Effectiveness of mRNA-1273 and BNT162b2 Vaccines in Qatar
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Abstract
Abstract BACKGROUND Growing evidence suggests that COVID-19 vaccines differ in effectiveness against breakthrough infection or severe COVID-19, but vaccines have yet to be investigated in controlled studies that head-to-head compare immunity of one to another. This study compared protection offered by the mRNA-1273 (Moderna) vaccine with that of the BNT162b2 (Pfizer-BioNTech) vaccine in Qatar. METHODS In a population of 1,531,736 vaccinated persons, two matched retrospective cohort studies were designed and used to investigate differences in mRNA-1273 and BNT162b2 vaccine protection, after the first and second doses, from December 21, 2020 to October 20, 2021. RESULTS After dose 1, cumulative incidence of breakthrough infection was 0.79% (95% CI: 0.75-0.83%) for mRNA-1273-vaccinated individuals and 0.86% (95% CI: 0.82-0.90%) for BNT162b2-vaccinated individuals, 21 days post-injection. Adjusted hazard ratio (AHR) for breakthrough infection was 0.89 (95% CI: 0.83-0.95; p=0.001). AHR was constant in the first two weeks at 1, but it declined to 0.67 (95% CI: 0.57-0.77; p<0.001) in the third week after dose 1. AHR for any severe, critical, or fatal COVID-19 was 0.71 (95% CI: 0.53-0.95; p=0.020). After dose 2, cumulative incidence was 0.59% (95% CI: 0.55-0.64%) for mRNA-1273-vaccinated individuals and 0.84% (95% CI: 0.79-0.89%) for BNT162b2-vaccinated individuals, 180 days post-injection. AHR for breakthrough infection was 0.69 (95% CI: 0.63-0.75; p<0.001) and was largely constant over time after dose 2. AHR for any severe, critical, or fatal COVID-19 was 0.37 (95% CI: 0.10-1.41; p=0.147). CONCLUSIONS mRNA-1273 vaccination is associated with lower SARS-CoV-2 breakthrough infection and COVID-19 hospitalization and death than BNT162b2 vaccination, but the number of hospitalizations and deaths was exceedingly small for both vaccines. Both vaccines demonstrated strikingly similar patterns of build-up of protection after the first dose and waning of protection after the second dose.
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Matching on sex, age, nationality, and calendar week was previously shown to adequately control for differences in SARS-CoV-2 exposure risk in Qatar.
“Matching according to these factors was previously shown to provide adequate control of differences in the risk of SARS-CoV-2 exposure in studies of different designs, all of which involved control groups, such as test-negative, case–control studies.”
From Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections (2022) · cites this paper as [11]
Matching was not possible for coexisting conditions, but matching on sex, age, and nationality provided demonstrable control of bias in earlier studies.
“Although matching was performed according to sex, age, and nationality, matching was not possible for other factors, such as coexisting conditions. However, matching according to these factors provided demonstrable control of bias in our earlier studies.11,12,15,21,22”
From Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections (2022) · cites this paper as [11]
Matching by sex, age, and nationality provided demonstrable control of bias in studies of different epidemiologic designs that used control groups in Qatar.
“However, matching by these factors provided demonstrable control of bias in studies of different epidemiologic designs and that used control groups in Qatar13,14,35–37.”
From Duration of mRNA vaccine protection against SARS-CoV-2 Omicron BA.1 and BA.2 subvariants in Qatar (2022) · cites this paper as [37]
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Self-citationSukik, L., Chemaitelly, H. S., Ayoub, H. H., Coyle, P. V., Tang, P., Yassine, H. M., Thani, A. A. A., Hasan, M. R., Kanaani, Z. A., Al‐Kuwari, E., et al. (2024) · Vaccine · doi:10.1016/j.vaccine.2024.04.026 · Cited by 17 · see citing works
Self-citationVerleye, A., Wijtvliet, V. P. W. M., Abrams, S., Hellemans, R., Bougrea, R., Massart, A., Pipeleers, L., Wissing, K. M., Ariën, K. K., Winter, B. Y. D., et al. (2022) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfac174 · Cited by 16 · see citing works
Genomic surveillance of SARS-CoV-2 in COVID-19 vaccinated healthcare workers in Lebanon
Alkalamouni, H., Hassan, F. F. A., Hamdan, M. B., Page, A. J., Lott, M. C., Matthews, M., Ghosn, N., Rady, A., Mahfouz, R. A., Araj, G. F., et al. (2023) · BMC Medical Genomics · doi:10.1186/s12920-023-01443-9 · Cited by 15 · see citing works
Solforosi, L., Costes, L. M. M., Tolboom, J. T. B. M., McMahan, K., Anioke, T., Hope, D. L., Murdza, T., Sciacca, M., Bouffard, E., Barrett, J., et al. (2023) · Nature Communications · doi:10.1038/s41467-023-37715-2 · Cited by 15 · see citing works
Mahmoud, M., Ayoub, H. H., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Thani, A. A. A., Kanaani, Z. A., Al‐Kuwari, E., Jeremijenko, A. M., et al. (2023) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.13224 · Cited by 12 · see citing works
Self-citationSoldatov, A. A., Kryuchkov, N. A., Витальевич, Г. Д., Авдеева, Ж. И., Свитич, О. А., & Soshnikov, S. S. (2025) · Vaccines · doi:10.3390/vaccines13080789 · Cited by 11 · see citing works
