Effectiveness of COVID-19 booster vaccines against COVID-19-related symptoms, hospitalization and death in England
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Abstract
Booster vaccination with messenger RNA (mRNA) vaccines has been offered to adults in England starting on 14 September 2021. We used a test-negative case–control design to estimate the relative effectiveness of a booster dose of BNT162b2 (Pfizer-BioNTech) compared to only a two-dose primary course (at least 175 days after the second dose) or unvaccinated individuals from 13 September 2021 to 5 December 2021, when Delta variant was dominant in circulation. Outcomes were symptomatic coronavirus disease 2019 (COVID-19) and hospitalization. The relative effectiveness against symptomatic disease 14–34 days after a BNT162b2 or mRNA-1273 (Moderna) booster after a ChAdOx1-S (AstraZeneca) and BNT162b2 as a primary course ranged from around 85% to 95%. Absolute vaccine effectiveness ranged from 94% to 97% and was similar in all age groups. Limited waning was seen 10 or more weeks after the booster. Against hospitalization or death, absolute effectiveness of a BNT162b2 booster ranged from around 97% to 99% in all age groups irrespective of the primary course, with no evidence of waning up to 10 weeks. This study provides real-world evidence of substantially increased protection from the booster vaccine dose against mild and severe disease irrespective of the primary course.
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Numerous studies conducted during the Omicron BA.1 period have reported an increase in VE against infection caused by this variant following a booster dose.
“Still, numerous studies conducted during the Omicron BA.1 period have reported an increase in VE against infection caused by this variant following a booster dose [19,26,32-35].”
From Vaccine effectiveness and duration of protection of COVID-19 mRNA vaccines against Delta and Omicron BA.1 symptomatic and severe COVID-19 outcomes in adults aged 50 years and over in France (2023) · cites this paper as [33]
The Discussion reports increased vaccine effectiveness after a booster, but specifies symptomatic COVID-19 during a period when Delta was dominant. The Methods (Data sources) say samples identified as non-Delta were excluded. This paper therefore does not support the claim specifically about Omicron BA.1 infection. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe eligible yet unvaccinated population in a massively campaigned environment such as Israel is plausibly different in health related behaviour, which could introduce a bias in rendering it the reference group.
“Therefore, apart from potential scarcity of data in comparing to unvaccinated individuals, this eligible yet unvaccinated population in a massively campaigned environment such as Israel is plausibly different in terms health related behaviour, which could introduce a bias in rendering it the reference group,43 as has been pointed out in previous vaccination studies of Israeli populations measuring”
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“1 period have reported an increase in VE against infection caused by this variant following a booster dose [19, 26, 32-35].”
- Authors
- Andrews, N., Stowe, J., Kirsebom, F., Toffa, S., Sachdeva, R., Gower, C., Ramsay, M., & Lopez Bernal, J.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- UK Health Security Agency (GB)
- Venue
- Nature Medicine
- Published
- 2022-01-14
- Volume
- 28
- Issue
- 4
- Pages
- 831-837
- ISSN
- 1078-8956 (ISSN-L)
- 1546-170X
- PMC
- PMC9018410
- OpenAlex
- W4205395943
- Cited by
- 453
- References
- 14
- Citations by year
- 2026: 18 · 2025: 30 · 2024: 72 · 2023: 140 · 2022: 182 · 2021: 11
- FWCI
- 51.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Nature Medicine (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Keywords
- COVID-19 booster vaccination, BNT162b2, mRNA-1273, ChAdOx1 nCoV-19 vaccine, vaccine effectiveness, waning immunity, Delta variant, hospitalization, COVID-19 mortality, real-world evidence
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Vaccines, mRNA Vaccines, BNT162 Vaccine, Adult, England, Hospitalization, Humans, Infant
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