cdc.gov/coronavirus

COVID-19 Vaccine Effectiveness

for Moderna and Janssen 

Vaccines

Jefferson Jones, MD MPH FAAP

CDC COVID-19 Response

CDR, US Public Health Service
Monitoring vaccine effectiveness (VE) evidence 

by risk group, outcome, and product over time

X Outcome X Product

Pre-Delta vs. Post-Delta or Time Since Vaccination

Risk group

X
HEROESRECOVER 

(mRNA)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pre-Delta Delta

Vaccine effectiveness (%)

SUPERNOVA (mRNA)

IVY ≥1 

underlying 

condition (all 

products)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pre-Delta Delta

Vaccine effectiveness (%)

VE against infection or hospitalization by Delta predominance*

NHSN: https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e3.htm

COVID-NET: CDC unpublished VISION: https://www.nejm.org/doi/10.1056/NEJMoa2110362/ https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e2.htm

IVY: CDC unpublished data SUPERNOVA: https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e3.htm

NYS: https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e1.htm HEROES-RECOVER: https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm 3

Underlying medical conditions Frontline workers

NHSN (mRNA)

COVID-NET (mRNA)

VISION (Pfizer)

VISION (Moderna)

NYS (all products) 

NYS (all products)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pre-Delta Delta

Vaccine effectiveness (%)

≥ 65 years of age

*Pre-delta: May 2021 or earlier

Delta: June 2021 or later
Rates of COVID-19 cases and hospitalizations 

among vaccinated
4 state public health departments: COVID-19 infection rates by 

month of vaccination, vaccine product, and age — July 2021*

5 *Utah, Indiana, New Mexico and New Jersey. A fully vaccinated case had SARS-CoV-2 RNA or antigen detected on a respiratory specimen collected ≥14 

days after completing the primary series of an FDA-authorized or approved COVID-19 vaccine.

18–49y

50–64y

≥65y

FEB MAR APR MAY JUN

Month of vaccination

0

100

200

300

400

500

Moderna

SARS-CoV-2 case rate per 100,000 

vaccinated persons

18–49y

50–64y

≥65y

MAR APR MAY JUN

Month of vaccination

0

100

200

300

400

500

Janssen

FEB

SARS-CoV-2 case rate per 100,000 

vaccinated persons

18–49y

50–64y

≥65y
Cosmos: COVID-19 hospitalization rates by month of vaccination by month 

of vaccination, vaccine product, and age — United States, August 2021*

* Hospitals and clinics that use Epic health record system and participate in Cosmos data set. See supplemental slides. COVID-19 hospitalization = hospital admission during 

which patient had a COVID-19 diagnosis or hospital admission with any respiratory diagnosis within 14 days of a +PCR test or COVID-19 diagnosis 6

0

100

200

300

400

500

600

SARS

JAN FEB MAR APR MAY JUN JUL

-CoV2-2 admission rate per 100,000 vaccinated 

persons

Month of vaccination

Moderna 

18-49 50-64 65+

0

100

200

300

400

500

600

SARS

JAN FEB MAR APR MAY JUN JUL

-CoV2-2 admission rate per 100,000 vaccinated 

persons

Month of vaccination

Janssen

18-49 50-64 65+
VE among people aged ≥65 years
COVID-19 VE against infection by month of vaccination, vaccine product, 

and age — New York State, May–Aug 2021

Rosenberg et al. MedRxIV. https://www.medrxiv.org/content/10.1101/2021.10.08.21264595v1.full.pdf

8
COVID-19 VE against hospitalization by month of vaccination, vaccine 

product, and age — New York State, May–Aug 2021

Rosenberg et al. MedRxIV. https://www.medrxiv.org/content/10.1101/2021.10.08.21264595v1.full.pdf

9
ICATT: Moderna VE against 

symptomatic infection by age 

group and time since vaccination 

in pre-Delta and Delta periods 

Pre-Delta (March 13–May 29) with 95% CIs in 

dotted lines

Delta (July 18–August 31) with 95% CIs in 

dotted lines

• VE is lower during Delta • VE wanes during both periods • Curves similar for 20-44, 45-54, and 55

-

64 age groups

• For ≥65, VE lower than for other age 

groups soon after vaccination, no clear 

trend over time since vaccination 

The presented (fitted) curves are 

truncated on the day with ≤10 

cases observed beyond it to avoid 

presenting wide confidence 

bounds.
ICATT: Janssen (J&J) VE against 

symptomatic infection by age 

group and time since vaccination 

in Delta period 

• VE appears stable over time since 

vaccination during Delta period

• Insufficient data to estimate VE 

over time during pre-Delta period

The presented (fitted) curves are 

truncated on the day with ≤10 

cases observed beyond it to avoid 

presenting wide confidence 

bounds and y-axis is truncated at 

0 (CIs <0 not shown).

Delta (July 18–August 31) with 95% CIs in 

dotted lines
SUPERNOVA: VE* of Moderna vaccine against COVID-19-associated 

Hospitalization— SUPERNOVA Network, February 1–September 17, 2021 

*Adjusted for site, time (admission date), age, sex, race/ethnicity. Stratified models exclude adjustment for stratification variable.

Among fully vaccinated 12

Age Group Time since full vaccination

95%

78%

90%

82%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18-64 years ≥65 years 14-119 days since full vaccination ≥120 days 

Vaccine Effectiveness (%)
13

Summary: VE among people aged ≥65 years

 Moderna

– VE against hospitalization is lower in those aged ≥65 years compared to younger 

adults

– Some studies show moderate declines in VE against infection and small declines in 

VE against hospitalization

 Janssen

– Lower VE compared with mRNA vaccines for infection and hospitalization

– Evidence of waning in VE over time is inconsistent 

– Fewer data available and VE estimates are less reliable
VE for adults aged <65 years with underlying 

medical conditions
IVY Network: COVID-19 VE against hospitalization among immunocompetent 

adults ≥18 years— March 11–September 15, 2021 for Moderna vaccine

* Adjusted for admission date (biweekly), HHS region, age, sex, race/ethnicity. **Chronic condition: ≥1 cardiovascular, endocrine, gastrointestinal, hematological, neurological, 

pulmonary, or renal condition (excluded patients with immunocompromising conditions) 

91.3 88.6 96.0 82.3 92.7 93.0 89.0 86.4

0

10

20

30

40

50

60

70

80

90

100

14-

120

days

>120

days

14-

120

days

>120

days

14-

120

days

>120

days

14-

120

days

>120

days

Vaccine Effectiveness (%)

Time since vaccination

All ages 18-44 years 45-64 years ≥65 years

≥1 chronic conditions**

99.6 98.5 100 100 96.7 96.9 100 99.7

0

10

20

30

40

50

60

70

80

90

100

14-

120

days

>120

days

14-

120

days

>120

days

14-

120

days

>120

days

14-

120

days

>120

days

Vaccine Effectiveness (%)

Time since vaccination

0 chronic conditions**

All ages 18-44 years 45-64 years ≥65 years
 75 hospitalizations and 108 controls in Janssen recipients (median 84 days from dose 

1 to illness onset)

IVY Network: COVID-19 vaccine effectiveness against hospitalization among 

immunocompetent adults ≥18 years — March 11–September 15, 2021 for Janssen 

vaccine

16 * Adjusted for admission date (biweekly), HHS region, age, sex, race/ethnicity. 

83

65

0

10

20

30

40

50

60

70

80

90

100

0 chronic conditions ≥1 chronic conditions

Vaccine Effectiveness (%)
VISION: VE against COVID-19 ED/UC visits among 

immunocompetent adults without chronic conditions — Jun–Sep 2021 

• In all age groups, Moderna VE is higher than Janssen VE.

