Document Type : Original Article


1 Faculty of Medicine & Surgery University of Malta

2 Faculty of Medicine & Surgery, University of Malta

3 Faculty of Medicine & Surgery



Background: COVID-19 has impacted the European microstates of Andorra, Liechtenstein, Malta, Monaco, the Republic of San Marino, and Vatican City. Even though they have similar population sizes, they are rarely studied. The goal was to summarize the COVID-19 situation (January 2020–July 2021) for these microstates, as well as the outcome and immunization roll-out throughout the first 18 months. While researching COVID-19 incidence and mortality trends among microstates and their land bordering nations,
Methods: Epidemiological data was gathered from the database "Our World in Data," whereas COVID-19-related tactics were based on Ministry of Health webpages and local newspapers. Using COVID-19 data (where applicable), the six microstates and their adjacent nations were compared.
Results: From the start of COVID-19 until August 1, 2021, the microstates reported a total of 60,174 positive cases and 730 deaths. Andorra had the greatest rates of COVID-19 infection (190 per 1,000) and mortality (1.66 per 1,000). The microstates had similar COVID-19 results, but their bordering nations shared the most striking similarities. COVID-19 cases, fatality rates, and vaccine doses all have a bidirectional link.
Conclusion: Whether land borders exist, timely mitigation measures and vaccination rollouts appear to be the keys to pandemic containment. The greatest pandemic impact on a country, however, appears to be dependent on cross-border transmission rates.


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