Effectiveness of the BNT162b2 Covid-19 Vaccine against the B.1.1.7 and B.1.351 Variants
Open accessAbstract
The messenger RNA vaccine BNT162b2 (Pfizer–BioNTech) has 95% efficacy against coronavirus disease 2019 (Covid-19). Qatar launched a mass immunization campaign with this vaccine on December 21, 2020. As of March 31, 2021, a total of 385,853 persons had received at least one vaccine dose and 265,410 had completed the two doses. Vaccination scale-up occurred as Qatar was undergoing its second and third waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which were triggered by expansion of the B.1.1.7 variant (starting in mid-January 2021) and the B.1.351 variant (starting in mid-February 2021). The B.1.1.7 wave peaked during the first week of March, and the rapid expansion of B.1.351 started in mid-March and continues to the present day. Viral genome sequencing conducted from February 23 through March 18 indicated that 50.0% of cases of Covid-19 in Qatar were caused by B.1.351 and 44.5% were caused by B.1.1.7. Nearly all cases in which virus was sequenced after March 7 were caused by either B.1.351 or B.1.1.7.
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The test-negative design mitigates bias from healthcare-seeking behavior and was chosen for this analysis for that reason.
“The test-negative design, which does not assume that a lack of a positive test equals a negative test and somewhat adjusts for testing volume, attempts to better mitigate this bias and is the reason we chose this method for this analysis”
From Waning effectiveness of the third dose of the BNT162b2 mRNA COVID-19 vaccine (2022) · cites this paper as [25]
Clinical trials reported reduced protection against symptomatic COVID-19 caused by the B.1.351 variant, but emerging data suggest high protection remains against severe disease and hospitalization.
“Reduced protection against any symptomatic COVID-19 disease caused by the B.1.351 variant of concern (now known as the Beta variant) has been reported from clinical trials18, but emerging data suggest that there remains high protection against the important end points of severe disease and hospitalization99.”
From Immunological mechanisms of vaccine-induced protection against COVID-19 in humans (2021) · cites this paper as [99]
The inclusion and exclusion criteria were implemented to allow immunity to build after vaccination and to reduce several potential biases.
“These inclusion and exclusion criteria were implemented to allow for build-up of immunity after vaccination4,14 and to minimize different types of potential bias, as informed by earlier analyses in the same population.”
From Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections (2022) · cites this paper as [14]
Effectiveness was assessed with a test-negative case-control design rather than a cohort design, but an earlier cohort study in the same population yielded similar findings.
“Effectiveness was assessed with the use of an observational, test-negative, case–control design rather than a design in which cohorts of individual persons were followed up. However, the cohort study design applied earlier to the same population yielded findings similar to those of the test-negative design.14,15,31”
From Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections (2022) · cites this paper as [14]
The cohort study design applied earlier to the same population of Qatar yielded findings similar to those of the test-negative case-control design, supporting the validity of this standard approach in assessing vaccine effectiveness.
“However, the cohort study design applied earlier to the same population of Qatar yielded findings similar to those of the test-negative case–control design36,38,39, supporting the validity of this standard approach in assessing vaccine effectiveness11,12,36,40.”
From Duration of mRNA vaccine protection against SARS-CoV-2 Omicron BA.1 and BA.2 subvariants in Qatar (2022) · cites this paper as [38]
Compared with recent Qatar findings on BNT162b2 effectiveness against the alpha and beta variants, the present findings suggest that effectiveness against the delta variant after a full vaccination course lies between those two estimates.
“As compared with recent findings from Qatar on the effectiveness of the BNT162b2 vaccine against the alpha and beta variants,17 our findings suggest that effectiveness against the delta variant after a full vaccination course lies somewhere between these two.”
From Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant (2021) · cites this paper as [17]
In cohort studies from Israel and Qatar, the BNT162b vaccine retained greater than 90% efficacy against the Alpha variant.
“In cohort studies from Israel and Qatar, the BNT162b vaccine also retained greater than 90% efficacy against this variant 210,211 (TABLe 2).”
From The biological and clinical significance of emerging SARS-CoV-2 variants (2021) · cites this paper as [211]
In the previously cited Qatar cohort study, the efficacy of BNT162b against the Beta variant was estimated to be 72%, which was 15% lower than that for the Alpha variant.
“In the previously cited Qatar cohort study, the efficacy of BNT162b against the Beta variant was estimated to be 72%, which was 15% lower than that for the Alpha variant 211 .”
From The biological and clinical significance of emerging SARS-CoV-2 variants (2021) · cites this paper as [211]
Clinical studies have reported somewhat reduced efficacy and effectiveness against the B.1.1.7, B.1.351, and B.1.617.2 variants.
“Likewise, clinical studies have reported somewhat reduced efficacy and effectiveness against the B.1.1.7, B.1.351, and B.1.617.2 variants (10–12).”
From Durability of mRNA-1273 vaccine–induced antibodies against SARS-CoV-2 variants (2021) · cites this paper as [10]
The low effectiveness of BNT162b2 against Delta could be due to measurement several months after the second dose, whereas Beta effectiveness was measured shortly after vaccination.
“The effectiveness of the BNT162b2 vaccine against the Beta variant was measured shortly after the population of Qatar had been vaccinated, whereas the effectiveness of BNT162b2 against the Delta variant was conducted several months after the second dose, which could be one of the reasons for low effectiveness of BNT162b2 against the Delta variant.404,405”
From Advances in COVID-19 mRNA vaccine development (2022) · cites this paper as [405]
Beta is a benchmark for partially reduced neutralization without major impact on effectiveness.