• In all age groups, Moderna VE shows a modest waning trend.

• There is no consistent pattern of waning for Janssen VE. 

0

10

20

30

40

50

60

70

80

90

100

<2 mo 2 to <4 mo 4 to <6 mo 6+ mo

Adjusted VE (%)

Time since last dose

Ages 18 to 44 yr

0

10

20

30

40

50

60

70

80

90

100

<2 mo 2 to <4 mo 4 to <6 mo 6+ mo

Adjusted VE (%)

Time since last dose

Ages 45 to 64 yr

0

10

20

30

40

50

60

70

80

90

100

<2 mo 2 to <4 mo 4 to <6 mo 6+ mo

Adjusted VE (%)

Time since last dose

Ages ≥65 yr

All VE estimates are based on comparisons of fully vaccinated persons with unvaccinated persons. 

Janssen VE estimates are based on preliminary analyses of relatively small samples. Sample size was insufficient to estimate Janssen VE for persons vaccinated ≥6 months.
VISION: VE against COVID-19 ED/UC visits among 

immunocompetent adults with chronic conditions —

Jun–Sep 2021 

• In all age groups, Moderna VE is higher than Janssen VE.

• In 45 to 64 year and ≥65 year age groups, Moderna VE shows a modest waning trend. 

• Janssen VE may be higher at 2 to 4 months post-vaccination than earlier or later. 

• For both vaccines, waning of VE is more pronounced in the oldest age group.

0

10

20

30

40

50

60

70

80

90

100

<2 mo 2 to <4 mo 4 to <6 mo 6+ mo

Adjusted VE (%)

Time since last dose

Ages 18 to 44 yr

0

10

20

30

40

50

60

70

80

90

100

<2 mo 2 to <4 mo 4 to <6 mo 6+ mo

Adjusted VE (%)

Time since last dose

Ages 45 to 64 yr

0

10

20

30

40

50

60

70

80

90

100

<2 mo 2 to <4 mo 4 to <6 mo 6+ mo

Adjusted VE (%)

Time since last dose

Ages ≥65 yr

All VE estimates are based on comparisons of fully vaccinated persons with unvaccinated persons. 

Janssen VE estimates are based on preliminary analyses of relatively small samples. Sample size was insufficient to estimate Janssen VE for persons vaccinated ≥6 months.
VISION: VE against COVID-19 hospitalization among 

immunocompetent adults with chronic conditions —

Jun–Sep 2021 

19

• In all age groups, Moderna VE is higher than Janssen VE.

• In all age groups, Moderna VE shows a modest waning trend, which is more pronounced among the oldest 

age group.

• There is no consistent pattern of waning for Janssen VE. 

0

10

20

30

40

50

60

70

80

90

100

<2 mo 2 to <4 mo 4 to <6 mo 6+ mo

Adjusted VE (%)

Time since last dose

Ages 45 to 64 yr

0

10

20

30

40

50

60

70

80

90

100

<2 mo 2 to <4 mo 4 to <6 mo 6+ mo

Adjusted VE (%)

Time since last dose

Ages ≥65 yr

0

10

20

30

40

50

60

70

80

90

100

<2 mo 2 to <4 mo 4 to <6 mo 6+ mo

Adjusted VE (%)

Time since last dose

Ages 18 to 44 yr

All VE estimates are based on comparisons of fully vaccinated persons with unvaccinated persons. 

Janssen VE estimates are based on preliminary analyses of relatively small samples. Sample size was insufficient to estimate Janssen VE for persons vaccinated ≥6 months.
 Moderna

– Mild decline in VE against hospitalization and against ED/UC visits, but VE 

remains high

 Janssen

– Lower VE compared with mRNA vaccines for infection and hospitalization

– No consistent evidence of waning

Summary: VE for adults age <65 years with underlying medical 

conditions

20
VE for workers employed in occupations with 

high risk of exposure to SARS-CoV-2
Adjusted VE against infection

% (95% CI)

Full cohort to date

Overall VE 80 (69-80)

14-119 days post dose 2 85 (68-93)

120-149 days post dose 2 81 (34-95)

≥150 days post dose 2 73 (49-86)

Pre-Delta variant predominance, overall VE 91 (81-96)

Delta variant predominance, overall VE 66 (26-84)

HEROES/RECOVER: mRNA VE against SARS-CoV-2 infection by Delta 

variant predominance* and time since full vaccination — Eight U.S. 

locations, Dec 2020 – Aug 2021

https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e4.htm

 VE against infection (80% symptomatic) declined from 91% pre-Delta to 66% during Delta

 Did not have enough power to look at time since vaccination pre-Delta and during Delta

 Do not see significant difference between mRNA products

0 20 40 60 80 100

Vaccine Effectiveness (%)

*Weeks when the Delta variant accounted for ≥50% of viruses sequenced, based on data from each respective location, were defined as weeks of Delta variant predominance
Global VE data
IVAC/WHO systematic review for Moderna VE against death 

or severe disease

24 International Vaccine Access Center and WHO, https://view-hub.org/resources

 VE against 

severe 

disease 

and death: 

89–100%
IVAC/WHO systematic review for Moderna VE against infection

25

International Vaccine Access Center and WHO, https://view-hub.org/resources

 VE against 

infection: 

75–100%

 VE against 

asymptomatic 

infection: 

70–90%
 Moderna-funded study

 Test-negative design using Kaiser 

Permanente Southern California 

patients

 8,153 cases diagnosed between March 

and July 2021 

– 1 case with 5 matched controls

 VE against Delta infection 

– declined from 94% to 80%

– lower among individuals aged ≥65 y (75%) 

compared with aged 18-64 y (88%)

 VE against hospitalization over time not 

included in manuscript, but was >96% 

for Delta and non-Delta 

Study: Moderna VE against infection

Bruxvoort, medRxiv, https://www.medrxiv.org/content/10.1101/2021.09.29.21264199v1 26
IVAC/WHO systematic review for Janssen vaccine

27

International Vaccine Access Center and WHO, https://view-hub.org/resources

 VE against severe disease: 

60–85%

 VE against symptomatic 

disease or any infection: 

12–95%

 Wide confidence intervals 

because of few 

participants who received 

Janssen vaccine
Study: Janssen VE against medically 

attended infection and hospitalization

Polinski et al., medRxiv, https://www.medrxiv.org/content/10.1101/2021.09.10.21263385v1.full.pdf 28

 Janssen-funded study using U.S. insurance claims data

 Cohort design, matched 390,517 vaccinated between 

March and July 2021 with 1,524,153 unvaccinated 

individuals

 VE calculated from proportional hazards

 VE against

– Medically attended COVID-19: ICD-10 code or PCR+ – Hospitalization: discharge diagnosis of COVID or positive test within 21 days of 

hospitalization

 Assumed 40% unreported vaccination in control group, 

resulting in higher VE by 8-10%

 No decline of VE against medically attended COVID-19 

or hospitalization

– Similar results when restricted to states with high Delta incidence

 Uncorrected VE by age

– VE against medically attended infection: Age ≥50y: 65%, Age 18y–49y: 75% – VE against hospitalization: Age ≥50y: 71%, Age 18y–49y: 79%

Medically attended infection

Hospitalization
 Groups prioritized for vaccination early were often those at higher risk for SARS-CoV2 infection or severe COVID-19 – High risk groups may practice preventive measures more frequently

 After vaccination, people may change their behavior, engaging in riskier activities 

because of confidence in protection or seek testing for COVID-19 less frequently – Some studies report vaccinated practice preventive measures more frequently 

