Comparative effectiveness of ChAdOx1 versus BNT162b2 covid-19 vaccines in health and social care workers in England: cohort study using OpenSAFELY

William J Hulme; Elizabeth J Williamson; Amelia C A Green; Krishnan Bhaskaran; Helen I McDonald; Christopher T Rentsch; Anna Schultze; John Tazare; Helen J Curtis; Alex J Walker; Laurie A Tomlinson; Tom Palmer; Elsie M F Horne; Brian MacKenna; Caroline E Morton; Amir Mehrkar; Jessica Morley; Louis Fisher; Sebastian C J Bacon; David Evans; Peter Inglesby; George Hickman; Simon Davy; Tom Ward; Richard Croker; Rosalind M Eggo; Angel Y S Wong; Rohini Mathur; Kevin Wing; Harriet Forbes; Daniel J Grint; Ian J Douglas; Stephen J W Evans; Liam Smeeth; Chris Bates; Jonathan Cockburn; John Parry; Frank Hester; Sam Harper; Jonathan A C Sterne; Miguel A Hernán; Ben Goldacre

doi:10.1136/bmj-2021-068946

Comparative effectiveness of ChAdOx1 versus BNT162b2 covid-19 vaccines in health and social care workers in England: cohort study using OpenSAFELY

William J Hulme, Elizabeth J Williamson, Amelia C A Green, Krishnan Bhaskaran, Helen I McDonald, Christopher T Rentsch, Anna Schultze, John Tazare, Helen J Curtis, Alex J Walker, Laurie A Tomlinson, Tom Palmer, Elsie M F Horne, Brian MacKenna, Caroline E Morton, Amir Mehrkar, Jessica Morley, Louis Fisher, Sebastian C J Bacon, David EvansPeter Inglesby, George Hickman, Simon Davy, Tom Ward, Richard Croker, Rosalind M Eggo, Angel Y S Wong, Rohini Mathur, Kevin Wing, Harriet Forbes, Daniel J Grint, Ian J Douglas, Stephen J W Evans, Liam Smeeth, Chris Bates, Jonathan Cockburn, John Parry, Frank Hester, Sam Harper, Jonathan A C Sterne, Miguel A Hernán, Ben Goldacre

Research output: Contribution to journal › Article › peer-review

12 Citations (SciVal)

Abstract

OBJECTIVE: 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, on behalf of NHS England.

SETTING: Linked primary care, hospital, and covid-19 surveillance records available within the OpenSAFELY-TPP research platform, covering a period when the SARS-CoV-2 Alpha variant was dominant.

PARTICIPANTS: 317 341 health and social care workers vaccinated between 4 January and 28 February 2021, registered with a general 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 attendance at an accident and emergency (A&E) department or hospital admission occurring within 20 weeks of receipt of the first vaccine dose.

RESULTS: Over the duration of 118 771 person-years of follow-up there were 6962 positive SARS-CoV-2 tests, 282 covid-19 related A&E attendances, and 166 covid-19 related hospital admissions. The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks after vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 20 weeks after first-dose vaccination with BNT162b2 was 21.7 per 1000 people (95% confidence interval 20.9 to 22.4) and with ChAdOx1 was 23.7 (21.8 to 25.6), representing a difference of 2.04 per 1000 people (0.04 to 4.04). The difference in the cumulative incidence per 1000 people of covid-19 related A&E attendance at 20 weeks was 0.06 per 1000 people (95% CI -0.31 to 0.43). For covid-19 related hospital admission, this difference was 0.11 per 1000 people (-0.22 to 0.44).

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 at 3-4 weeks after vaccination, and there were few covid-19 related hospital attendance and admission events after this period. This is in line with expected onset of vaccine induced immunity and suggests strong protection against Alpha variant covid-19 disease for both vaccines in this relatively young and healthy population of healthcare workers.

Original language	English
Article number	e068946
Pages (from-to)	e068946
Journal	BMJ (Clinical research ed.)
Volume	378
DOIs	https://doi.org/10.1136/bmj-2021-068946
Publication status	Published - 20 Jul 2022
Externally published	Yes

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.

