Time-Varying Effectiveness of Three COVID-19 Vaccines in Puerto Rico

Abstract

Background: On July 15, 2020, with 58% of the population fully vaccinated, the start of a COVID-19 surge was being observed in Puerto Rico. On July 22, 2021, the government commenced imposing a series of strict vaccine mandates. Two months later, over 70% of the population was vaccinated, more than in any US state, and laboratory-confirmed SARS-CoV-2 had dropped substantially. The decision to impose mandates, as well as current Department of Health recommendations related to boosters, were guided by the data and time-varying effectiveness estimates presented here.Methods: Between December 15, 2020, when the vaccination process began in Puerto Rico, and October 15,2021, 2,276,966 individuals were fully vaccinated against COVID-19. During this period 112,726 laboratory confirmed SARS-CoV-2 infections have been reported. These data permitted us to quantify the outcomes of the immunization campaign and to compare effectiveness of the mRNA-1273 (Moderna), BNT162b2(Pfizer), and Ad26.COV2.S (J&J) vaccines. We obtained vaccination status, SARS-CoV-2 test results, and COVID-19 hospitalizations and deaths, from the Department of Health. We fit statistical models that adjusted for time-varying incidence rates and age group to estimate time-varying vaccine effectiveness against lab-confirmed SARS-CoV-2 infection, and COVID-19 hospitalization and death. Code and data to reproduce the analyses are provided here: https://github.com/rafalab/vax-eff-pr. Results: At their peak, the mRNA-1273, BNT162b2, and Ad26.COV2.S vaccines had an effectiveness of 90% (95% CI: 88-91), 87% (85-89), and, 62% (54-68) respectively. After five months, effectiveness waned to about 70%, 60%, and 40%, respectively. We found no evidence that effectiveness was different after the Delta variant became dominant. For those infected, the vaccines provided further protection against COVID-19 hospitalization and deaths across all age groups, and this conditional effect did not wane in time.Interpretation: The mRNA-1273 and BNT162b2 vaccines were highly effective across all age groups. They were still effective after five months although the protection against SARS-CoV-2 infection waned. The Ad26.COV2.S vaccine was effective but to a lesser degree compared to the mRNA vaccines. Although, conditional on infection, protection against adverse outcomes did not wane, the waning in effectiveness resulted in a decreased protection against serious COVID-19 outcomes across time.Funding: RAI’s work was partly funded by NIH Grant R35GM131802.Declaration of Interest: The authors declare no conflict of interests.Ethical Approval: The data used for the analysis contains no identifiers. The original records are kept in y the Puerto Rico Department of Health. HIPAA compliant databases. The data used in the manuscript was curated and shared publicly by the Department of Health. The research that led to the manuscript received human subject exemption from the DFCI IRB.