Five years after the COVID-19 pandemic, Georgian health data reveal persistent excess mortality, long COVID burden, and system weaknesses that the crisis exposed but the post-pandemic recovery has not yet resolved.
“Pandemics do not end when emergency declarations are lifted. They end when the excess mortality they caused has returned to baseline and the system weaknesses they revealed have been addressed. Georgia has not yet met either criterion.”
Pkhakadze G. Post-Pandemic Health Systems Assessment Georgia. Tbilisi: PHIG; 2025.[1]
Introduction
Georgia’s COVID-19 response was characterised by early decisive action — a state of emergency declared on 21 March 2020 — followed by progressive relaxation and waves of infection associated with delta and omicron variants in 2021–2022.[2] Prof. Giorgi Pkhakadze served as principal public health adviser to the Prime Minister and Cabinet of Ministers throughout the 2020–2022 period, providing direct counsel on pandemic management, policy sequencing, and public communication strategy. This analysis draws on that institutional experience alongside published epidemiological data to assess Georgia’s post-pandemic health system trajectory.
| Indicator | Value | Data Source | Context |
|---|---|---|---|
| Confirmed COVID-19 deaths (cumulative to Dec 2023) | 17,848 | MoLHSA/NCDC | Population 3.7M |
| Estimated excess deaths (all causes, 2020–2022) | 26,400 | Geostat/PHIG est. | 48% above confirmed count |
| Crude COVID-19 mortality rate (per 100,000) | 482 | MoLHSA 2024 | EU avg: 286 |
| Peak hospital occupancy (Jan 2022) | 94% ICU | MoLHSA | Near system collapse |
| Vaccination coverage (fully vaccinated, peak 2022) | 34% | WHO EURO data | EU avg at same time: 72% |
| Post-acute sequelae (long COVID) prevalence est. | 8–12% of infected | PHIG survey 2024 | ~280,000 persons affected |
| Health worker infections (cumulative) | 12,400 | MoLHSA 2024 | 18% of health workforce |
Sources: MoLHSA COVID-19 Data Dashboard 2024; WHO EURO COVID tracker; NCDC; PHIG estimates.[1,2,3]
Excess Mortality: The Full Picture
Official COVID-19 death counts in Georgia captured only a fraction of pandemic-attributable mortality. PHIG’s analysis of all-cause mortality data from Geostat, using a pre-pandemic trend baseline (2015–2019) adjusted for demographic change, estimates total excess deaths during 2020–2022 at approximately 26,400 — 48% higher than the confirmed COVID-19 death count of 17,848.[1] This gap reflects both direct COVID-19 deaths miscategorised as other causes and indirect mortality from deferred care, reduced preventive services, and health system strain during peak periods.[4]
Figure 1. All-Cause Mortality Georgia 2015–2024: Observed vs. Trend Baseline (per 100,000)
Sources: Geostat mortality data 2015–2024; PHIG trend analysis.[1,4]
Long COVID: The Unquantified Burden
Post-acute sequelae of SARS-CoV-2 (PASC), commonly termed long COVID, represent a substantial and chronically underquantified health burden in Georgia. The WHO defines long COVID as symptoms persisting more than 12 weeks after acute infection not explained by an alternative diagnosis.[5] Using the WHO prevalence estimate of 10–20% of infected persons and Georgia’s cumulative confirmed case count of approximately 1.9 million (likely an undercount), PHIG estimates 190,000–380,000 persons in Georgia have or have had long COVID, of whom fewer than 3,000 have accessed specialist post-COVID assessment services.[1,3]
| Reform Area | Status | Evidence of Impact | Outstanding Action |
|---|---|---|---|
| Pandemic preparedness plan update | Completed 2023 | Framework in place | Funding and exercises needed |
| ICU capacity expansion | Partially completed | +140 ICU beds (18% increase) | Further regional capacity needed |
| Health information system upgrade | In progress | EHR coverage 34% → 51% | National rollout 2026–2028 |
| Long COVID assessment service | Pilot only (Tbilisi) | ~3,000 patients seen | National scale-up needed |
| Health worker mental health support | Programme launched 2023 | 400 sessions provided | Sustainable funding absent |
| One Health surveillance integration | Not implemented | N/A | Requires legislative change |
| Vaccination programme reform | Under review | Coverage remained below 40% | Mandatory HW vaccination policy |
Sources: MoLHSA 2025; PHIG post-pandemic review.[1,2]
Figure 2. COVID-19 Vaccination Coverage: Georgia vs. EU Average 2021–2023 (% fully vaccinated)
Sources: WHO EURO COVID-19 vaccination tracker; Our World in Data.[3]
Conclusion
The COVID-19 pandemic was the most severe health shock to the Georgian system in the post-Soviet period. Five years on, mortality has returned to near-baseline levels, but structural vulnerabilities exposed during the crisis — low vaccination coverage, inadequate ICU surge capacity, fragmented health information systems, and an absent long COVID service — remain partially or wholly unaddressed. The lesson of COVID-19 for Georgia is not that the health system failed in a crisis; it is that the pre-existing weaknesses that caused the failure are still present. PHIG’s post-pandemic assessment identifies ICU regional capacity, EHR national rollout, and long COVID service expansion as the three highest-priority outstanding reforms for the 2025–2027 period.
References
- Pkhakadze G. Post-Pandemic Health System Assessment: Georgia 2020–2025. Tbilisi: PHIG; 2025.
- Ministry of Labour, Health and Social Affairs of Georgia. COVID-19 Response After-Action Review. Tbilisi: MoLHSA; 2023.
- WHO Regional Office for Europe. COVID-19 Dashboard: Georgia. Copenhagen: WHO/Europe; 2024. Available from: https://who.maps.arcgis.com
- Geostat. Vital Statistics and Cause of Death 2020–2024. Tbilisi: National Statistics Office of Georgia; 2024.
- WHO. Post COVID-19 Condition (Long COVID): Technical Brief. Geneva: WHO; 2023. WHO/2019-nCoV/Post_COVID-19_condition/2023.1
- Our World in Data. COVID-19 Vaccinations: Georgia. 2024. Available from: https://ourworldindata.org
Public Health Institute of Georgia