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Mbarek, H., & Ismail, S. I. (2022) · Nature Genetics · doi:10.1038/s41588-022-01239-0 · Cited by 10 · see citing works
Butt, A. A., Guerrero, M. D., Canlas, E. B., Al-Dwairi, H., Alimam, A., Mohamad, A. R., Ali, M. T., Asaad, N., Alkeldi, A. A. S. S., Mohammad, M. F. S., et al. (2023) · Nature Communications · doi:10.1038/s41467-022-35653-z · Cited by 9 · see citing works
BNT162b2 antigen dose and SARS-CoV-2 omicron infection in adolescents
Chemaitelly, H. S., Ayoub, H. H., Coyle, P. V., Tang, P., Yassine, H. M., Thani, A. A. A., Al-Khatib, H. A., Hasan, M. R., Kanaani, Z. A., Al‐Kuwari, E., et al. (2023) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(23)00005-1 · Cited by 8 · see citing works
Self-citationChemaitelly, H. S., Ayoub, H. H., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Thani, A. A. A., Kanaani, Z. A., Al‐Kuwari, E., Jeremijenko, A. M., et al. (2024) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.13357 · Cited by 8 · see citing works
Self-citationChemaitelly, H. S., Akhtar, N., Jerdi, S. A., Kamran, S., Joseph, S., Morgan, D., Uy, R. S., Abid, F. B., Al‐Khal, A., Abou‐Samra, A., et al. (2025) · Expert Review of Vaccines · doi:10.1080/14760584.2025.2596676 · Cited by 6 · see citing works
Self-citationWaheed, M. A., Mannai, L. A., Khudadad, H., Alenbawi, J., Mansaray, M. A., & Abdulla, S. A. A. (2023) · JMIR Formative Research · doi:10.2196/42753 · Cited by 5 · see citing works
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Rapid SARS-CoV-2 Seroprevalence Survey in Central and Western Divisions of Fiji, 2021
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Dai, Y.-C., Lin, Y.-C., Ching, L. L., Tsai, J., Ishikawa, K. M., Tsai, W.-Y., Chen, J. J., Nerurkar, V. R., & Wang, W. (2023) · Microbiology Spectrum · doi:10.1128/spectrum.04081-22 · Cited by 4 · see citing works
Protection against reinfection with SARS-CoV-2 omicron BA.2.75 * sublineagePreprint
Chemaitelly, H. S., Tang, P., Coyle, P. V., Yassine, H. M., Al-Khatib, H. A., Smatti, M. K., Hasan, M. R., Ayoub, H. H., Altarawneh, H. N., Kanaani, Z. A., et al. (2022) · medRxiv · doi:10.1101/2022.10.29.22281606 · Cited by 4 · see citing works
Self-citationSukik, L., Chemaitelly, H. S., Ayoub, H. H., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Thani, A. A. A., Kanaani, Z. A., Al‐Kuwari, E., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-19168-3 · Cited by 3 · see citing works
Self-citationImmune histories and natural infection protection during the omicron era
Chemaitelly, H. S., Ayoub, H. H., Bobrovitz, N., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Thani, A. A. A., Kanaani, Z. A., Al‐Kuwari, E., et al. (2025) · Communications Medicine · doi:10.1038/s43856-025-00974-9 · Cited by 3 · see citing works
Self-citationFactors Associated with SARS-CoV-2 Infection before Vaccination among European Health Care Workers
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Immediate and contributory causes of death in patients hospitalized with COVID-19
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Self-citationEvaluating COVID-19 Vaccine Efficacy Using Kaplan–Meier Survival Analysis
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Patterns in Repeat Reinfections: Pre and Post Omicron EmergencePreprint
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Self-citationIntegrated disease model considering mutation-induced infection waves with COVID-19 cases
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Healthy vaccinee effect did not bias COVID-19 vaccine effectiveness estimates
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Self-citationThe bench-to-bedside journey of circular RNAs in cancer: Status, challenges and future prospects
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Self-citationSukik, L., Paul, P., Ayoub, H. H., Coyle, P. V., Tang, P., Hasan, M. R., Yassine, H. M., Thani, A. A. A., Kanaani, Z. A., Al‐Kuwari, E., et al. (2026) · International Journal of Epidemiology · doi:10.1093/ije/dyag210
Self-citation
- Authors
- Abu-Raddad, L. J., Chemaitelly, H., & Bertollini, R.
- Affiliations
- Cornell University (US)
- Ministry of Public Health (QA)
- Corresponding author
- Abu-Raddad, Laith J.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2022-02-24
- Volume
- 386
- Issue
- 8
- Pages
- 799-800
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC8796790
- OpenAlex
- W4205191515
- Cited by
- 79
- References
- 28
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 6 · 2023: 26 · 2022: 26 · 2021: 1
- FWCI
- 8.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Biomedical Research Program and the Biostatistics, Epidemiology, and Biomathematics Research Core, both at Weill Cornell Medicine-Qatar
- Ministry of Public Health, Hamad Medical, and Sidra Medicine
- 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
- mRNA-1273 vaccine, BNT162b2, COVID-19 vaccines, vaccine effectiveness, SARS-CoV-2, Qatar
- MeSH terms
- COVID-19, COVID-19 Vaccines, Vaccine Efficacy, BNT162 Vaccine, 2019-nCoV Vaccine mRNA-1273, Breakthrough Infections, Humans, Immunization, Secondary, Qatar, Retrospective Studies
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