Health · Romania and the European Union · 2011–2025
More than half of the babies in the EU whose death certificates say pneumonia are Romanian
In 2023, 282 children under one died of pneumonia in the European Union. 159 were in Romania, a country with 4.4% of the EU's births. The share was above half every year from 2011 to 2023.
Part of the gap is what goes on the death certificate: Romania records “sudden infant death” and “unknown cause” several times less often than other countries. But counted without any cause, deaths between one month and one year are still more than twice as frequent as in the rest of the EU. Between 2016 and 2025, about 4,600 more babies died in Romania, of all causes, than at the rest of the EU's rate.
Romania: 159rest of the EU: 123
What the certificate says#
When a baby dies at home or after a few days of illness, a doctor picks a cause. In the rest of the EU many such deaths are recorded as “sudden infant death” or “unknown cause”. In Romania, several times fewer: sudden infant death, in 2023, 3.7 per 100,000 births, against 13.3 in the rest of the EU. Pneumonia, instead, appears 28 times as often.
So comparing a single cause exaggerates. The more causes that can stand in for one another are pooled, the smaller the gap: from 28 times for pneumonia, to 19 for all respiratory disease, to 3.4 when sudden death, unspecified causes and infections are added, down to 1.7 for all deaths under one.
One test does not depend on the certificate at all: children who die between their 28th day and their first birthday. In 2023, Romania had 2.3 per 1,000 births, the rest of the EU 1.0: 2.3 times as many. The ratio stayed above 2 every year from 2011 to 2023. For newborns in their first month the ratio is much smaller: 1.4.
Save the Children Romania reported in 2024 that Romania had, in 2021, more than half of the EU's infant deaths from respiratory disease. The same pattern, weaker, shows in Bulgaria (1.9 times on the pooled causes) and Slovakia (3.2), but not in Hungary (0.9) or Poland (0.7).
Romaniarest of the EU
How big the gap is, depending on how many causes are pooled
- Pneumonia only28×
- All respiratory disease19×
- + sudden death and unspecified causes3.5×
- + infections3.4×
- All deaths under one1.7×
- Deaths between one month and one year (no cause)2.3×
Your county#
Cause of death is not published by county. Total deaths under one, of all causes, are: here, by the child's home address, pooled over ten years (2016–2025) so that small numbers do not mislead. The comparison is with the rest of the EU's rate, 3.3 per 1,000.
Nationally, in 2023, the gap with the rest of the EU in all deaths under one came 43% from respiratory disease, infections and sudden or unspecified deaths, 28% from malformations and 17% from perinatal conditions.
Deaths under one per 1,000 births< 44–55–66–7≥ 7rest of EU: 3.3
Romania
In Romania, between 2016 and 2025, 10,965 children under one died of all causes, out of 1,928,737 births: 5.7 per 1,000. At the rest of the EU's rate about 6,370 would have died.
