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Real-world effectiveness “easily as good, if not better” than trials
Growing real-world evidence suggests that available COVID-19 vaccines are highly protective against known SARS-CoV-2 strains, including those designated as variants of concern by the CDC, according to NIAID Director Anthony Fauci, MD.
In the opening keynote address at the American Thoracic Society (ATS) virtual meeting, Fauci highlighted newly reported vaccine data showing near complete protection against severe disease and death from the U.K. variant (B.1.1.7), now the dominant strain in the U.S., and against the South African variant as well (B.1.351).
While less is known about their effectiveness against the P.1 variant, first reported in Brazil, and the B.1.617 variant, which has led to a massive surge of infections in India, the early data are promising, according to Fauci.
“It does not look like at this point — and this is subject to change — that [the B.1.617 variant] is any more problematic than B.1.351,” he said.
Fauci cited real-world data from May 2021 involving 385,000 people in Qatar that showed the Pfizer/BioNTech vaccine to be roughly 90% effective against the B.1.1.7 variant, which was dominant early in the vaccination program, and 75% effective against the B.1.351 variant, which became dominant among the population in mid-March.
The vaccine’s efficacy against severe, critical, or fatal COVID-19 across all variants was 97.4%, with sensitivity analyses confirming the results.
“As many of you know, effectiveness in the real-world is usually not as good as efficacy in the pristine conditions of a clinical trial,” he said. “We have found just the opposite with the COVID-19 vaccine, where the effectiveness is easily as good, if not better, in real-world settings.”
He also cited recent real-world findings from Israel showing that Pfizer’s mRNA vaccine is highly efficacious across all age groups, including the very elderly.
Surveillance data from late January to early April 2021 of the comprehensive vaccination campaign showed full vaccination to be 95% effective overall against SARS-CoV-2 infection, and 97% effective against symptomatic infection, hospitalization for COVID-19, and related death.
Fauci noted that in countries like Israel, Qatar, and the U.S. — where vaccination campaigns began as outbreaks were occurring and infection rates were rising — widespread vaccination quickly led to infection declines.
During the ATS talk, Fauci did not address the latest CDC guidance stating that fully vaccinated people no longer need to wear masks indoors. But Sunday morning on Face the Nation, he said that the guidance resulted from the new real-world data on vaccine efficacy for preventing infection, severe disease, and death, along with other new findings.
“We’re seeing that it is very unlikely that a vaccinated person, even if there’s a breakthrough infection, would transmit it to someone else,” he said on the news show. “So the accumulation of all of those scientific facts, information, and evidence brought the CDC to make that decision to say now when you’re vaccinated, you don’t need to wear a mask, not only outdoors, but you don’t need to wear it indoors.”
Fauci added that he hopes the latest guidance from federal health officials will help convince people who are eligible, but still not vaccinated, to get the vaccine.
“The underlying reason for the CDC doing this was just based on the evolution of the science,” he said. “But if, in fact, this serves as an incentive for people to get vaccinated, all the better. I hope it does, actually.”
During the ATS talk, Fauci discussed the speed of vaccine development, which is one of the most commonly cited concerns among people who are reluctant to get it. He also recently wrote on the topic in an editorial in Science.
He noted that the building blocks that led to rapid development were in place years before COVID-19 emerged as a global threat. In the editorial, he wrote that the discovery of “an immunogen adaptable to the multiple platforms (messenger RNA and others) used for COVID-19 vaccines resulted from collaboration across different scientific subspecialties.”
In his discussion, Fauci noted that the COVID-19 vaccine resulted from “an extraordinary multidisciplinary effort by preclinical and clinical science that had been underway, out of the spotlight, for decades before the unfolding of the COVID-19 pandemic.”
“This is a fact that very few people fully appreciate, and it highlights the importance of investment in biomedical research,” he said.
Créditos: Comité científico Covid