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Comparative effectiveness of ChAdOx1 versus BNT162b2 COVID-19 vaccines in Health and Social Care workers in England

Comparative effectiveness of ChAdOx1 versus BNT162b2 COVID-19 vaccines in Health and Social Care workers in England: a cohort study using OpenSAFELY

How to cite: William J Hulme, Elizabeth J Williamson, Amelia Green, Krishnan Bhaskaran, Helen I McDonald, Christopher T Rentsch, Anna Schultze, John Tazare, Helen J Curtis, Alex J Walker, Laurie Tomlinson, Tom Palmer, Elsie Horne, Brian MacKenna, Caroline E Morton, Amir Mehrkar, Jessica Morley, Louis Fisher, Seb Bacon, Dave Evans, Peter Inglesby, George Hickman, Simon Davy, Tom Ward, Richard Croker, Rosalind M Eggo, Angel YS Wong, Rohini Mathur, Kevin Wing, Harriet Forbes, Daniel Grint, Ian J Douglas, Stephen JW Evans, Liam Smeeth, Chris Bates, Jonathan Cockburn, John Parry, Frank Hester, Sam Harper, Jonathan AC Sterne, Miguel Hernán, Ben Goldacre. BMJ 2022;378:e068946


Objectives: To compare the effectiveness of the BNT162b2 mRNA (Pfizer-BioNTech) and the ChAdOx1 (Oxford-AstraZeneca) COVID-19 vaccines against infection and COVID-19 disease in health and social care workers.

Design: Cohort study, emulating a comparative effectiveness trial.

Setting: Linked primary care, hospital, and COVID-19 surveillance records available within the OpenSAFELY-TPP research platform.

Participants: 317,341 health and social care workers vaccinated between 4 January and 28 February 2021, registered with a GP practice using the TPP SystmOne clinical information system in England, and not clinically extremely vulnerable.

Interventions: Vaccination with either BNT162b2 or ChAdOx1 administered as part of the national COVID-19 vaccine roll-out.

Main outcome measures: Recorded SARS-CoV-2 positive test, or COVID-19 related Accident and Emergency attendance or hospital admission occurring within 20 weeks of vaccination.

Results: The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks post-vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 6 weeks after vaccination with BNT162b2 was 19.2 per 1000 people (95%CI 18.6 to 19.7) and with ChAdOx1 was 18.9 (95%CI 17.6 to 20.3), representing a difference of -0.24 per 1000 people (95%CI -1.71 to 1.22). The difference in the cumulative incidence per 1000 people of COVID-19 accident and emergency attendance at 6 weeks was 0.01 per 1000 people (95%CI -0.27 to 0.28). For COVID-19 hospital admission, this difference was 0.03 per 1000 people (95%CI -0.22 to 0.27).

Conclusions: In this cohort of healthcare workers where we would not anticipate vaccine type to be related to health status, we found no substantial differences in the incidence of SARS-CoV-2 infection or COVID-19 disease up to 20 weeks after vaccination. Incidence dropped sharply after 3-4 weeks and there were very few COVID-19 hospital attendance and admission events after this period. This is in line with expected onset of vaccine-induced immunity, and suggests strong protection against COVID-19 disease for both vaccines.