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

  1. William J Hulme
  2. Elizabeth J Williamson
  3. Amelia Green
  4. Krishnan Bhaskaran
  5. Helen I McDonald
  6. Christopher T Rentsch
  7. Anna Schultze
  8. John Tazare
  9. Helen J Curtis
  10. Alex J Walker
  11. Laurie Tomlinson
  12. Tom Palmer
  13. Elsie Horne
  14. Brian MacKenna
  15. Caroline E Morton
  16. Amir Mehrkar
  17. Louis Fisher
  18. Seb Bacon
  19. Dave Evans
  20. Peter Inglesby
  21. George Hickman
  22. Simon Davy
  23. Tom Ward
  24. Richard Croker
  25. Rosalind M Eggo
  26. Angel YS Wong
  27. Rohini Mathur
  28. Kevin Wing
  29. Harriet Forbes
  30. Daniel Grint
  31. Ian J Douglas
  32. Stephen JW Evans
  33. Liam Smeeth
  34. Chris Bates
  35. Jonathan Cockburn
  36. John Parry
  37. Frank Hester
  38. Sam Harper
  39. Jonathan AC Sterne
  40. Miguel Hernán
  41. Ben Goldacre
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Abstract

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.

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