Funding

Funding This work was supported by the UKRI (COV0076;MR/V015737/1) NIHR and Asthma UK-BLF and the Longitudinal Health and wellbeing strand of the National Core Studies programme (UKRI MRC MC_PC_20030 and MC_PC_20059). The OpenSAFELY platform is funded by the Wellcome Trust (222097/Z/20/Z). TPP provided technical expertise and infrastructure within their data centre pro bono in the context of a national emergency. BG’s work on clinical informatics is supported by the NIHR Oxford Biomedical Research Centre and the NIHR Applied Research Collaboration Oxford and Thames Valley. BG’s work on better use of data in healthcare more broadly is currently funded in part by: NIHR Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation, NHS England, and the Health Foundation; all DataLab staff are supported by BG’s grants on this work. LS reports grants from Wellcome, MRC, NIHR, UKRI, British Council, GSK, British Heart Foundation, and Diabetes UK outside this work. KB holds a Wellcome Senior Research Fellowship (220283/Z/20/Z). HIM is funded by the NIHR Health Protection Research Unit in Immunisation, a partnership between Public Health England and London School of Hygiene and Tropical Medicine. AYSW holds a fellowship from the British Heart Foundation. EJW holds grants from MRC. RM holds a Sir Henry Wellcome Fellowship funded by the Wellcome Trust (201375/Z/16/Z). HF holds a UKRI fellowship. IJD holds grants from NIHR and GSK. TP receives support from the Integrative Epidemiology Unit which receives funding from the UK Medical Research Council and the University of Bristol (MC_UU_00011/1, MC_UU_00011/3, MC_UU_00011/4). Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Competing interests: All authors have completed the ICMJE uniform disclosure form and declare the following: BG has received research funding from Health Data Research UK (HDRUK), the Laura and John Arnold Foundation, the Wellcome Trust, the NIHR Oxford Biomedical Research Centre, the NHS National Institute for Health Research School of Primary Care Research, the Mohn-Westlake Foundation, the Good Thinking Foundation, the Health Foundation, and the World Health Organisation; he also receives personal income from speaking and writing for lay audiences on the misuse of science. IJD holds shares in GlaxoSmithKline (GSK).

Funders	Funder number
Asthma UK-BLF
Good Thinking Foundation
Health Data Research UK
NHS National Institute for Health Research School of Primary Care Research
NIHR Applied Research Collaboration Oxford
National Core Studies programme
Public Health England and London School of Hygiene and Tropical Medicine	201375/Z/16/Z
Thames Valley
UKRI MRC	MC_PC_20030, MC_PC_20059
GlaxoSmithKline
World Health Organization
Laura and John Arnold Foundation
Wellcome Trust	222097/Z/20/Z
Heart of England NHS Foundation Trust
UK Research and Innovation	MR/V015737/1, COV0076
Medical Research Council
National Institute for Health and Care Research
British Heart Foundation
British Council
Diabetes UK	220283/Z/20/Z
Health Foundation
University of Bristol	MC_UU_00011/4, MC_UU_00011/3, MC_UU_00011/1
NIHR Oxford Biomedical Research Centre
Mohn Westlake Foundation

Keywords

BNT162 Vaccine
COVID-19/epidemiology
COVID-19 Vaccines
Cohort Studies
Health Personnel
Humans
SARS-CoV-2
Social Support
Viral Vaccines

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1136/bmj-2021-068946Licence: CC BY

Cite this

Hulme, W. J., Williamson, E. J., Green, A. C. A., Bhaskaran, K., McDonald, H. I., Rentsch, C. T., Schultze, A., Tazare, J., Curtis, H. J., Walker, A. J., Tomlinson, L. A., Palmer, T., Horne, E. M. F., MacKenna, B., Morton, C. E., Mehrkar, A., Morley, J., Fisher, L., Bacon, S. C. J., ... Goldacre, B. (2022). Comparative effectiveness of ChAdOx1 versus BNT162b2 covid-19 vaccines in health and social care workers in England: cohort study using OpenSAFELY. BMJ (Clinical research ed.), 378, e068946. Article e068946. https://doi.org/10.1136/bmj-2021-068946