All counties as a table
| County | Deaths under one | Births | Per 1,000 | 95% interval | Against the rest of the EU's rate |
|---|---|---|---|---|---|
| Tulcea | 156 | 16,210 | 9.6 | 8.2–11.3 | +102 |
| Mureș | 437 | 55,347 | 7.9 | 7.2–8.7 | +254 |
| Sălaj | 189 | 24,450 | 7.7 | 6.7–8.9 | +108 |
| Călărași | 207 | 26,845 | 7.7 | 6.7–8.8 | +118 |
| Botoșani | 309 | 40,342 | 7.7 | 6.8–8.6 | +176 |
| Satu Mare | 254 | 33,459 | 7.6 | 6.7–8.6 | +144 |
| Suceava | 620 | 85,581 | 7.2 | 6.7–7.8 | +337 |
| Constanța | 468 | 65,722 | 7.1 | 6.5–7.8 | +251 |
| Brăila | 161 | 22,621 | 7.1 | 6.1–8.3 | +86 |
| Covasna | 149 | 20,938 | 7.1 | 6.0–8.4 | +80 |
| Maramureș | 314 | 45,250 | 6.9 | 6.2–7.8 | +165 |
| Vrancea | 212 | 32,049 | 6.6 | 5.8–7.6 | +106 |
| Bihor | 381 | 58,344 | 6.5 | 5.9–7.2 | +188 |
| Caraș-Severin | 139 | 21,395 | 6.5 | 5.5–7.7 | +68 |
| Hunedoara | 201 | 31,240 | 6.4 | 5.6–7.4 | +98 |
| Bistrița-Năsăud | 209 | 32,686 | 6.4 | 5.6–7.3 | +101 |
| Ialomița | 166 | 26,722 | 6.2 | 5.3–7.2 | +78 |
| Brașov | 378 | 60,863 | 6.2 | 5.6–6.9 | +177 |
| Dolj | 361 | 58,805 | 6.1 | 5.5–6.8 | +167 |
| Mehedinți | 134 | 21,853 | 6.1 | 5.1–7.3 | +62 |
| Harghita | 184 | 30,139 | 6.1 | 5.3–7.1 | +85 |
| Galați | 306 | 50,195 | 6.1 | 5.4–6.8 | +140 |
| Sibiu | 253 | 41,772 | 6.1 | 5.3–6.9 | +115 |
| Bacău | 376 | 62,173 | 6.0 | 5.5–6.7 | +171 |
| Gorj | 154 | 26,097 | 5.9 | 5.0–6.9 | +68 |
| Neamț | 254 | 43,765 | 5.8 | 5.1–6.6 | +110 |
| Buzău | 199 | 34,527 | 5.8 | 5.0–6.6 | +85 |
| Argeș | 281 | 48,793 | 5.8 | 5.1–6.5 | +120 |
| Olt | 178 | 31,403 | 5.7 | 4.9–6.6 | +74 |
| Arad | 229 | 40,746 | 5.6 | 4.9–6.4 | +94 |
| Alba | 159 | 29,276 | 5.4 | 4.6–6.3 | +62 |
| Giurgiu | 122 | 22,834 | 5.3 | 4.4–6.4 | +47 |
| Vâlcea | 136 | 25,684 | 5.3 | 4.4–6.3 | +51 |
| Prahova | 288 | 58,751 | 4.9 | 4.4–5.5 | +94 |
| Cluj | 337 | 68,915 | 4.9 | 4.4–5.4 | +109 |
| Timiș | 338 | 70,030 | 4.8 | 4.3–5.4 | +107 |
| Teleorman | 121 | 25,076 | 4.8 | 4.0–5.8 | +38 |
| Dâmbovița | 193 | 43,256 | 4.5 | 3.9–5.1 | +50 |
| Iași | 438 | 100,869 | 4.3 | 3.9–4.8 | +105 |
| Vaslui | 199 | 46,692 | 4.3 | 3.7–4.9 | +45 |
| Ilfov | 191 | 47,980 | 4.0 | 3.4–4.6 | +33 |
| Bucharest | 584 | 199,042 | 2.9 | 2.7–3.2 | −73 |
From 1990 to today#
In 1990, 3,165 children under one died of pneumonia in Romania. In 2024, 172 (2025, provisional: 118). The fall is huge, but the rest of Europe fell too, and the gap remained: in 2023, Romania's rate was 28 times the rest of the EU's.
What could prevent some of them#
The pneumococcal vaccine joined Romania's national immunisation programme in October 2017. For 2023, WHO and UNICEF estimated that 78% of children had received the third dose; by the programme's own administrative reports, only 41%.
Against respiratory syncytial virus (RSV), Spain and France began in September 2023 to offer every newborn an antibody, nirsevimab. Among immunised infants in the first months, effectiveness was at least 70% against hospital admission for RSV lower respiratory infection in Spain, and about 76% (interval 49–89%) against paediatric intensive-care admission for RSV bronchiolitis in France.
In Romania, the medicines agency decided in October 2025 to add nirsevimab conditionally to the reimbursed medicines list, for newborns and infants in their first RSV season. On 16 July 2026 it was still not on the list: the cost-volume contract was under negotiation.
