HONG KONG –
Researchers at the University of Hong Kong (HKU) have found that the pandemic did not merely pull deaths forward in time: across 34 mainly high‑income countries, mortality remained elevated well after the worst COVID‑19 waves, and the expected “catch‑up” dip in deaths rarely materialized. In a cross‑country analysis of 352,182,284 deaths from 2015 through 2024, statistically significant mortality displacement – the idea that the virus hastened the deaths of frail people who would have died soon anyway – was detected in just three countries. (jamanetwork.com)
The study, published January 29, 2026 in JAMA Network Open, challenges a persistent narrative that pandemic death tolls were largely self‑correcting and would be followed by unusually low mortality. Instead, in most places the post‑2022 declines in deaths were too small to offset earlier losses, especially among people aged 85 and older. The United States had returned to its pre‑pandemic pattern of stable mortality by 2024; most European countries had not. (jamanetwork.com)
How the researchers tested the ‘harvesting’ hypothesis
HKU epidemiologists used harmonized weekly all‑cause mortality from the Human Mortality Database’s Short‑Term Mortality Fluctuations series to compare observed deaths with those expected if 2015-2019 trends had continued. They defined mortality displacement as a statistically significant deficit in deaths in 2023-2024 following positive excess mortality earlier in the pandemic, and quantified it with a displacement ratio: the post‑pandemic deficit divided by the pandemic‑period excess. Sensitivity checks included alternative statistical specifications and broader age bands; false discovery risk was controlled with Benjamini‑Hochberg adjustments. (jamanetwork.com)
Key country findings include:
- Significant mortality displacement was found only in Greece (10%), Latvia (21%), and Poland (21%), largely among adults 85 and older and in countries hit hardest in 2020-2022.
- The United States showed near‑zero 2024 excess mortality (3 per 100,000; 95% CI −2 to 7), indicating a return to pre‑pandemic stability.
- Many European countries still ran above expected mortality in 2024 – from 11 per 100,000 in France to 115 in Lithuania – signaling that pre‑COVID mortality declines had not resumed.
- New Zealand sustained better‑than‑expected mortality during 2020-2024, while Bulgaria and Lithuania recorded some of the highest cumulative excesses in 2020-2022.
(jamanetwork.com)
Europe’s lingering mortality burden
The new findings align with official statistics showing that, even after the emergency phase, Europe continued to register more deaths than expected. Eurostat estimates about 1.96 million additional deaths in the European Union between March 2020 and February 2024 compared with the 2016-2019 baseline, with positive excess recorded well into 2023 and parts of 2024. In November 2024, the EU’s excess mortality rate still stood around 5%, although some member states posted negative excess. (ec.europa.eu)
Those patterns matter for policy because they sit uneasily alongside the European Union’s formal declaration, under the EU cross‑border health threats regulation, that the COVID‑19 public health emergency phase has ended. While emergency powers have been scaled back, the mortality data suggest that underlying health vulnerabilities and care backlogs remain entrenched in several member states, complicating debates over long‑term investment in hospitals, primary care, and surveillance systems.
Life expectancy: rebounds and gaps
COVID‑19 drove historic falls in life expectancy across wealthy nations. While some recovery is visible, it is uneven. The OECD reports that as of 2022, life expectancy remained below pre‑pandemic levels in 28 member countries. Eurostat’s provisional data suggest the EU’s life expectancy rose to 81.5 years in 2023, slightly above 2019. In the United States, final figures released this week show life expectancy reached a record 79.0 years in 2024, up from 78.4 in 2023, though still below many peers. (oecd.org)
For governments, those partial rebounds sharpen questions about the quality and resilience of health systems rather than allowing them to close the books on COVID‑19. Persistently lower‑than‑expected gains in life expectancy can feed into pension and social‑security planning, fiscal projections, and the politics of health‑care reform, especially in ageing societies where small shifts in mortality trajectories have large budgetary implications.
Why the ‘pull‑forward’ story faltered
“Mortality displacement,” sometimes observed after short, intense crises like heat waves, presumes a later trough in deaths as the most vulnerable die earlier than they otherwise would have. The HKU analysis finds that for COVID‑19, any such displacement was typically small and concentrated at the oldest ages – dwarfed by the scale of pandemic‑era excess mortality. This echoes prior evidence that harvesting after severe heat events is modest relative to the immediate death surge. (jamanetwork.com)
Broader health‑system dynamics likely contributed to persistent losses. International assessments point to post‑pandemic health backlogs, disrupted chronic‑disease management, and seasonal respiratory pressures as ongoing headwinds – factors consistent with documented delays in cardiovascular care and elevated non‑COVID mortality in several settings. For health ministries and insurers, that reinforces the case for clearing diagnostic and surgical backlogs, rebuilding routine screening, and investing in workforce capacity rather than assuming that mortality will “normalize” on its own. (oecd.org)
Scale of the global shock
The World Health Organization estimates 14.9 million excess deaths worldwide in 2020-2021 alone – a measure that captures both direct COVID‑19 fatalities and indirect losses from health‑system disruption. That global baseline helps explain why later “make‑up” declines were too small in most rich countries to close the gap left by earlier surges. (who.int)
“These findings underscore the need for broad population-wide protection during pandemics and for understanding why many countries have yet to return to pre-COVID-19 mortality trajectories.”
(jamanetwork.com)
The HKU results also arrive as governments revisit national pandemic preparedness plans and financing arrangements under the World Health Organization’s International Health Regulations and parallel treaty talks. Persistent excess mortality gives statistical weight to arguments that preparedness metrics should go beyond emergency case counts and ICU capacity to track medium‑term effects on non‑COVID deaths and life expectancy.
Methodological guardrails and limits
The study’s conclusions rest on weekly, age‑specific death counts through December 2024, standardized across 34 countries. Results were robust across modeling approaches, but the authors caution that observational designs cannot establish causality and that country‑level patterns may reflect differences in demographics, health systems, and data completeness. (jamanetwork.com)
The HKU analysis was published in JAMA Network Open on January 29, 2026, using national mortality data updated through December 2024; most European statistical offices have yet to publish finalized mortality series for full‑year 2025. That lag means the study offers a near‑real‑time view of how countries are emerging from the pandemic – and underscores how much of the long tail of COVID‑19‑era mortality still has to be fully accounted for in official statistics and in public policy.