 With time, risk of misclassification of vaccine status may increase

 SARS-CoV-2 infection and subsequent population infection-derived immunity will 

increase over time in the unvaccinated group, leading to apparent waning VE

Limitations of VE studies

WHO 20210928 Weekly COVID 29 -19 Epi Update, https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---28-september-2021
Summary and conclusions
 Moderna

– Moderna VE against infection declines over time; both circulation of Delta variant and increasing time from 

vaccination appear to contribute

– ≥65 years of age

• VE against hospitalization is lower in those aged ≥65 years compared with VE in younger adults

• Some studies show moderate declines in VE against infection and small declines in VE against hospitalization

– <65 years of age with underlying medical conditions

• Mild decline in VE against hospitalization and against ED/UC visits, but VE remains high

– Occupations with high risk of exposure to SARS-CoV-2

• No Moderna-specific data

• For combined mRNA vaccines, VE against hospitalization declining

 Janssen

– Lower VE compared with mRNA for infection and hospitalization

– Evidence of waning in VE over time is inconsistent across studies

– Fewer data available and VE estimates are less reliable

Summary & conclusions
Acknowledgements

 Site PIs and teams for IVY, VISION, Signature, NHSN, 

HEROES-RECOVER, SUPERNOVA, COVID-NET, 

Cosmos

 CDC

– Sara Oliver

– Stephanie Schrag

– Katherine Fleming-Dutra

– Jennifer Verani

– John Jernigan

– Nong Shang

– Gordana Derado

– Stephanie Bialek

– Meredith McMorrow

– Ruth Link-Gelles

– Kathleen Dooling

– Epi and Vaccine Task Forces

 CDC

– Heather Scobie

– Mark Tenforde

– Srinivas Nanduri

– Tamara Pilishvili

– Diya Surie

– Mila Prill

– Kristina Bajema

– Mark Thompson

– Jill Ferdinands

– Ian Plumb

– Fiona Havers

– Heidi Moline

– Jessica Smith

– Manish Patel

– Minal Patel
For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.
Extra slides for reference
COVID-19 case rates by vaccination cohort, vaccine 

product and age, 4 states*, July 2021

*Public health department data from Utah, Indiana, New Mexico and New Jersey 35

COVID-19 Surveillance data from 4 States. A fully vaccinated case had SARS-CoV-2 RNA or antigen detected on a respiratory specimen collected 

≥14 days after completing the primary series of an FDA-authorized or approved COVID-19 vaccine.
Cosmos Data Set

 Largest single-source EHR data set in US – 120+ million patients, 700+ hospitals, 10k clinics, all 50 states

– All participating sites use Epic EHR

 Data Representativeness

– All patient ages, all insurance types (including self-pay)

– Data submission is automated, no site drop-outs in data overtime

 Data Items

– Longitudinal charts - immunizations, problems, medications, lab results, office visits, social determinants, 

hospitalization records, etc.

– Charts are de-duplicated when added to Cosmos

© 2020-2021 EHRN. All rights 

reserved
Cosmos Methods

17,677,683 

fully vaccinated patients

*Excludes patients with 

vaccinations from multiple 

manufacturers or different 

dosing, such as a third dose

151,570

breakthroughs

58,707

August 

breakthroughs

17,666

July 

breakthroughs

10,657

Pfizer

5,096

Moderna

1,913

J+J

35,941

Pfizer

16,554

Moderna

6,212

J+J

*Breakthroughs are from 

Jan 16, 2021 – Sept 22, 2021

*Initial vaccination is from 

Dec 11, 2021 – Sept 8, 2021

*Includes anyone who 

completed a vaccination 

series prior to July and then 

had a breakthrough in July

© 2020-2021 EHRN. All rights reserved.

*Includes anyone who 

completed a vaccination 

series prior to August and 

then had a breakthrough in 

August
Cosmos Limitations

Limitations of Epic vaccination data

• We do not include unvaccinated patients for comparison since it is difficult to know if a patient is truly unvaccinated, or 

whether they received the vaccine, and it was not added to the state registry. Additionally, patients need to have an 

“encounter” with an Epic health system (a phone call, an office visit, etc.) in order to reconcile vaccinations received 

outside of an Epic facility. 

• We are very confident that the 17,677,683 patients in our cohort are fully vaccinated and know the date when they had 

their final dose. We define “fully vaccinated” as a patient who is > 14 days after completing the primary series of an FDAauthorized or approved COVID-19 vaccine.

Limitations of surveillance data in general

• We don’t know if a patient had a breakthrough case if they didn’t get tested or weren’t seen at a medical facility with a 

diagnosis or billing code of COVID-19.

© 2020-2021 EHRN. All rights reserved.
July 2021 Breakthrough Infections

August -2021 Breakthrough Infections

Overall Breakthrough** Infections

Vaccine

Total Fully

Vaccinated Infections Hospitalizations Deaths Infections/100k Hospitalizations/100k Deaths/100k % Hospitalized*

Pfizer 10,355,292 90,611 8,575 927 875.0 82.8 9.0 9.5%

Moderna 6,198,326 44,433 4,507 510 716.9 72.7 8.2 10.1%

JJ 1,124,065 16,526 2,155 203 1,470.2 191.7 18.1 13.0%

Total 17,677,683 151,570 15,237 1,640 857.4 86.2 9.3 10.1%

Vaccine

Total Fully 

Vaccinated Infections Hospitalizations Deaths Infections/100k Hospitalizations/100k Deaths/100k % Hospitalized*

Pfizer 9,713,025 10,657 1,106 137 109.7 11.4 1.4 10.4%

Moderna 6,003,385 5,096 564 77 84.9 9.4 1.3 11.1%

JJ 1,036,174 1,913 221 28 184.6 21.3 2.7 11.6%

Total 16,752,584 17,666 1,891 242 105.5 11.3 1.4 10.7%

Vaccine

Total Fully 

Vaccinated Infections Hospitalizations Deaths Infections/100k Hospitalizations/100k Deaths/100k % Hospitalized*

Pfizer 10,009,351 35,941 3,237 444 359.1 32.3 4.4 9.0%

Moderna 6,102,663 16,554 1,678 233 271.3 27.5 3.8 10.1%

JJ 1,078,579 6,212 754 94 575.9 69.9 8.7 12.1%

Total 17,190,593 58,707 5,669 771 341.5 33.0 4.5 9.7%

* “% Hospitalized” is the percent of breakthrough cases that were admitted (hospitalized).

**Overall breakthrough cases and admissions are from January 16, 2021 – September 22, 2021.

The infection, hospitalization, and in-hospital death rates are per 100,000 fully vaccinated patients. © 2020-2021 EHRN. All rights reserved.

Cosmos Data Set
July 2021 Cases

0

100

200

300

400

500

JAN FEB MAR APR MAY JUN

SARS-CoV2-2 case rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

Pfizer - SARS-CoV-2 Month = JUL (Cosmos Source) 

18-49 50-64 65+

0

100

200

300

400

500

JAN FEB MAR APR MAY JUN

SARS-CoV2-2 case rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

Moderna - SARS-CoV-2 Month = JUL (Cosmos Source) 

18-49 50-64 65+

0

100

200

300

400

500

JAN FEB MAR APR MAY JUN

SARS-CoV2-2 case rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

J and J - SARS-CoV-2 Month = JUL (Cosmos Source) 

18-49 50-64 65+

© 2020-2021 EHRN. All rights reserved.

