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Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study - PubMed Skip to main page content
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Observational Study
. 2021 May 1;397(10285):1646-1657.
doi: 10.1016/S0140-6736(21)00677-2. Epub 2021 Apr 23.

Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study

Eleftheria Vasileiou  1 , Colin R Simpson  2 , Ting Shi  1 , Steven Kerr  1 , Utkarsh Agrawal  3 , Ashley Akbari  4 , Stuart Bedston  4 , Jillian Beggs  5 , Declan Bradley  6 , Antony Chuter  7 , Simon de Lusignan  8 , Annemarie B Docherty  1 , David Ford  9 , Fd Richard Hobbs  8 , Mark Joy  8 , Srinivasa Vittal Katikireddi  10 , James Marple  11 , Colin McCowan  3 , Dylan McGagh  8 , Jim McMenamin  12 , Emily Moore  12 , Josephine Lk Murray  12 , Jiafeng Pan  13 , Lewis Ritchie  14 , Syed Ahmar Shah  1 , Sarah Stock  1 , Fatemeh Torabi  4 , Ruby Sm Tsang  8 , Rachael Wood  15 , Mark Woolhouse  1 , Chris Robertson  16 , Aziz Sheikh  17
Affiliations
Observational Study

Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study

Eleftheria Vasileiou et al. Lancet. .

Abstract

Background: The BNT162b2 mRNA (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines have shown high efficacy against disease in phase 3 clinical trials and are now being used in national vaccination programmes in the UK and several other countries. Studying the real-world effects of these vaccines is an urgent requirement. The aim of our study was to investigate the association between the mass roll-out of the first doses of these COVID-19 vaccines and hospital admissions for COVID-19.

Methods: We did a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19-EAVE II-database comprising linked vaccination, primary care, real-time reverse transcription-PCR testing, and hospital admission patient records for 5·4 million people in Scotland (about 99% of the population) registered at 940 general practices. Individuals who had previously tested positive were excluded from the analysis. A time-dependent Cox model and Poisson regression models with inverse propensity weights were fitted to estimate effectiveness against COVID-19 hospital admission (defined as 1-adjusted rate ratio) following the first dose of vaccine.

Findings: Between Dec 8, 2020, and Feb 22, 2021, a total of 1 331 993 people were vaccinated over the study period. The mean age of those vaccinated was 65·0 years (SD 16·2). The first dose of the BNT162b2 mRNA vaccine was associated with a vaccine effect of 91% (95% CI 85-94) for reduced COVID-19 hospital admission at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 88% (95% CI 75-94). Results of combined vaccine effects against hospital admission due to COVID-19 were similar when restricting the analysis to those aged 80 years and older (83%, 95% CI 72-89 at 28-34 days post-vaccination).

Interpretation: Mass roll-out of the first doses of the BNT162b2 mRNA and ChAdOx1 vaccines was associated with substantial reductions in the risk of hospital admission due to COVID-19 in Scotland. There remains the possibility that some of the observed effects might have been due to residual confounding.

Funding: UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK.

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Conflict of interest statement

Declaration of interests AS and JMcM are members of the Scottish Government chief medical officer's COVID-19 Advisory Group. JMcM is a member of the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) and AS is a member of the NERVTAG Risk Stratification Subgroup. JMcM is a member of the Scientific Advisory Group on Emergencies (SAGE) and chairs the COVID Scottish National Incident Management Team and the Scientific Committee of the European Centre for Disease Prevention and Control-funded and WHO-funded IMOVE-COVID-19 group. CRS declares funding from the Medical Research Council, the National Institute of Health Research, Chief Scientist Office, and New Zealand Ministry for Business, Innovation and Employment and Health Research Council during the conduct of this study. SVK is co-chair of the Scottish Government's Expert Reference Group on COVID-19 and ethnicity; is a member of the SAGE subgroup on ethnicity; and acknowledges funding from a National Health Service Research Scotland Senior Clinical Fellowship, the Medical Research Council, and Chief Scientist Office. CR is a member of the Scottish Government chief medical officer's COVID-19 Advisory Group, Scientific Pandemic Influenza Group on Modelling, and Medicines and Healthcare products Regulatory Agency Vaccine Benefit and Risk Working Group. DB reports employment by Queen's University Belfast, Public Health Agency, and a secondment to Northern Ireland's Department of Health. SdL reports that he is the director of the Oxford-Royal College of General Practitioners Research and Surveillance Centre and that its principal funder is Public Health England. SdL has received funding through the University of Oxford for studies from AstraZeneca, Daiichi Sankyo, Eli Lilly, Sanofi, GSK, Merck Sharp & Dohme, Seqirus, and Takeda; and has been a member of advisory boards for influenza for Seqirus and Sanofi. FDRH reports that the University of Oxford received research funding from Her Majesty's Government for the ChadOx1 vaccine trial programme and entered a partnership with AstraZeneca for the manufacture and distribution of the vaccine. FDRH was not involved in these relationships. All other authors report no competing interests.

Figures

Figure 1
Figure 1
COVID-19 vaccine uptake (A) Uptake over time by age group. (B) Uptake by age and vaccine type.
Figure 2
Figure 2
COVID-19 hospital admissions over time by age group
Figure 3
Figure 3
COVID-19 hospital admissions by age group from September, 2020, to February, 2021 The black dotted vertical line represents the start of vaccination (Dec 8, 2020) and the blue dotted lines represent the two lockdowns on Dec 26, 2020, and Jan 5, 2021. The smooth lines are obtained from fitting a generalised additive Poisson model to the admissions.
See this image and copyright information in PMC

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