The page cannot say how many Romanian deaths would have been avoided: the virus or bacterium behind each pneumonia is not in the published statistics.
What these data do not show#
- The data do not say which certificate is “right”. They show only that Romania and the rest of the EU record similar deaths under different causes, and that, pooled, deaths from the causes that can stand in for one another remain about 3.4 times higher in Romania.
- Cause of death is not published by county or by finer age bands for children under one. That is why the map shows all deaths under one, not pneumonia alone.
- Eurostat has cause data up to 2023. For 2024 and 2025 the figures come from INS only; 2025 is provisional.
- Eurostat's regional data are not used: in Romania, deaths appear to be recorded where the child died (for example in Bucharest hospitals), not where it lived.
How the analysis was done#
- Deaths under one by cause: Eurostat table hlth_cd_aro (residents, both sexes), 2011–2023. Live births: Eurostat demo_gind. Infant and neonatal mortality rates: Eurostat demo_minfind.
- “Rest of the EU” = the other EU countries with cause-of-death data that year (Luxembourg and Malta are missing in most years, Cyprus in seven years and Latvia in 2019). Rates are pooled deaths divided by the same countries' pooled births. Romania's births are by usual residence, as in Eurostat; since 2022 they are 3–9% fewer than by domicile, so Romanian rates on this page are, if anything, slightly higher than on a domicile basis.
- Post-neonatal mortality (28 days to 1 year) = infant rate minus neonatal rate, multiplied by each country's births. Countries without a neonatal rate that year are left out (in 2023: Denmark, Ireland, Italy, Cyprus); leaving out Italy, with low rates, makes the ratio smaller, not larger. Threshold set before calculating: if the Romania/rest-of-EU ratio stays at 2 or more in every year checked, the gap cannot be put down to certificates alone. It stayed between 2.3 and 3.8.
- Counties: INS TEMPO, deaths under one (POP208C) and live births (POP201D) by domicile, by locality, summed by county, 2016–2025 (2025 provisional). The 95% interval is the exact Poisson interval. “At the rest of the EU's rate” = births multiplied by the rest of the EU's rate for 2016–2023 (3.3 per 1,000).
- The series since 1990: INS, deaths under one by cause (POP208D, by domicile).
Questions#
Does this mean Romanian doctors get the diagnosis wrong?
These data cannot say. They show only that the same kinds of deaths are recorded under different causes in different countries. Counted together, deaths from these causes remain about 3.4 times higher in Romania.
Where is the gap largest?
After the first month of life. In the first month Romania has 1.4 times the rest of the EU's deaths; between one month and one year, 2.3 times. The published data do not show why.
Can I find out how many babies died in my village?
The page publishes no figures by locality: the numbers are very small, and each one is a child who could be recognised.
Sources#
All sources were opened on 1 November 2026.
- Eurostat, Causes of death by age group, residents (hlth_cd_aro), deaths under one, 2011–2023.
- Eurostat, Infant mortality indicators (demo_minfind) and live births (demo_gind).
- Romania's National Institute of Statistics, TEMPO: POP208D (deaths under one by cause), POP208F, POP208G (deaths under one by locality, usual residence), POP201K (live births by locality).
- Save the Children Romania, press release on infant respiratory deaths, 16 October 2024 (Romanian).
- UNICEF Romania, A Matter of Life and Death: infant mortality in Romania, April 2026.
- WHO and UNICEF, Romania immunisation profile (WUENIC estimates, 2023 revision): pneumococcal vaccine introduction and PCV3 coverage.
- ANMDMR, health technology assessments of Beyfortus (nirsevimab): 46366/2025 (conditional inclusion, decision 1250/01.10.2025), 74545/2025 and 14988/2026.
- López-Lacort et al., early nirsevimab effectiveness in Spain, Eurosurveillance, 2024; Paireau et al., nirsevimab and paediatric intensive-care admissions in France, Influenza and Other Respiratory Viruses, 2024.