Vaccine effectiveness of one, two, and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong: a population-based observational study

Background Hong Kong maintained low circulation of SARS-CoV-2 until a major community epidemic of the omicron (B.1.1.529) sublineage BA.2 began in January, 2022. Both mRNA (BNT162b2 [Fosun Pharma-BioNTech]) and inactivated CoronaVac (Sinovac, Beijing, China) vaccines are widely available; however, vaccination coverage has been low, particularly in older adults aged 70 years or older. We aimed to assess vaccine effectiveness in this predominantly infection-naive population. Methods In this observational study, we used individual-level case data on mild or moderate, severe or fatal, and fatal disease in patients hospitalised with COVID-19 along with census information and coverage data of BNT162b2 and CoronaVac. We used a negative binomial model, adjusting for age, sex, and calendar day to estimate vaccine effectiveness of one, two, and three doses of both BNT162b2 and CoronaVac vaccines, and relative effectiveness by number of doses and vaccine type. Findings Between Dec 31, 2020, and March 16, 2022, 13 center dot 2 million vaccine doses were administered in Hong Kong's 7 center dot 4-million population. We analysed data from confirmed cases with mild or moderate (n=5566), severe or fatal (n=8875), and fatal (n=6866) COVID-19. Two doses of either vaccine protected against severe disease and death within 28 days of a positive test, with higher effectiveness among adults aged 60 years or older with BNT162b2 (vaccine effectiveness 89 center dot 3% [95% CI 86 center dot 6-91 center dot 6]) compared with CoronaVac (69 center dot 9% [64 center dot 4-74 center dot 6]). Three doses of either vaccine offered very high levels of protection against severe or fatal outcomes (97 center dot 9% [97 center dot 3-98 center dot 4]). Interpretation Third doses of either BNT162b2 or CoronaVac provide substantial additional protection against severe COVID-19 and should be prioritised, particularly in older adults older than 60 years and others in high-risk populations who received CoronaVac primary schedules. Longer follow-up is needed to assess duration of protection across different vaccine platforms and schedules. Copyright (c) 2022 Published by Elsevier Ltd. All rights reserved.

Automated summary

In Hong Kong, two doses of either BNT162b2 or CoronaVac vaccines are effective in preventing severe disease and death, with higher effectiveness seen in adults aged 60 years or older with BNT162b2. Three doses of either vaccine offer a very high level of protection against severe or fatal outcomes.