“Beta [as a benchmark for partially reduced neutralization (7) without major impact on effectiveness (19, 20)]”
From Neutralization of SARS-CoV-2 Omicron by BNT162b2 mRNA vaccine–elicited human sera (2022) · cites this paper as [19]
Covid-19 vaccines are highly effective against symptomatic disease and, more so, against severe disease and fatal outcomes caused by the original strain of SARS-CoV-2 as well as the alpha variant.
“Coronavirus disease 2019 (Covid-19) vaccines are highly effective against symptomatic disease and, more so, against severe disease and fatal outcomes caused by the original strain of SARS-CoV-2 as well as the alpha (B.1.1.7) variant that predominated in early 2021.”
From Effectiveness of COVID-19 vaccines against the Omicron (B.1.1.529) variant of concern (2021) · cites this paper as [15]
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“7) are consistent with those previously reported (7, 8, 10, 17).”
BackgroundResultInfluentialSARS-CoV-2 Vaccines Based on the Spike Glycoprotein and Implications of New Viral Variants
Martínez-Flores, D., Zepeda–Cervantes, J., Cruz-Reséndiz, A., Aguirre‐Sampieri, S., Sampieri, A., & Vaca, L. A. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.701501 · Cited by 237 · see citing works
Immune responses to two and three doses of the BNT162b2 mRNA vaccine in adults with solid tumors
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Duration of mRNA vaccine protection against SARS-CoV-2 Omicron BA.1 and BA.2 subvariants in Qatar
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Self-citationSARS-COV-2 Variants: Differences and Potential of Immune Evasion
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SARS-CoV-2 infection generates tissue-localized immunological memory in humans
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Waves and variants of SARS-CoV-2: understanding the causes and effect of the COVID-19 catastrophe
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“Pfizer vaccine showed only 75% efficacy [84], whereas AstraZeneca AZD1222 vaccine failed in preventing even mild and moderate COVID-19 infection in South African trials [85, 86].”
ResultSeverity of SARS-CoV-2 Reinfections as Compared with Primary Infections
Abu-Raddad, L. J., Chemaitelly, H., & Bertollini, R. (2021) · New England Journal of Medicine · doi:10.1056/nejmc2108120 · Cited by 194 · see citing works
Self-citationThe Impact of Evolving SARS-CoV-2 Mutations and Variants on COVID-19 Vaccines
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COVID-19: Unmasking Emerging SARS-CoV-2 Variants, Vaccines and Therapeutic Strategies
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Self-citationImmunity to SARS‐CoV‐2 induced by infection or vaccination
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Differential Antibody Response to mRNA COVID-19 Vaccines in Healthy Subjects
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Emerging SARS-CoV-2 Variants: A Review of Its Mutations, Its Implications and Vaccine Efficacy
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Protective prototype-Beta and Delta-Omicron chimeric RBD-dimer vaccines against SARS-CoV-2
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Waning effectiveness of the third dose of the BNT162b2 mRNA COVID-19 vaccine
Patalon, T., Saciuk, Y., Peretz, A., Perez, G., Lurie, Y., Maor, Y., & Gazit, S. (2022) · Nature Communications · doi:10.1038/s41467-022-30884-6 · Cited by 143 · see citing works
“The test negative design, which has long been used in vaccine effectiveness research, is becoming increasingly common in SARS-CoV-2 vaccine studies, due to its strength in controlling against bias stemming from healthcare seeking behavior.(11,23,24) In this analysis, we defined cases as PCR-positive persons or persons…”
MethodAu, W. Y., & Cheung, P. P.-H. (2022) · BMJ · doi:10.1136/bmj-2022-069989 · Cited by 143 · see citing works
Waning Effectiveness of the Third Dose of the BNT162b2 mRNA COVID-19 Vaccine
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Lustig, Y., Zuckerman, N. S., Nemet, I., Atari, N., Kliker, L., Regev‐Yochay, G., Sapir, E., Mor, O., Alroy‐Preis, S., Mendelson, E., et al. (2021) · Eurosurveillance · doi:10.2807/1560-7917.es.2021.26.26.2100557 · Cited by 143 · see citing works
Two Years into the COVID-19 Pandemic: Lessons Learned
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Molecular characteristics, immune evasion, and impact of SARS-CoV-2 variants
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Recall of preexisting cross-reactive B cell memory after Omicron BA.1 breakthrough infection
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Coronavirus Disease 2019 Disease Severity in Children Infected With the Omicron Variant
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Vaccinations Against COVID-19 May Have Averted Up To 140,000 Deaths In The United States
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- Authors
- Abu-Raddad, L. J., Chemaitelly, H., & Butt, A. A.
- Affiliations
- Weill Cornell Medical College in Qatar (QA)
- Hamad Medical Corporation (QA)
- Corresponding author
- Abu-Raddad, Laith J.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2021-07-08
- Volume
- 385
- Issue
- 2
- Pages
- 187-189
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC8117967
- OpenAlex
- W3157162195
- Cited by
- 899
- References
- 4
- Citations by year
- 2026: 16 · 2025: 32 · 2024: 46 · 2023: 92 · 2022: 358 · 2021: 351 · 2020: 3
- FWCI
- 67.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Qatar University QSpace (Qatar University) (submittedVersion)
- Funders
- Biomedical Research Program and the Biostatistics, Epidemiology, and Biomathematics Research Core, both at Weill Cornell Medicine-Qatar, the Ministry of Public Health and Hamad Medical Corporation
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- BNT162b2, COVID-19 vaccine efficacy, SARS-CoV-2 variants, B.1.1.7 variant, B.1.351 variant, Omicron variant, vaccination campaigns, viral genome sequencing, COVID-19 waves
- MeSH terms
- Immunogenicity, Vaccine, COVID-19, SARS-CoV-2, COVID-19 Vaccines, BNT162 Vaccine, Humans, Qatar, Cohort Studies, Case-Control Studies, Polymerase Chain Reaction, Treatment Outcome
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