Pfizer Infection Rate (July): 109.7 / 100k vaccinated

N = 10,657 / 9,713,025

Moderna Infection Rate (July): 84.9 / 100k vaccinated 

N = 5,096 / 6,003,385

J and J Infection Rate (July): 184.6 / 100k vaccinated

N = 1,913 / 1,036,174

COVID-19 case rates by vaccination cohort, vaccine product, and age, July 2021. A patient is considered fully vaccinated > 14 days after completing the primary series of an 

FDA-authorized or approved COVID-19 vaccine. A breakthrough case defined as a patient with PCR SARS-CoV-2 positive test result or a COVID-19 medical diagnosis.

Data is from Cosmos, a HIPAA-defined Limited Data Set. As of September 23, 2021, there were 17,677,683 fully vaccinated patients in the Cosmos data set. Cosmos data are 

from 700+ hospitals, 10,000 clinics, and all 50 states. 

Cosmos Data Set
0

50

100

150

200

JAN FEB MAR APR MAY JUN

SARS-CoV2-2 admission rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

Pfizer - SARS-CoV-2 Month = JUL (Cosmos Source) 

18-49 50-64 65+

0

50

100

150

200

JAN FEB MAR APR MAY JUN

SARS-CoV2-2 admission rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

Moderna - SARS-CoV-2 Month = JUL (Cosmos Source) 

18-49 50-64 65+

0

50

100

150

200

JAN FEB MAR APR MAY JUN

SARS-CoV2-2 admission rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

J and J - SARS-CoV-2 Month = JUL (Cosmos Source) 

18-49 50-64 65+

© 2020-2021 EHRN. All rights reserved.

COVID-19 hospitalization rates by vaccination cohort, vaccine product, and age, July 2021. A patient is considered fully vaccinated > 14 days after completing the primary series 

of an FDA-authorized or approved COVID-19 vaccine. A breakthrough case defined as a patient with PCR SARS-CoV-2 positive test result or a COVID-19 medical diagnosis.

Data is from Cosmos, a HIPAA-defined Limited Data Set. As of September 23, 2021, there were 17,677,683 fully vaccinated patients in the Cosmos data set. Cosmos data are 

from 700+ hospitals, 10,000 clinics, and all 50 states. 

July 2021 Hospitalizations

Pfizer Hospitalization Rate (July): 11.4 / 100k vaccinated

N = 1,106 / 9,713,025

Moderna Hospitalization Rate (July): 9.4 / 100k vaccinated 

N = 564 / 6,003,385

J and J Hospitalization Rate (July): 21.3 / 100k vaccinated

N = 221 / 1,036,174

Cosmos Data Set
0

250

500

750

1000

1250

1500

1750

JAN FEB MAR APR MAY JUN JUL

SARS-CoV2-2 case rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

Pfizer - SARS-CoV-2 Month = AUG (Cosmos Source) 

18-49 50-64 65+

0

250

500

750

1000

1250

1500

1750

JAN FEB MAR APR MAY JUN JUL

SARS-CoV2-2 case rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

Moderna - SARS-CoV-2 Month = AUG (Cosmos Source) 

18-49 50-64 65+

0

250

500

750

1000

1250

1500

1750

JAN FEB MAR APR MAY JUN JUL

SARS-CoV2-2 case rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

J and J - SARS-CoV-2 Month = AUG (Cosmos Source) 

18-49 50-64 65+

© 2020-2021 EHRN. All rights reserved.

COVID-19 case rates by vaccination cohort, vaccine product, and age, August 2021. A patient is considered fully vaccinated > 14 days after completing the primary series of an 

FDA-authorized or approved COVID-19 vaccine. A breakthrough case defined as a patient with PCR SARS-CoV-2 positive test result or a COVID-19 medical diagnosis.

Data is from Cosmos, a HIPAA-defined Limited Data Set. As of September 23, 2021, there were 17,677,683 fully vaccinated patients in the Cosmos data set. Cosmos data are 

from 700+ hospitals, 10,000 clinics, and all 50 states. 

Pfizer Infection Rate (Aug): 359.1 / 100k vaccinated

N= 35,941 / 10,009,351

Moderna Infection Rate (Aug): 271.3 / 100k vaccinated

N = 16,554 / 6,102,663

J and J Infection Rate (Aug): 575.9 / 100k vaccinated

N= 6,212 / 1,078,579

August 2021 Cases

Cosmos Data Set
0

100

200

300

400

500

600

JAN FEB MAR APR MAY JUN JUL

SARS-CoV2-2 admission rate per 100,000 vaccinated 

persons

Cohort Fully Vaccinated by Month

Pfizer - SARS-CoV-2 Month = AUG (Cosmos Source) 

18-49 50-64 65+

0

100

200

300

400

500

600

JAN FEB MAR APR MAY JUN JUL

SARS-CoV2-2 admission rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

Moderna - SARS-CoV-2 Month = AUG (Cosmos Source) 

18-49 50-64 65+

0

100

200

300

400

500

600

JAN FEB MAR APR MAY JUN JUL

SARS-CoV2-2 admission rate per 100,000 vaccinated persons

Cohort Fully Vaccinated by Month

J and J - SARS-CoV-2 Month = AUG (Cosmos Source) 

18-49 50-64 65+

© 2020-2021 EHRN. All rights reserved.

COVID-19 hospitalization rates by vaccination cohort, vaccine product, and age, August 2021. A patient is considered fully vaccinated > 14 days after completing the primary 

series of an FDA-authorized or approved COVID-19 vaccine. A breakthrough case defined as a patient with PCR SARS-CoV-2 positive test result or a COVID-19 medical diagnosis.

Data is from Cosmos, a HIPAA-defined Limited Data Set. As of September 23, 2021, there were 17,677,683 fully vaccinated patients in the Cosmos data set. Cosmos data are 

from 700+ hospitals, 10,000 clinics, and all 50 states. 

Pfizer Hospitalization Rate (Aug): 32.3/ 100k vaccinated

N = 3,237 / 10,009,351

Moderna Hospitalization Rate (Aug): 27.5 / 100k vaccinated 

N = 1,678 / 6,102,663

J and J Hospitalization Rate (Aug): 69.9 / 100k vaccinated

N = 754 / 1,078,579

August 2021 Hospitalizations

Cosmos Data Set
 Nationwide community-based COVID-19 testing via pharmacies and partners

 Self-reported vaccine history at time of registration for COVID-19 testing; excluded 

those who did not report vaccination status (18%)

 Design: Test-negative, case-control assessment 

 Period: Pre-Delta: March 13–May 29 (N=255,519); Delta: July 18–August 31 (N=519,699)

 Population: Persons aged 20–64 years of age with COVID-like illness (CLI) and 

laboratory-based nucleic acid amplification testing (NAAT)

 Adjusted for: – Calendar day, race, ethnicity, gender, site’s HHS region and state, site census tract’s social vulnerability index (SVI)

– Not adjusted for underlying conditions or prior infection

Increasing Community Access to Testing (ICATT) Partnership: 

VE analysis for symptomatic infection, March 13–August 31, 2021
ICATT: Pfizer VE against 

symptomatic infection by age 

group and time since vaccination 

in pre-Delta and Delta periods 

Pre-Delta (March 13–May 29) with 95% CIs in 

dotted lines

Delta (July 18–August 31) with 95% CIs in 

dotted lines

• VE is lower during Delta • VE wanes during both periods • Curves similar for 20-44, 45-54, and 55

-

64 age groups

• For ≥65, VE lower than for other age 

groups soon after vaccination, no clear 

trend over time since vaccination 

The presented (fitted) curves are 

truncated on the day with ≤10 

cases observed beyond it to avoid 

presenting wide confidence 

bounds.
 Self-reported vaccination data, no clinical assessment – By limiting to persons with known vaccination status, a substantial proportion of records were lost

