 36 percent two doses and only 33 percent of 70 to 79-year-olds have received one dose and 8 percent two doses. 

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FACT CHECK: Did Sweden have lower pandemic mortality than Denmark and Norway?

A graphic published by the Svenska Dagbladet newspaper last week claimed that Sweden had the lowest excess mortality of all EU and Nordic counties between the start of 2020 and the end of 2022. We looked into whether this extraordinary claim is true.

FACT CHECK: Did Sweden have lower pandemic mortality than Denmark and Norway?

At one point in May 2020, Sweden had the highest Covid-19 death rate in the world, spurring newspapers like the New York Times and Time Magazine to present the country as a cautionary tale, a warning of how much more Covid-19 could ravage populations if strict enough measures were not applied. 

“Per million people, Sweden has suffered 40 percent more deaths than the United States, 12 times more than Norway, seven times more than Finland and six times more than Denmark,” the New York Times reported in July 2020

An article in Time in October 2020 declared Sweden’s Covid response “a disaster”, citing figures from Johns Hopkins University ranking Sweden’s per capita death rate as the 12th highest in the world.

So there was undisguised glee among lockdown sceptics when Svenska Dagbladet published its data last week showing that in the pandemic years 2020, 2021 and 2022 Sweden’s excess mortality was the lowest, not only in the European Union, but of all the Nordic countries, beating even global Covid-19 success stories, such as Norway, Denmark and Finland. 

Versions of the graph or links to the story were tweeted out by international anti-lockdown figures such as Bjørn Lomborg, a Danish sceptic of climate action, and Fraser Nelson, editor of Britain’s Spectator Magazine, while in Sweden columnists like Dagens Nyheter’s Alex Schulman and Svenska Dagbladet’s opinion editor Peter Wennblad showed that Anders Tegnell, the state epidemiologist who led Sweden’s strategy had been “right all along”. 

Excess mortality — the number of people who die in a year compared to the number expected to die based on previous years — is seen by some statisticians as a better measure for comparing countries’ Covid-19 responses, as it is less vulnerable to differences in how Covid-19 deaths are reported. 

But are these figures legitimate, where do they come from, and do they show what they purport to show?

Here are the numbers used by SvD in its chart: 

Where do the numbers come from? 

Örjan Hemström, a statistician specialising in births and deaths at Sweden’s state statistics agency Statistics Sweden (SCB), put together the figures at the request of Svenska Dagbladet. 

He told The Local that the numbers published in the newspaper came from him and had not been doctored in any way by the journalists.

He did, however, point out that he had produced an alternative set of figures for the Nordic countries, which the newspaper chose not to use, in which Sweden had exactly the same excess mortality as Denmark and Norway. 

“I think they also could have published the computation I did for the Nordic countries of what was expected from the population predictions,” he said of the way SvD had used his numbers. “It takes into consideration trends in mortality by age and sex. The excess deaths were more similar for Denmark, Sweden, and Norway. Almost the same.” 

Here are Hemström’s alternative numbers: 

Another issue with the analysis is that the SvD graph compares deaths in the pandemic years to deaths over just three years, a mean of 2017-2019, and does not properly take into account Sweden’s longstanding declining mortality trend, or the gently rising mortality trend in some other countries where mortality is creeping upwards due to an ageing population, such as Finland. 

“It’s very difficult to compare countries and the longer the pandemic goes on for the harder it is, because you need a proper baseline, and that baseline depends on what happened before,” Karin Modig, an epidemiologist at Sweden’s Karolinska Institute whose research focuses on ageing populations, told The Local.

“As soon as you compare between countries, it’s more difficult because countries have different trends of mortality, they have different age structures, and in the pandemic they might have had different seasonal variations.” 

She described analyses such as Hemström’s as “quite crude”. 

In an interview with SvD to accompany the graph, Tegnell also pushed back against giving the numbers too much weight. 

“Mortality doesn’t tell the whole story about what effect a pandemic has had on different countries,” he said. “The excess mortality measure has its weaknesses and depends a lot on the demographic structures of countries, but anyway, when it comes to that measure, it looks like Sweden managed to do quite well.”

Do the numbers match those provided by other international experts and media? 

Sweden’s excess mortality over the three years of the pandemic is certainly below average worldwide, but it is only in the SvD/SCB figures that it beats Norway and Denmark. 

A ranking of excess mortality put together by Our World in Data for the same period as the SvD/SCB table estimates Sweden’s excess mortality between the start of 2020 and the end of 2022 at 5.62 percent, considerably more than the 4.4 percent SvD claims and above that of Norway on 5.08 percent and Denmark on 2.52 percent. 

The Economist newspaper also put together an estimate, using their own method based on projected deaths.  

Our World in Data uses the estimate produced by Ariel Karlinsky and Dmitry Kobak, who manage the World Mortality Dataset (WMD). To produce the estimate, they fit a regression model for each region using historical deaths data from 2015–2019, so a time period of five years rather than the three used by SCB.

What’s clear, is that, whatever method you use, Sweden is, along with the other Nordic countries, among the countries with the lowest excess mortality over the pandemic. 

“Most methods seem to put Sweden and the other Nordic countries among the countries in Europe with the lowest cumulative excess deaths for 2020-2022,” said Preben Aavitsland, the Director for Surveillance and the Norwegian Institute of Public Health.

So if Sweden had similar excess mortality as the other Nordics over the period, does that mean it had a similar Covid-19 death rate?

Not at all. Sweden’s per capita death rate from Covid-19 over the period covered by the SvD/SCB figures, at 2,249 per million people, is more than double Norway’s 959 per million, 60 percent more than the 1,409 per million who died in Denmark, and more than 50 percent more than the 1,612 per million who died in Finland. 

While Sweden’s death rate is still far ahead of those of its Nordic neighbours, it is now much closer to theirs than it was at the end of 2020. 

“The most striking difference between Sweden and the other Nordic countries is that only Sweden had large excess mortality in 2020 and the winter of 2020-21,” Aavitsland explained. “In 2022, the field levelled out as the other countries also had excess mortality when most of the population was infected by the omicron variant after all measures had been lifted.”

So why, if the Covid-19 death rates are still so different, are the excess mortality rates so similar?

This largely reflects the fact that many of those who died in Sweden in the first year of the pandemic were elderly people in care homes who would have died anyway by the end of 2022. 

About 90 percent of Covid-19 deaths were in people above 70, Aavitsland pointed out, adding that this is the same age group where you find around 80 percent of all deaths, regardless of cause, in a Scandinavian country.

“My interpretation is that in the first year of the pandemic, say March 2020 – February 2021, Sweden had several thousand excess deaths among the elderly, including nursing home residents,” he said. “Most of this was caused by Covid-19. In the other [Nordic] countries, more people like these survived, but they died in 2022. The other countries managed to delay some deaths, but now, three years after, we end up at around the same place.” 

So does that mean Sweden’s state epidemiologist Anders Tegnell was right all along? 

It depends on how you view the shortened lives of the close to ten thousand elderly people who caught Covid-19 and died in Sweden in the first wave because Sweden did not follow the example of Denmark, Norway, and Finland and bring in a short three-week lockdown in March and April 2020. 

Tegnell himself probably said it best in the SvD interview. 

“You’ve got to remember that a lot of people died in the pandemic, which is of course terrible in many ways, not least for their many loved ones who were affected, so you need to be a bit humble when presented with these kinds of figures.”