Waning of BNT162b2 Vaccine Protection against SARS-CoV-2 Infection in Qatar

Chemaitelly, Hiam; Tang, Patrick; Hasan, Mohammad R.; AlMukdad, Sawsan; Yassine, Hadi M.; Benslimane, Fatiha M.; Al Khatib, Hebah A.; Coyle, Peter; Ayoub, Houssein H.; Al Kanaani, Zaina; Al Kuwari, Einas; Jeremijenko, Andrew; Kaleeckal, Anvar H.; Latif, Ali N.; Shaik, Riyazuddin M.; Abdul Rahim, Hanan F.; Nasrallah, Gheyath K.; Al Kuwari, Mohamed G.; Al Romaihi, Hamad E.; Butt, Adeel A.; Al-Thani, Mohamed H.; Al Khal, Abdullatif; Bertollini, Roberto; Abu-Raddad, Laith J.

BACKGROUND: Waning of vaccine protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (Covid-19) is a concern. The persistence of BNT162b2 (Pfizer–BioNTech) vaccine effectiveness against infection and disease in Qatar, where the B.1.351 (or beta) and B.1.617.2 (or delta) variants have dominated incidence and polymerase-chain-reaction testing is done on a mass scale, is unclear. METHODS: We used a matched test-negative, case–control study design to estimate vaccine effectiveness against any SARS-CoV-2 infection and against any severe, critical, or fatal case of Covid-19, from January 1 to September 5, 2021. RESULTS: Estimated BNT162b2 effectiveness against any SARS-CoV-2 infection was negligible in the first 2 weeks after the first dose. It increased to 36.8% (95% confidence interval [CI], 33.2 to 40.2) in the third week after the first dose and reached its peak at 77.5% (95% CI, 76.4 to 78.6) in the first month after the second dose. Effectiveness declined gradually thereafter, with the decline accelerating after the fourth month to reach approximately 20% in months 5 through 7 after the second dose. Effectiveness against symptomatic infection was higher than effectiveness against asymptomatic infection but waned similarly. Variant-specific effectiveness waned in the same pattern. Effectiveness against any severe, critical, or fatal case of Covid-19 increased rapidly to 66.1% (95% CI, 56.8 to 73.5) by the third week after the first dose and reached 96% or higher in the first 2 months after the second dose; effectiveness persisted at approximately this level for 6 months. CONCLUSIONS: BNT162b2-induced protection against SARS-CoV-2 infection appeared to wane rapidly following its peak after the second dose, but protection against hospitalization and death persisted at a robust level for 6 months after the second dose. (Funded by Weill Cornell Medicine–Qatar and others.)