 No information on co-morbidities, prior infection, risk behaviors

 Analysis based on tests, no unique identifiers to track individuals in data

 No genetic sequencing results

– Pre-Delta: March 13–May 29 2021

– Delta: July 18–August 31 2021

ICATT limitations for VE against symptomatic infection
https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e3.htm

Vaccine effectiveness of mRNA vaccines against COVID-19-

associated Hospitalization: SUPERNOVA Network

 Design: Test-negative, case-control assessment 

 Period: February 1–September 17, 2021

 Population: U.S. Veterans (aged ≥18 years) hospitalized at 

5 Veterans Affairs Medical Centers

 Participants

– Cases: COVID-like illness (CLI) and SARS-CoV-2-positive 

test results by RT-PCR

– Controls: CLI and SARS-CoV-2-negative test results by 

RT-PCR

 Demographics:

– Median age: 68 years – 48% Black, non-Hispanic – 44% with Charlson Comorbidity Index score ≥3

• 69% hypertension; 47% obesity; 43% diabetes

SUrveillance Platform for Enteric and 

Respiratory iNfectious Organisms at the VA
VE* against COVID-19-associated Hospitalization, by mRNA vaccine —

SUPERNOVA Network, February 1–September 17, 2021 

89%

71%

95%

78%

92%

74%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18-64 years ≥65 18-64 years ≥65 18-64 years ≥65

Vaccine Effectiveness (%)

Moderna**

n=219 (32%)

Pfizer-BioNTech**

n=469 (68%)

Combined mRNA**

N=688 

*Adjusted for site, time (admission date), age, sex, race/ethnicity. Stratified models exclude adjustment for stratification variable

**Among fully vaccinated participants
VE* of Moderna vaccine against COVID-19-associated Hospitalization, by 

Delta variant predominance and time since vaccination — SUPERNOVA 

Network, February 1–September 17, 2021 

49

84% 85%

90%

82%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

February 1-June 30 July 1-September 17 14-119 days ≥120 days 

Vaccine Effectiveness (%)

Pre-Delta vs. Delta Time since full vaccination

*Adjusted for site, time (admission date), age, sex, race/ethnicity. Stratified models exclude adjustment for stratification variable.
VE* of Moderna vaccine against COVID-19-associated Hospitalization —

SUPERNOVA Network, February 1–September 17, 2021 

*Adjusted for site, time (admission date), age, sex, race/ethnicity. Stratified models exclude adjustment for stratification variable. 50

95%

78%

90%

82%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18-64 years ≥65 years 14-119 days since full vaccination ≥120 days 

Vaccine Effectiveness (%)

Age Group Time since full vaccination
Effectiveness of mRNA Vaccines for Preventing COVID-19 

Hospitalizations, IVY Network

Tenforde et al. MMWR https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e2.htm

 Population: Adults (≥18 years) hospitalized at 21

medical centers in 18 states

 Case status:

– Cases with COVID-19-like illness and

SARS-CoV-2 antigen / RT-PCR positive

– Controls: SARS-CoV-2 RT-PCR negative

 SARS-CoV-2 testing within 10 days of illness onset and admission within 14 days of illness onset

 Analytic period: Admitted March 11–September 15, 2021

 Chronic condition: ≥1 cardiovascular, endocrine, gastrointestinal, hematological, neurological, 

pulmonary, or renal condition (excluded patients with immunocompromising conditions) 
VISION Waning VE Study

52

• VISION VE uses linked EMR, laboratory, and vaccination data from 187 hospitals and 265 

EDs/urgent care clinics to estimate VE against COVID-19 hospitalizations and emergency 

department (ED)/urgent care (UC) visits

• Research question: Does vaccine effectiveness against laboratory-confirmed COVID-19-

associated medical encounters vary with time since vaccination among adults ≥18 years 

old?

• This analysis includes medical encounters experienced from June to September 2021.

• This analysis is restricted to immunocompetent adults, and VE for prevention of ED/UC visits 

is stratified by presence or absence of an underlying medical condition. 

• Results are presented by age group (18 to 44 years, 45 to 64 years, 65+ years) and vaccine 

product.
VISION VE methods

53

• Data: Hospitalizations and ED/UC visits among adults ≥18 yr with SARS-CoV-2 molecular 

testing and a COVID-19-like illness diagnosis

• Design: Test-negative design

• Statistical model: Logistic regression conditioned on calendar week and site-region, 

adjusted for covariates (age, sex, race ethnicity, underlying medical conditions, local 

percent SARS-CoV-2 positivity by date, propensity to be vaccinated score)

• Outcome: Laboratory-confirmed COVID-19-related hospitalization; ED/UC visit 

(separate analyses)

• Excludes: Vaccinees with more than 2 doses, individuals with prior positive SARS-CoV-2 

test (historical infection)
VISION VE methods, continued

54

• Comorbidities included asthma, COPD, other lung disease, heart failure, ischemic heart 

disease, hypertension, other heart disease, stroke, other cerebrovascular disease, 

diabetes, other metabolic diseases, obesity, underweight, renal, liver, blood disorders, 

musculoskeletal/neurologic disorders, Down syndrome, dementia, and cancers without 

immunocompromise

• Immunocompromising conditions included HIV/AIDS other than asymptomatic 

HIV/AIDS, hematologic and solid malignancies, organ transplant, rheumatologic 

disorders, and chronic systemic steroid use
VE against COVID-19 ED/UC visits 

among immunocompetent persons 

without comorbidity

• Ages 18-44: Pfizer, Moderna, Janssen

• Ages 45-64: Pfizer, Moderna, Janssen

• Ages 65+: Pfizer, Moderna, Janssen

55
56

Pfizer-BioNTech VE against ED/UC visits for COVID-19 among 

immunocompetent adults 18-44 years without comorbidity

• VE against ED/UC visits was high among recent vaccinees.

• Pfizer VE waned, declining to 79% among those vaccinated ≥6 months.

Vaccination Status BNT162b2 (Pfizer-BioNTech)

Pos./Total

(%)

VE

% (95% CI)

p*

Unvaccinated 5459/17,763 (30.7)

Full <2 mo 22/923 (2.4) 93 (89 – 95)

Full 2 to <4 mo 108/2182 (4.9) 88 (86 – 90)

Full 4 to <6 mo 96/1249 (7.7) 82 (77 – 85)

Full ≥6 mo 50/497 (10.1) 79 (71 – 84) <0.001

*Comparing most remote vaccination category to full vaccination <2 mo
57

Moderna VE against ED/UC visits for COVID-19 among 

immunocompetent adults 18-44 years without comorbidity

• Moderna VE against ED/UC visits was high among recent vaccinees.

• Moderna VE waned, declining to 81% among those vaccinated ≥6 months.

Vaccination Status mRNA-1273 (Moderna)

Pos./Total

(%)

VE

% (95% CI)

P*

Unvaccinated 5459/17,763 (30.7)

Full <2 mo 10/431 (2.3) 93 (87 – 96)

Full 2 to <4 mo 43/1228 (3.5) 93 (90 – 95)

Full 4 to <6 mo 45/918 (4.9) 89 (85 – 92)

Full ≥6 mo 37/397 (9.3) 81 (74 – 87) 0.006

*Comparing most remote vaccination category to full vaccination <2 mo
58

Janssen VE against ED/UC visits for COVID-19 among 

immunocompetent adults 18-44 years without comorbidity

Vaccination Status Janssen

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 5310/16,949 (31.3)

Full <2 mo 16/150 (10.7) 74 (55 – 85)

Full 2 to <4 mo 38/398 (9.5) 76 (67 – 83)

Full ≥4 mo 55/363 (15.2) 68 (57 – 76) 0.55

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against ED/UC visits among recent vaccinees was lower for Janssen vaccinees compared to mRNA 

vaccinees.

