Waning of first- and second-dose ChAdOx1 and BNT162b2 COVID-19 vaccinations : a pooled target trial study of 12.9 million individuals in England, Northern Ireland, Scotland and Wales

Kerr, Steven and Bedston, Stuart and Bradley, Declan T and Joy, Mark and Lowthian, Emily and Mulholland, Rachel M and Akbari, Ashley and Hobbs, FD Richard and Katikireddi, Srinivasa Vittal and de Lusignan, Simon and Rudan, Igor and Torabi, Fatemeh and Tsang, Ruby SM and Lyons, Ronan A. and Robertson, Chris and Sheikh, Aziz (2022) Waning of first- and second-dose ChAdOx1 and BNT162b2 COVID-19 vaccinations : a pooled target trial study of 12.9 million individuals in England, Northern Ireland, Scotland and Wales. International Journal of Epidemiology. ISSN 0300-5771 (https://doi.org/10.1093/ije/dyac199)

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Abstract

Background:  Several SARS-CoV-2 vaccines have been shown to provide protection against COVID-19 hospitalization and death. However, some evidence suggests that notable waning in effectiveness against these outcomes occurs within months of vaccination. We undertook a pooled analysis across the four nations of the UK to investigate waning in vaccine effectiveness (VE) and relative vaccine effectiveness (rVE) against severe COVID-19 outcomes. Methods:  We carried out a target trial design for first/second doses of ChAdOx1(Oxford–AstraZeneca) and BNT162b2 (Pfizer–BioNTech) with a composite outcome of COVID-19 hospitalization or death over the period 8 December 2020 to 30 June 2021. Exposure groups were matched by age, local authority area and propensity for vaccination. We pooled event counts across the four UK nations. Results:  For Doses 1 and 2 of ChAdOx1 and Dose 1 of BNT162b2, VE/rVE reached zero by approximately Days 60–80 and then went negative. By Day 70, VE/rVE was –25% (95% CI: –80 to 14) and 10% (95% CI: –32 to 39) for Doses 1 and 2 of ChAdOx1, respectively, and 42% (95% CI: 9 to 64) and 53% (95% CI: 26 to 70) for Doses 1 and 2 of BNT162b2, respectively. rVE for Dose 2 of BNT162b2 remained above zero throughout and reached 46% (95% CI: 13 to 67) after 98 days of follow-up. Conclusions:  We found strong evidence of waning in VE/rVE for Doses 1 and 2 of ChAdOx1, as well as Dose 1 of BNT162b2. This evidence may be used to inform policies on timings of additional doses of vaccine.