Hulme, WJ, Williamson, EJ, Green, ACA, Bhaskaran, K, McDonald, HI, Rentsch, CT, Schultze, A, Tazare, J, Curtis, HJ, Walker, AJ, Tomlinson, LA, Palmer, T, Horne, EMF, MacKenna, B, Morton, CE, Mehrkar, A, Morley, J, Fisher, L, Bacon, SCJ, Evans, D, Inglesby, P, Hickman, G, Davy, S, Ward, T, Croker, R, Eggo, RM, Wong, AYS, Mathur, R, Wing, K, Forbes, H, Grint, DJ, Douglas, IJ, Evans, SJW, Smeeth, L, Bates, C, Cockburn, J, Parry, J, Hester, F, Harper, S, Sterne, JAC, Hernán, MA & Goldacre, B 2022, 'Comparative effectiveness of ChAdOx1 versus BNT162b2 covid-19 vaccines in health and social care workers in England: cohort study using OpenSAFELY', BMJ (Clinical research ed.), vol. 378, e068946, pp. e068946. https://doi.org/10.1136/bmj-2021-068946

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title = "Comparative effectiveness of ChAdOx1 versus BNT162b2 covid-19 vaccines in health and social care workers in England: cohort study using OpenSAFELY",

abstract = "OBJECTIVE: 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, on behalf of NHS England.SETTING: Linked primary care, hospital, and covid-19 surveillance records available within the OpenSAFELY-TPP research platform, covering a period when the SARS-CoV-2 Alpha variant was dominant.PARTICIPANTS: 317 341 health and social care workers vaccinated between 4 January and 28 February 2021, registered with a general 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 attendance at an accident and emergency (A&E) department or hospital admission occurring within 20 weeks of receipt of the first vaccine dose.RESULTS: Over the duration of 118 771 person-years of follow-up there were 6962 positive SARS-CoV-2 tests, 282 covid-19 related A&E attendances, and 166 covid-19 related hospital admissions. The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks after vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 20 weeks after first-dose vaccination with BNT162b2 was 21.7 per 1000 people (95% confidence interval 20.9 to 22.4) and with ChAdOx1 was 23.7 (21.8 to 25.6), representing a difference of 2.04 per 1000 people (0.04 to 4.04). The difference in the cumulative incidence per 1000 people of covid-19 related A&E attendance at 20 weeks was 0.06 per 1000 people (95% CI -0.31 to 0.43). For covid-19 related hospital admission, this difference was 0.11 per 1000 people (-0.22 to 0.44).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 at 3-4 weeks after vaccination, and there were few covid-19 related hospital attendance and admission events after this period. This is in line with expected onset of vaccine induced immunity and suggests strong protection against Alpha variant covid-19 disease for both vaccines in this relatively young and healthy population of healthcare workers.",

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author = "Hulme, {William J} and Williamson, {Elizabeth J} and Green, {Amelia C A} and Krishnan Bhaskaran and McDonald, {Helen I} and Rentsch, {Christopher T} and Anna Schultze and John Tazare and Curtis, {Helen J} and Walker, {Alex J} and Tomlinson, {Laurie A} and Tom Palmer and Horne, {Elsie M F} and Brian MacKenna and Morton, {Caroline E} and Amir Mehrkar and Jessica Morley and Louis Fisher and Bacon, {Sebastian C J} and David Evans and Peter Inglesby and George Hickman and Simon Davy and Tom Ward and Richard Croker and Eggo, {Rosalind M} and Wong, {Angel Y S} and Rohini Mathur and Kevin Wing and Harriet Forbes and Grint, {Daniel J} and Douglas, {Ian J} and Evans, {Stephen J W} and Liam Smeeth and Chris Bates and Jonathan Cockburn and John Parry and Frank Hester and Sam Harper and Sterne, {Jonathan A C} and Hern{\'a}n, {Miguel A} and Ben Goldacre",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = jul,

day = "20",

doi = "10.1136/bmj-2021-068946",

language = "English",

volume = "378",

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TY - JOUR

T1 - Comparative effectiveness of ChAdOx1 versus BNT162b2 covid-19 vaccines in health and social care workers in England

