Effectiveness and Durability of the BNT162b2 Vaccine against Omicron Sublineages in South Africa
Open accessAbstract
Effectiveness and Durability of the BNT162b2 Vaccine against Omicron Sublineages in South AfricaTo the Editor: Data are limited regarding the effectiveness of the BNT162b2 vaccine (Pfizer-BioNTech) against the BA.4 and BA.5 sublineages of the B.1.1.529(omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that drove the recent fifth wave of infection in South Africa. 1 We previously reported a vaccine effectiveness of 70% after two doses of the BNT162b2 vaccine against severe disease during the fourth wave of omicron infection driven by the BA.1 sublineage in South Africa.1,2 In this analysis, we separately assessed the effectiveness and durability of the BNT162b2 vaccine against BA.1 or BA.2 and against BA.4 or BA.5 among members of Discovery Health, a medical care organization that provides health insurance to 3.7 million persons in South Africa.During the period from November 15, 2021, to June 24, 2022, a total of 32,883 patients who had been hospitalized for medical treatment underwent polymerase-chain-reaction testing for SARS-CoV-2, a period that spanned the BA.1-BA.2 and BA.4-BA.5 omicron waves.Of these patients,
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In the South Africa Discovery Health study, no difference was observed in vaccine effectiveness after the first booster dose of BNT162b2 with up to 8 months follow-up, and no difference was observed following a second booster dose with up to 4 months follow-up.
“no difference was observed in VE after the first booster dose of BNT162b2, with up to 8 months follow-up, and also no difference was observed following a second booster dose with up to 4 months follow-up.”
From Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization (2023) · cites this paper as [21]
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Experimental — accuracy not yet measuredIn the South Africa Discovery Health study, vaccine effectiveness of the primary series of BNT162b2 tended to be 10-20 percentage points lower during the BA.4/5 period than the BA.1/2 period from 3 to 8 months after vaccination, although with overlapping confidence intervals.
“Comparing absolute VE within two-month time intervals since the most recent vaccine dose, VE of the primary series of BNT162b2 (monovalent Pfizer-BioNTech) tended to be 10-20 percentage points lower during the BA.4/5 period than the BA.1/2 period from 3 to 8 months after vaccination, although with overlapping confidence intervals;”
From Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization (2023) · cites this paper as [21]
The paper’s main text (page unavailable) compares two-dose BNT162b2 effectiveness in Discovery Health members across the BA.1–BA.2 and BA.4–BA.5 periods. At 3–4 months, it reports 56.3% versus 47.4%, with overlapping 95% confidence intervals—a difference of 8.9 percentage points, not 10–20. Our copy lists 5–6- and 7–8-month intervals but does not provide their estimates, so it does not establish the claimed pattern through eight months. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAmong three studies that compared VE against BA.1/2 with BA.4/5, one showed a similar VE within the first four months following a booster dose, but lower VE against BA.4/5 beyond 4 months; one study showed similar VE at all periods; the third showed lower VE against BA.4/5 than BA.1/2 at all periods, though confidence intervals overlapped.
“Among three studies that compared VE against BA.1/2 with BA.4/5, one showed a similar VE within the first four months following a booster dose, but lower VE against BA.4/5 beyond 4 months; one study showed similar VE at all periods; the third showed lower VE against BA.4/5 than BA.1/2 at all periods, though confidence intervals overlapped [21,28,30].”
From Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization (2023) · cites this paper as [21]
Split into 3 atoms — 0 confirmed, 3 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredEight studies assessed VE of primary series or first booster dose vaccination separately for at least two different Omicron subvariants (six assessed VE of both primary series and booster dose vaccination and two assessed VE of a booster dose only).
“Eight studies assessed VE of primary series or first booster dose vaccination separately for at least two different Omicron subvariants (six assessed VE of both primary series and booster dose vaccination and two assessed VE of a booster dose only, Tables 1 and 2) [21,24-26,28-33].”
From Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization (2023) · cites this paper as [21]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
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Cites
Effectiveness of BNT162b2 Vaccine against Omicron Variant in South Africa
Collie, S., Champion, J., Moultrie, H., Bekker, L.-G., & Gray, G. (2022) · New England Journal of Medicine · doi:10.1056/nejmc2119270 · Cited by 600 · see citing works
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Bivalent Omicron BA.1–Adapted BNT162b2 Booster in Adults Older than 55 Years
Winokur, P., Gayed, J., Fitz-Patrick, D., Thomas, S. J., Diya, O., Lockhart, S., Xu, X., Zhang, Y., Bangad, V., Schwartz, H. I., et al. (2023) · New England Journal of Medicine · doi:10.1056/nejmoa2213082 · Cited by 116 · see citing works
Surie, D., Bonnell, L., Adams, K., Gaglani, M., Ginde, A. A., Douin, D. J., Talbot, H. K., Casey, J. D., Mohr, N. M., Zepeski, A., et al. (2022) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7142a3 · Cited by 59 · see citing works
Palmer, C. D., Scallan, C. D., Kraemer Tardif, L. D., Kachura, M. A., Rappaport, A. R., Koralek, D. O., Uriel, A., Gitlin, L., Klein, J., Davis, M. J., et al. (2023) · Nature Communications · doi:10.1038/s41467-023-39053-9 · Cited by 42 · see citing works
Feikin, D. R., Higdon, M. M., Andrews, N., Collie, S., Deloria Knoll, M., Kwong, J. C., Link-Gelles, R., Pilishvili, T., & Patel, M. K. (2023) · Vaccine · doi:10.1016/j.vaccine.2023.02.020 · Cited by 36 · see citing works
“Study (Country, Vaccine) Outcome Age group (years) Time interval since last dose used for VE estimate Median of time interval since last dose (days) 2 dose VE (95 % CI) BA.1 BA.2* BA.1/BA.2* BA.4/BA.5 Chemaitelly et al (Qatar, BNT162b2) [29] Symptomatic disease All ages 1–3 m 46.6 (33.4, 57.2) 51.7 (43.2, 58.9) 4–6 m…”
BackgroundInfluentialSelf-citationEffectiveness of mRNA COVID-19 vaccine booster doses against Omicron severe outcomes
Grewal, R., Nguyen, L., Buchan, S. A., Wilson, S. E., Nasreen, S., Austin, P. C., Brown, K. A., Fell, D. B., Gubbay, J., Schwartz, K. L., et al. (2022) · doi:10.1101/2022.10.31.22281766 · Cited by 59 · see citing works
- Authors
- Collie, S., Nayager, J., Bamford, L., Bekker, L.-G., Zylstra, M., & Gray, G.
- Affiliations
- Discovery Health, Sandton, South Africa
- Department of Health (ZA)
- Desmond Tutu HIV Foundation (ZA)
- South African Medical Research Council (ZA)
- Corresponding author
- Gray, Glenda
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2022-10-06
- Volume
- 387
- Issue
- 14
- Pages
- 1332-1333
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC9511610
- OpenAlex
- W4295761788
- Cited by
- 97
- References
- 1
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 23 · 2023: 49 · 2022: 9
- FWCI
- 11.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Keywords
- BNT162b2, COVID-19 vaccine effectiveness, Omicron subvariants, BA.4, BA.5, BA.1, BA.2, SARS-CoV-2, vaccine durability, breakthrough infection, hospitalized patients, South Africa
- MeSH terms
- COVID-19, SARS-CoV-2, Vaccine Efficacy, BNT162 Vaccine, Humans, South Africa, Vaccination
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