• VE declined from 74% to 68% but this decline was not statistically significant.

• Sample size was insufficient to estimate VE for persons vaccinated ≥6 months.
59

Pfizer-BioNTech VE against ED/UC visits for COVID-19 among 

immunocompetent adults 45-64 years without comorbidity

• VE against ED/UC visits was high among recent vaccinees.

• Pfizer VE waned, declining to 78% among those vaccinated ≥6 months.

Vaccination Status BNT162b2 (Pfizer-BioNTech)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 2310/5409 (42.7)

Full <2 mo 15/341 (4.4) 91 (84 - 95)

Full 2 to <4 mo 131/1136 (11.5) 80 (76 - 84)

Full 4 to <6 mo 148/993 (14.9) 79 (74 – 83)

Full ≥6 mo 36/233 (15.5) 78 (68 - 85) 0.008

*Comparing most remote vaccination category to full vaccination <2 mo
60

Moderna VE against ED/UC visits for COVID-19 among 

immunocompetent adults 45-64 years without comorbidity

• Moderna VE against ED/UC visits was very high among recent vaccinees.

• Moderna VE waned, declining to 85% among those vaccinated ≥6 months.

Vaccination Status mRNA-1273 (Moderna)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 2310/5409 (42.7)

Full <2 mo 4/198 (2.0) 96 (88 - 98)

Full 2 to <4 mo 36/744 (4.8) 94 (91 - 95 )

Full 4 to <4 mo 55/676 (8.1) 90 (87 – 93)

Full ≥6 mo 26/231 (11.3) 85 (78 - 90) 0.03

*Comparing most remote vaccination category to full vaccination <2 mo
61

Janssen VE against ED/UC visits for COVID-19 among 

immunocompetent adults 45-64 years without comorbidity

• VE against ED/UC visits among recent vaccinees was lower for Janssen vaccinees compared to mRNA 

vaccinees.

• VE declined from 66% to 61% but this decline was not statistically significant.

• Sample size was insufficient to estimate VE for persons vaccinated ≥6 months.

Vaccination Status Janssen

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 2267/3052 (43.1)

Full <2 mo 12/63 (19.0) 66 (34 – 83)

Full 2 to <4 mo 43/222 (19.4) 62 (46 – 74)

Full ≥4 mo 80/301 (26.6) 61 (48 – 70) 0.69

*Comparing most remote vaccination category to full vaccination <2 mo
62

Pfizer-BioNTech VE against ED/UC visits for COVID-19 among 

immunocompetent adults 65+ years without comorbidity

• VE against ED/UC visits was moderate (84%) among recent vaccinees.

• VE declined from 84% to 62% but this decline was not statistically significant.

Vaccination Status BNT162b2 (Pfizer-BioNTech)

Pos./Total

(%)

VE

% (95% CI)

p*

Unvaccinated 769/2422 (42.2)

Full <2 mo 6/63 (9.5) 84 (60 – 94)

Full 2 to <4 mo 43/544 (7.9) 80 (72 – 86)

Full 4 to <6 mo 237/1237 (19.2) 69 (62 – 75)

Full ≥6 mo 90/304 (29.6) 62 (49 – 72) 0.08

*Comparing most remote vaccination category to full vaccination <2 mo
63

Moderna VE against ED/UC visits for COVID-19 among 

immunocompetent adults 65+ years without comorbidity

• Moderna VE against ED/UC visits was high among recent vaccinees.

• VE declined from 90% to 82% but this decline was not statistically significant.

Vaccination Status mRNA-1273 (Moderna)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 769/1822 (42.2)

Full <2 mo 3/48 (6.3) 90 (66 – 97)

Full 2 to <4 mo 23/399 (5.8) 87 (79 – 92)

Full 4 to <4 mo 113/787 (14.4) 83 (78 – 87)

Full ≥6 mo 33/182 (18.1) 82 (73 – 89) 0.37

*Comparing most remote vaccination category to full vaccination <2 mo
64

Janssen VE against ED/UC visits for COVID-19 among 

immunocompetent adults 65+ years without comorbidity

• VE against ED/UC visits among recent vaccinees was lower for Janssen vaccinees compared to mRNA 

vaccinees.

• Protection remained consistent, with no evidence of waning.

• Sample size was insufficient to estimate VE for persons vaccinated ≥6 months.

Vaccination Status Janssen

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 761/1783 (42.7)

Full <2 mo 2/14 (14.3) 76 (-16 – 95)

Full 2 to <4 mo 5/57 (8.8) 83 (49 – 94)

Full ≥4 mo 22/114 (19.3) 76 (57 – 86) 0.98

*Comparing most remote vaccination category to full vaccination <2 mo
Summary among persons without comorbidity

65

• mRNA vaccines have high initial VE.

• Pfizer VE exhibits mild to moderate waning.

• Moderna VE exhibits mild to moderate waning. 

• Janssen vaccine has moderate initial VE and no statistically significant evidence of waning.
VE against COVID-19 ED/UC visits 

among immunocompetent persons 

with comorbidity

• Ages 18-44: Pfizer, Moderna, Janssen

• Ages 45-64: Pfizer, Moderna, Janssen

• Ages 65+: Pfizer, Moderna, Janssen

66
67

Pfizer-BioNTech VE against ED/UC visits for COVID-19 among 

immunocompetent adults 18-44 years with comorbidity

• VE against ED/UC visits was very high among recent vaccinees.

• VE estimates declined with increasing time since vaccination but this decline was not statistically 

significant.

Vaccination Status BNT162b2 (Pfizer-BioNTech)

Pos./Total

(%)

VE

% (95% CI)

p*

Unvaccinated 1013/3959 (25.6)

Full <2 mo 3/201 (1.5) 95 (84 - 99)

Full 2 to <4 mo 12/379 (3.2) 92 (85 - 95)

Full 4 to <6 mo 14/206 (6.8) 88 (77 – 93)

Full ≥6 mo 3/73 (4.1) 92 (73 - 97) 0.52

*Comparing most remote vaccination category to full vaccination <2 mo
68

Moderna VE against ED/UC visits for COVID-19 among 

immunocompetent adults 18-44 years with comorbidity

• VE against ED/UC visits was very high among recent vaccinees.

• VE estimates declined with increasing time since vaccination but this decline was not statistically 

significant. Protection remained high among those vaccinated ≥6 months.

Vaccination Status mRNA-1273 (Moderna)

Pos./Total

(%)

VE

% (95% CI)

P*

Unvaccinated 1013/3959 (25.6)

Full <2 mo 1/120 (0.8) 98 (84 - 100)

Full 2 to <4 mo 5/232 (2.2) 96 (90 - 98)

Full 4 to <6 mo 8/184 (4.3) 92 (83 – 96)

Full ≥6 mo 2/47 (4.3) 94 (75 - 99) 0.45

*Comparing most remote vaccination category to full vaccination <2 mo
69

Janssen VE against ED/UC visits for COVID-19 among 

immunocompetent adults 18-44 years with comorbidity

Vaccination Status Janssen

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 994/3828 (26.0)

Full <2 mo 5/51 (9.8) 69 (18 – 89)

Full 2 to <4 mo 5/101 (5.0) 84 (59 – 94)

Full ≥4 mo 9/71 (12.7) 73 (40 – 87) 0.86

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against ED/UC visits among recent vaccinees was lower for Janssen vaccinees compared to mRNA 

vaccinees.