T2 - cohort study using OpenSAFELY

AU - Hulme, William J

AU - Williamson, Elizabeth J

AU - Green, Amelia C A

AU - Bhaskaran, Krishnan

AU - McDonald, Helen I

AU - Rentsch, Christopher T

AU - Schultze, Anna

AU - Tazare, John

AU - Curtis, Helen J

AU - Walker, Alex J

AU - Tomlinson, Laurie A

AU - Palmer, Tom

AU - Horne, Elsie M F

AU - MacKenna, Brian

AU - Morton, Caroline E

AU - Mehrkar, Amir

AU - Morley, Jessica

AU - Fisher, Louis

AU - Bacon, Sebastian C J

AU - Evans, David

AU - Inglesby, Peter

AU - Hickman, George

AU - Davy, Simon

AU - Ward, Tom

AU - Croker, Richard

AU - Eggo, Rosalind M

AU - Wong, Angel Y S

AU - Mathur, Rohini

AU - Wing, Kevin

AU - Forbes, Harriet

AU - Grint, Daniel J

AU - Douglas, Ian J

AU - Evans, Stephen J W

AU - Smeeth, Liam

AU - Bates, Chris

AU - Cockburn, Jonathan

AU - Parry, John

AU - Hester, Frank

AU - Harper, Sam

AU - Sterne, Jonathan A C

AU - Hernán, Miguel A

AU - Goldacre, Ben

PY - 2022/7/20

Y1 - 2022/7/20

N2 - OBJECTIVE: 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, on behalf of NHS England.SETTING: Linked primary care, hospital, and covid-19 surveillance records available within the OpenSAFELY-TPP research platform, covering a period when the SARS-CoV-2 Alpha variant was dominant.PARTICIPANTS: 317 341 health and social care workers vaccinated between 4 January and 28 February 2021, registered with a general 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 attendance at an accident and emergency (A&E) department or hospital admission occurring within 20 weeks of receipt of the first vaccine dose.RESULTS: Over the duration of 118 771 person-years of follow-up there were 6962 positive SARS-CoV-2 tests, 282 covid-19 related A&E attendances, and 166 covid-19 related hospital admissions. The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks after vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 20 weeks after first-dose vaccination with BNT162b2 was 21.7 per 1000 people (95% confidence interval 20.9 to 22.4) and with ChAdOx1 was 23.7 (21.8 to 25.6), representing a difference of 2.04 per 1000 people (0.04 to 4.04). The difference in the cumulative incidence per 1000 people of covid-19 related A&E attendance at 20 weeks was 0.06 per 1000 people (95% CI -0.31 to 0.43). For covid-19 related hospital admission, this difference was 0.11 per 1000 people (-0.22 to 0.44).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 at 3-4 weeks after vaccination, and there were few covid-19 related hospital attendance and admission events after this period. This is in line with expected onset of vaccine induced immunity and suggests strong protection against Alpha variant covid-19 disease for both vaccines in this relatively young and healthy population of healthcare workers.

AB - OBJECTIVE: 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, on behalf of NHS England.SETTING: Linked primary care, hospital, and covid-19 surveillance records available within the OpenSAFELY-TPP research platform, covering a period when the SARS-CoV-2 Alpha variant was dominant.PARTICIPANTS: 317 341 health and social care workers vaccinated between 4 January and 28 February 2021, registered with a general 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 attendance at an accident and emergency (A&E) department or hospital admission occurring within 20 weeks of receipt of the first vaccine dose.RESULTS: Over the duration of 118 771 person-years of follow-up there were 6962 positive SARS-CoV-2 tests, 282 covid-19 related A&E attendances, and 166 covid-19 related hospital admissions. The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks after vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 20 weeks after first-dose vaccination with BNT162b2 was 21.7 per 1000 people (95% confidence interval 20.9 to 22.4) and with ChAdOx1 was 23.7 (21.8 to 25.6), representing a difference of 2.04 per 1000 people (0.04 to 4.04). The difference in the cumulative incidence per 1000 people of covid-19 related A&E attendance at 20 weeks was 0.06 per 1000 people (95% CI -0.31 to 0.43). For covid-19 related hospital admission, this difference was 0.11 per 1000 people (-0.22 to 0.44).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 at 3-4 weeks after vaccination, and there were few covid-19 related hospital attendance and admission events after this period. This is in line with expected onset of vaccine induced immunity and suggests strong protection against Alpha variant covid-19 disease for both vaccines in this relatively young and healthy population of healthcare workers.

KW - BNT162 Vaccine

KW - COVID-19/epidemiology

KW - COVID-19 Vaccines

KW - Cohort Studies

KW - Health Personnel

KW - Humans

KW - SARS-CoV-2

KW - Social Support

KW - Viral Vaccines

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DO - 10.1136/bmj-2021-068946

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SP - e068946

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

M1 - e068946

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Comparative effectiveness of ChAdOx1 versus BNT162b2 covid-19 vaccines in health and social care workers in England: cohort study using OpenSAFELY

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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