BACKGROUND: By March, 2023, 54 countries, areas, and territories (hereafter CAT) in the WHO European Region had reported more than 2·2 million COVID-19-related deaths to the WHO Regional Office for Europe. Here, we estimated how many lives were directly saved by vaccinating adults in the WHO European Region from December, 2020, to March, 2023. METHODS: In this retrospective surveillance study, we estimated the number of lives directly saved by age group, vaccine dose, and circulating variant-of-concern (VOC) period, regionally and nationally, using weekly data on COVID-19 mortality and infection, COVID-19 vaccination uptake, and SARS-CoV-2 virus characterisations by lineage downloaded from The European Surveillance System on June 11, 2023, as well as vaccine effectiveness data from the literature. We included data for six age groups (25-49 years, 50-59 years, ≥60 years, 60-69 years, 70-79 years, and ≥80 years). To be included in the analysis, CAT needed to have reported both COVID-19 vaccination and mortality data for at least one of the four older age groups. Only CAT that reported weekly data for both COVID-19 vaccination and mortality by age group for 90% of study weeks or more in the full study period were included. We calculated the percentage reduction in the number of expected and reported deaths. FINDINGS: Between December, 2020, and March, 2023, in 34 of 54 CAT included in the analysis, COVID-19 vaccines reduced deaths by 59% overall (CAT range 17-82%), representing approximately 1·6 million lives saved (range 1·5-1·7 million) in those aged 25 years or older: 96% of lives saved were aged 60 years or older and 52% were aged 80 years or older; first boosters saved 51% of lives, and 60% were saved during the Omicron period. INTERPRETATION: Over nearly 2·5 years, most lives saved by COVID-19 vaccination were in older adults by first booster dose and during the Omicron period, reinforcing the importance of up-to-date vaccination among the most at-risk individuals. Further modelling work should evaluate indirect effects of vaccination and public health and social measures. FUNDING: US Centers for Disease Control and Prevention.

Cantacuzino National Military Medical Institute for Research and Development Bucharest Romania

Centre for Health Security and Communicable Disease Control Reykjavik Iceland

Directorate of Disease Prevention and Health Promotion Directorate General of Health Lisbon Portugal

Directorate of Information and Analysis Directorate General of Health Lisbon Portugal

Finnish Institute for Health and Welfare Helsinki Finland

Health Directorate Luxembourg Luxembourg

Health Service Executive Health Protection Surveillance Centre Dublin Ireland

Hellenic National Public Health Organization Athens Greece

Infectious Disease Prevention and Control Unit Health Promotion and Disease Prevention Directorate Pietà Malta

Institute of Health Information and Statistics of the Czech Republic Nové Město Czechia

Institute of Public Health of Republic of North Macedonia Skopje North Macedonia

Instituto de Salud Carlos 3 Madrid Spain

Istituto Superiore di Sanità Rome Italy

Medical and Public Health Services Ministry of Health Nicosia Cyprus

Medical University Vienna Austria

Ministry of Health Madrid Spain

National Agency for Public Health Chisinau Moldova

National Center for Public Health and Pharmacy Budapest Hungary

National Health Institute Doutor Ricardo Jorge Lisbon Portugal

National Institute of Public Health Bucureşti Romania

National Institute of Public Health Ljubljana Slovenia

National Institute of Public Health Prague Czechia

National Institute of Public Health Prague Czechia; 3rd Faculty of Medicine Charles University Prague Czechia

National Public Health Center under the Ministry of Health Vilnius Lithuania

Norwegian Institute of Public Health Oslo Norway

Österreichische Agentur für Gesundheit und Ernährungssicherheit Vienna Austria

Public Health Scotland Glasgow UK

Regional Public Health Authority Banská Bystrica Slovakia

Sciensano Brussels Belgium

Statens Serum Institute Copenhagen Denmark

UK Health Security Agency London UK

World Health Organization Regional Office for Europe Copenhagen Denmark

Lancet Respir Med. 2025 Jun 23:S2213-2600(25)00235-8. doi: 10.1016/S2213-2600(25)00235-8. PubMed

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