• Protection remained consistent, with no evidence of waning.

• Sample size was insufficient to estimate VE for persons vaccinated ≥6 months.
70

Pfizer-BioNTech VE against ED/UC visits for COVID-19 among 

immunocompetent adults 45-64 years with comorbidity

Vaccination Status BNT162b2 (Pfizer-BioNTech)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1035/3120 (33.2)

Full <2 mo 3/239 (1.3) 97 (89 - 99)

Full 2 to <4 mo 26/552 (4.7) 89 (83 - 93)

Full 4 to <6 mo 41/381 (10.8) 82 (74 – 87)

Full ≥6 mo 9/81 (11.1) 84 (67 - 92) 0.03

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against ED/UC visits was very high among recent vaccinees.

• Pfizer VE waned, with VE of 84% at 6 months or more after vaccination. 
71

Moderna VE against ED/UC visits for COVID-19 among 

immunocompetent adults 45-64 years with comorbidity

Vaccination Status mRNA-1273 (Moderna)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1035/3120 (33.2)

Full <2 mo 1/161 (0.6) 99 (91 - 100)

Full 2 to <4 mo 13/417 (3.1) 95 (90 - 97 )

Full 4 to <4 mo 12/276 (4.3) 94 (89 – 97)

Full ≥6 mo 4/52 (7.7) 90 (72 - 97) 0.08

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against ED/UC visits was very high among recent vaccinees.

• VE declined from 99% to 90% but this decline was not statistically significant.
72

Janssen VE against ED/UC visits for COVID-19 among 

immunocompetent adults 45-64 years with comorbidity

Vaccination Status Janssen

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1026/3052 (33.6)

Full <2 mo 8/53 (15.1) 64 (20 – 84)

Full 2 to <4 mo 13/148 (8.8) 82 (66 – 90)

Full ≥4 mo 15/123 (12.2) 81 (66 – 89) 0.21

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against ED/UC visits among recent vaccinees was lower for Janssen vaccinees as compared to 

mRNA vaccines.

• Protection remained consistent, with no evidence of waning. 

• Sample size was insufficient to estimate VE for persons vaccinated ≥6 months.
73

Pfizer-BioNTech VE against ED/UC visits for COVID-19 among 

immunocompetent adults 65+ years with comorbidity

• VE against ED/UC visits was moderately high (88%) among recent vaccinees.

• VE declined from 88% to 64% but this decline was not statistically significant at the p<0.05 level.

Vaccination Status BNT162b2 (Pfizer-BioNTech)

Pos./Total

(%)

VE

% (95% CI)

p*

Unvaccinated 680/2422 (28.1)

Full <2 mo 4/149 (2.7) 88 (65 – 96)

Full 2 to <4 mo 33/938 (3.5) 82 (74 – 88)

Full 4 to <6 mo 121/1220 (9.9) 74 (67 – 80)

Full ≥6 mo 55/310 (17.7) 64 (48 – 75) 0.05

*Comparing most remote vaccination category to full vaccination <2 mo
74

Moderna VE against ED/UC visits for COVID-19 among 

immunocompetent adults 65+ years with comorbidity

Vaccination Status mRNA-1273 (Moderna)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 680/2422 (28.1)

Full <2 mo 1/108 (0.9) 98 (82 – 100)

Full 2 to <4 mo 16/671 (2.4) 93 (89 – 96)

Full 4 to <4 mo 72/908 (7.9) 87 (82 – 90)

Full ≥6 mo 22/165 (13.3) 80 (66 – 88) 0.05

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against ED/UC visits was very high among recent vaccinees.

• VE declined from 98% to 80% but this decline was not statistically significant at the p<0.05 level.
75

Janssen VE against ED/UC visits for COVID-19 among 

immunocompetent adults 65+ years with comorbidity

Vaccination Status Janssen

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 673/2392 (28.1)

Full <2 mo 4/46 (8.7) 60 (-27 – 87)

Full 2 to <4 mo 13/148 (8.8) 63 (30 – 80)

Full ≥4 mo 28/125 (22.4) 42 (6 – 65) 0.57

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against ED/UC visits among recent vaccinees was lower for Janssen vaccinees as compared to 

mRNA vaccines. 

• VE declined from 60% to 42% but this decline was not statistically significant.

• Sample size was insufficient to estimate VE for persons vaccinated ≥6 months.
VE against COVID-19 hospitalizations 

among immunocompetent persons with 

comorbidity

• Ages 18-44: Pfizer, Moderna, Janssen

• Ages 45-64: Pfizer, Moderna, Janssen

• Ages 65+: Pfizer, Moderna, Janssen

76
77

Pfizer-BioNTech VE against COVID-19 hospitalizations among 

immunocompetent adults 18-44 years with comorbidity

Vaccination Status BNT162b2 (Pfizer-BioNTech)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1440/4983 (28.9)

Full <2 mo 1/274 (0.4) 99 (94 - 100)

Full 2 to <4 mo 12/517 (2.3) 97 (94 - 98)

Full 4 to <6 mo 6/259 (2.3) 98 (94 – 99)

Full ≥6 mo 6/62 (9.7) 88 (70 - 95) 0.02

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against hospitalization was very high among recent vaccinees.

• Pfizer VE had mild waning, to VE of 88% at 6 months post vaccination.
78

Moderna VE against COVID-19 hospitalizations among 

immunocompetent adults 18-44 years with comorbidity

Vaccination Status mRNA-1273 (Moderna)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1440/4983 (28.9)

Full <2 mo 1/132 (0.8) 99 (90 - 100)

Full 2 to <4 mo 5/302 (1.7) 98 (96 - 99)

Full 4 to <6 mo 7/160 (4.4) 96 (92 – 98)

Full ≥6 mo 3/33 (9.1) 92 (71 - 98) 0.14

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against hospitalization was very high among recent vaccinees.

• VE declined from 99% to 92% but this decline was not statistically significant.
79

Janssen VE against COVID-19 hospitalizations among 

immunocompetent adults 18-44 years with comorbidity

Vaccination Ad26.COV2.S (Janssen)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1323/3869 (34.2)

Full <2 mo 2/36 (5.6) 93 (69- 99)

Full 2 to <4 mo 5/75 (6.7) 93 (82 – 98)

Full ≥4 mo 7/42 (16.7) 89 (72 – 96) 0.58

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against hospitalizations among recent vaccinees was high for Janssen vaccinees aged 18-44 yr.

• Protection remained consistent, with no evidence of waning.

• Sample size was insufficient to estimate VE for persons vaccinated ≥6 months.
80

Pfizer-BioNTech VE against COVID-19 hospitalizations among 

immunocompetent adults 45-64 years with comorbidity

Vaccination Status BNT162b2 (Pfizer-BioNTech)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1885/4760 (39.6)

Full <2 mo 3/346 (0.9) 98 (94 - 99)

Full 2 to <4 mo 44/844 (5.2) 94 (92 - 96)

Full 4 to <6 mo 42/447 (9.4) 94 (90 – 96)

Full ≥6 mo 8/76 (10.5) 96 (89 - 98) 0.25

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against hospitalizations was very high among recent vaccinees.

• Protection remained consistent, with no evidence of waning.
81

Moderna VE against COVID-19 hospitalizations among 

immunocompetent adults 45-64 years with comorbidity

Vaccination mRNA-1273 (Moderna)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1885/4760 (39.6)

Full <2 mo 2/265 (0.8) 99 (96 - 100)

Full 2 to <4 mo 15/675 (2.2) 98 (96 - 99)

Full 4 to <6 mo 18/321 (5.6) 97 (94 – 98)

Full ≥6 mo 7/48 (14.6) 92 (81 - 97) 0.02

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against hospitalizations was very high among recent vaccinees.

