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Nationwide Vaccination Campaign with BNT162b2 in Israel Demonstrates High Vaccine Effectiveness and Marked Declines in Incidence of SARS-CoV-2 Infections and COVID-19 Cases, Hospitalizations, and Deaths

24 Pages Posted: 24 Mar 2021

See all articles by Eric J. Haas

Eric J. Haas

Ministry of Health (Israel) - Public Health Services

Frederick J. Angulo

Pfizer, Inc.

John M. McLaughlin

Pfizer, Inc.

Emilia Anis

Ministry of Health (Israel) - Public Health Services

Shepherd R. Singer

Ministry of Health (Israel) - Public Health Services

Farid Khan

Pfizer, Inc.

Nati Brooks

Ministry of Health (Israel) - Information Technology Department

Meir Smaja

Ministry of Health (Israel) - Information Technology Department

Gabriel Mircus

Pfizer Pharmaceuticals Israel Ltd

Kaijie Pan

Pfizer, Inc.

Jo Southern

Pfizer, Inc.

David L. Swerdlow

Pfizer, Inc.

Luis Jodar

Pfizer, Inc. - Vaccines Medical Development & Scientific Affairs

Yeheskel Levy

Ministry of Health (Israel)

Sharon Alroy-Preis

Israel Ministry of Health; Ministry of Health (Israel) - Department of Maternal and Child Health

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Abstract

Background: Following emergency use authorization of the Pfizer/BioNTech mRNA SARS-CoV-2 vaccine, BNT162b2, the Ministry of Health (MoH) launched a campaign to immunize all Israelis aged ≥ 16 years (6∙4 million).

Methods: Using national public health surveillance data from Jan 24, 2021–Mar 6, 2021, vaccine coverage and COVID-19 incidence were monitored and vaccine effectiveness (VE) was estimated, adjusted for age, sex, and week. Prevalence of SARS-CoV-2 variant B.1.1.7 was determined using polymerase chain reaction S gene target failure of selected specimens.

Findings: Through Mar 6, 2021, 51∙5% of persons aged ≥ 16 years received two doses of BNT162b2. During the observation period, SARS-CoV-2 B.1.1.7 prevalence was 93∙9%. Estimates of VE at ≥ 7 days after the second dose were: 94∙1% (95% CI 93∙4–94∙7) against SARS-CoV-2 infection, 90∙4% (95% CI 89∙1–91∙5) against asymptomatic SARS-CoV-2 infection, 96∙3% (95% CI 95∙9–96∙7) against symptomatic COVID-19 cases, 96∙0% (95% CI 95∙2 – 96∙6) against hospitalizations, 96∙2% (95% CI 95∙5–96∙8) against severe and critical hospitalizations, and 93∙3% (95% CI 91∙5–94∙8) against deaths. Estimates of VE were even higher at ≥ 14 days after the second dose of BNT162b2. In all age groups, as vaccine coverage increased, the incidence of SARS-CoV-2 outcomes declined markedly among the vaccinated.

Interpretation: Two doses of BNT162b2 were highly effective in preventing SARS-CoV-2 infections and COVID-19 cases, hospitalizations, severe and critical hospitalizations, and deaths in a large, nationwide observational study conducted when B.1.1.7 was the dominant SARS-CoV-2 strain. This study provides the first demonstration of the effectiveness of two doses of BNT162b2 against death and is also the first to show marked nationwide declines in incidence of SARS-CoV-2 infections corresponding with increasing vaccine coverage. The high VE in a real-world setting, including apparent effectiveness against asymptomatic infections, offers hope that COVID-19 vaccination will eventually control the pandemic.

Funding: Israel MoH and Pfizer.

Conflict of Interest: Frederick Angulo, John McLaughlin, Farid Khan, Gabriel Mircus, Kaijie Pan, Jo Southern, David Swerdlow, and Luis Jodar are employees of Pfizer and hold stock and stock options. All other authors report no conflicts.

Ethical Approval: Analysis of these data was judged to be exempt from ethics board review based on MoH guidelines for human subject research. The study followed the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines.

Keywords: COVID-19, SARS-CoV-2, vaccine effectiveness, prevention, mRNA vaccines, pandemic, observational study, epidemiology

Suggested Citation

Haas, Eric J. and Angulo, Frederick J. and McLaughlin, John M. and Anis, Emilia and Singer, Shepherd R. and Khan, Farid and Brooks, Nati and Smaja, Meir and Mircus, Gabriel and Pan, Kaijie and Southern, Jo and Swerdlow, David L. and Jodar, Luis and Levy, Yeheskel and Alroy-Preis, Sharon, Nationwide Vaccination Campaign with BNT162b2 in Israel Demonstrates High Vaccine Effectiveness and Marked Declines in Incidence of SARS-CoV-2 Infections and COVID-19 Cases, Hospitalizations, and Deaths. Available at SSRN: https://ssrn.com/abstract=3811387

Eric J. Haas

Ministry of Health (Israel) - Public Health Services ( email )

Jerusalem
Israel

Frederick J. Angulo

Pfizer, Inc. ( email )

235 East 42 Street
New York, NY 10017
United States

John M. McLaughlin

Pfizer, Inc. ( email )

235 East 42 Street
New York, NY 10017
United States

Emilia Anis

Ministry of Health (Israel) - Public Health Services

Jerusalem
Israel

Shepherd R. Singer

Ministry of Health (Israel) - Public Health Services ( email )

Jerusalem
Israel

Farid Khan

Pfizer, Inc.

235 East 42 Street
New York, NY 10017
United States

Nati Brooks

Ministry of Health (Israel) - Information Technology Department ( email )

Israel

Meir Smaja

Ministry of Health (Israel) - Information Technology Department ( email )

Israel

Gabriel Mircus

Pfizer Pharmaceuticals Israel Ltd ( email )

235 East 42 Street
New York, NY 10017
United States

Kaijie Pan

Pfizer, Inc. ( email )

235 East 42 Street
New York, NY 10017
United States

Jo Southern

Pfizer, Inc. ( email )

235 East 42 Street
New York, NY 10017
United States

David L. Swerdlow

Pfizer, Inc. ( email )

235 East 42 Street
New York, NY 10017
United States

Luis Jodar

Pfizer, Inc. - Vaccines Medical Development & Scientific Affairs

New York City, NY
United States

Yeheskel Levy

Ministry of Health (Israel) ( email )

Israel

Sharon Alroy-Preis (Contact Author)

Israel Ministry of Health ( email )

Jerusalem
Israel

Ministry of Health (Israel) - Department of Maternal and Child Health

Jerusalem
Israel

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