• Moderna VE waned modestly, but protection remained high at 6 months post vaccination.
82

Janssen VE against COVID-19 hospitalizations among 

immunocompetent adults 45-64 years with comorbidity

Vaccination Janssen

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1756/3809 (46.1)

Full <2 mo 12/62 (19.4) 62 (20 – 82)

Full 2 to <4 mo 16/193 (8.3) 89 (80 – 94)

Full ≥4 mo 36/135 (26.7) 84 (73 – 90) 0.06

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against hospitalizations among recent vaccinees was lower among Janssen vaccinees.

• Protection remained consistent, with no evidence of waning.

• Sample size was insufficient to estimate VE for persons vaccinated ≥6 months.

• Janssen VE estimates are based on preliminary analyses of relatively small samples. 
83

Pfizer-BioNTech VE against COVID-19 hospitalizations among 

immunocompetent adults 65+ years with comorbidity

• VE against hospitalizations was very high among recent vaccinees.

• Pfizer VE waned, declining to 74% among adults aged 65+ vaccinated 6 months or more.

Vaccination Status BNT162b2 (Pfizer-BioNTech)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1299/5137 (25.3)

Full <2 mo 3/262 (1.1) 95 (85 - 99)

Full 2 to <4 mo 66/2128 (3.1) 85 (80 - 88)

Full 4 to <6 mo 252/2870 (8.8) 81(77 – 84)

Full ≥6 mo 76/488 (15.6) 74 (65 - 81) 0.004

*Comparing most remote vaccination category to full vaccination <2 mo
84

Moderna VE against COVID-19 hospitalizations among 

immunocompetent adults 65+ years with comorbidity

• VE against hospitalizations was very high among recent vaccinees.

• Moderna VE waned, declining to 81% among adults aged 65+ vaccinated 6 months or more

Vaccination mRNA-1273 (Moderna)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1299/5137 (25.3)

Full <2 mo 2/195 (1.0) 96 (83 - 99)

Full 2 to <4 mo 36/1621 (2.2) 93 (90 - 95)

Full 4 to <6 mo 96/1939 (5.0) 92 (90 – 94)

Full ≥6 mo 30/247 (14.6) 81 (71 - 88) 0.04

*Comparing most remote vaccination category to full vaccination <2 mo
85

Janssen VE against COVID-19 hospitalizations among 

immunocompetent adults 65+ years with comorbidity

Vaccination Ad26.COV2.S (Janssen)

Pos./Total (%) VE % (95% CI) p*

Unvaccinated 1183/3889 (30.4)

Full <2 mo 7/80 (8.8) 90 (71 - 97)

Full 2 to <4 mo 18/237 (7.6) 80 (65 - 88)

Full ≥4 mo 21/123 (17.1) 81 (67 – 89) 0.27

*Comparing most remote vaccination category to full vaccination <2 mo

• VE against hospitalizations was high among recent vaccinees.

• VE declined from 90% to 81% but this decline was not statistically significant.

• Sample size was insufficient to estimate VE for persons vaccinated ≥6 months.
Summary among persons with comorbidity

86

• mRNA vaccines have high initial VE against both outcomes.

• Pfizer VE exhibits mild to moderate waning, with waning more pronounced for VE against ED/UC visits. Pfizer VE against 

hospitalization remains >85% at 6 months after second dose for 18-64 yo but declines to 74% among 65+ yo.

• Moderna VE wanes mildly for both outcomes and remains highly protective (≥90%) at 6 months after second dose for 18-

64 yo, but declines to 81% among 65+ yo.

• Janssen vaccine has moderate initial VE against ED/UC visits and high to moderate VE against hospitalizations (depending 

on age group), with no significant evidence of waning. Sample sizes were smaller and duration of follow-up shorter for 

Janssen.
Acknowledgements

87

VISION Waning VE Work Group: Jill Ferdinands PhD, Bruce Fireman MS, Ned 

Lewis MPH, Brian E. Dixon MPA PhD, Shaun J. Grannis MD MSc, Suchitra Rao 

MBBS MSCS, Peter J. Embi MD MS, Stephanie A Irving, MHS , Malini de Silva 

MD MPH, Rebecca Birch MPH, Patrick Mitchell ScD, Daniel Yoo MSPH, DuckHye Yang PhD, Sue Reynolds PhD MS MPH, Mark Thompson PhD
Acknowledgements

88

Catherine H. Bozio, Palak Patel, Eric P. Griggs, Jeremiah Williams, Lenee Blanton, Monica 

Dickerson, Andrea Steffens, Natalie Olson, Stephanie J. Schrag, Jennifer R. Verani, Alicia M. Fry, 

Eduardo Azziz-Baumgartner, CDC COVID-19 Response Team; Kristin Dascomb, Nancy Grisel, 

Julie Arndorfer, Division of Infectious Diseases and Clinical Epidemiology, Intermountain 

Healthcare; William F. Fadel, Nimish Ramesh Valvi, Center for Biomedical Informatics, 

Regenstrief Institute; Sarah W. Ball, Patrick K. Mitchell, Sarah Reese, Matthew E. Levy, Maria 

Demarco, Yan Zhuang, Patricia Shifflett, Westat; Allison Naleway, Center for Health Research, 

Kaiser Permanente Northwest, Michelle A. Barron, Department of Medicine, University of 

Colorado; Elyse O. Kharbanda, HealthPartners Institute; Jungmi Han, Department of 

Biomedical Informatics, Columbia University; Nicola Klein, Kristin Goddard, Ousseny Zerbo, 

Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California; Anupam 

Kharbanda, Children’s Minnesota; Manjusha Gaglani, Baylor Scott & White Health, Texas 

A&M University College of Medicine
Ongoing systematic review of vaccine effectiveness, WHO 

and International Vaccine Access Center

89

 Available at https://view-hub.org/resources

 Methods for VE and impact studies

 Published or preprint studies (not press release, presentations, media)

 Needs confidence intervals around VE

 Needs to include persons with & without infection or disease and with and without vaccination 

(i.e., a proper comparison group)

 No case only studies (e.g., impact studies, risk of progression to severe disease [i.e., PHE]). 

 No modeled comparison group

 No comparison to historical cohort

 VE should be adjusted or state adjustment made no difference 

 Outcomes must be lab confirmed, not syndromic

 Documented vaccination status needed

 VE for one vaccine or combined vaccines of same platform e.g., Pfizer + Moderna

 No significant bias that likely affects results 

 Cannot include day 0-12 in unvaccinated definition

 Cannot compare to early post vaccination to calculate VE (e.g., day 0-12 vs day 12-21)
 Public health data in Navarre, Spain

 Included 30,240 close contacts of 12,263 

laboratory-confirmed cases during April 

to August 2021

– 7,177 infections

 Compared incidence in vaccinated and 

unvaccinated

 VE against infection decreased if last dose 

≥90 days from time of close contact

 VE against Delta lower than against Alpha 

but overlapping 95% CI

Study: VE against transmission from close contacts 

(infection)

Martinez-Baz et al. Eurosurveillance. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.39.2100894 90

Adjust VE (95% CI)

Vaccine

<90 days since 

last dose 

≥90 days since 

last dose

Unvaccinated REF REF

Janssen 52 (44-59) 28 (-8-53)

Moderna 85 (80-88) 67 (50-78)

Variant

Alpha Delta

Unvaccinated REF REF

Janssen 77 (27-93) 42 (18-59)

Moderna 86 (56-95) 77 (64-85)