Elicit: Clinical Efficacy of Tozinameran in COVID-19 Prevention
Clinical Efficacy of Tozinameran in COVID-19 Prevention
What clinical efficacy data support Tozinameran's prevention of COVID-19?
Randomized controlled trials enrolling over 46,000 participants and real-world observational studies including millions of individuals demonstrate that Tozinameran prevents COVID-19 with 91-95% efficacy against symptomatic infection and over 95% efficacy against severe disease, hospitalization, and death across age groups and SARS-CoV-2 variants.
Abstract
Tozinameran demonstrated 95% efficacy (95% CI: 90.3-97.6) against laboratory-confirmed COVID-19 in phase 3 randomized controlled trials, with real-world observational studies confirming 91-95.3% effectiveness. Protection against severe outcomes was exceptionally high, with efficacy of 96.7% against severe disease, 94.3% against hospitalization, and 96.1% against COVID-19-related death. The vaccine also prevented asymptomatic infection with 89-91% efficacy. Efficacy declined gradually from 96.2% in the first two months to 83.7% after four months following the second dose, but a third booster dose administered at a median of 10.8 months restored efficacy to 95.3%. The vaccine maintained substantial protection across SARS-CoV-2 variants, including 100% efficacy against the B.1.351 (beta) variant in South Africa, 85-97% against B.1.1.7 (alpha), and 81-96% against Delta.
Efficacy was preserved across age groups from adolescents (100% efficacy) to adults aged 75 and older (82%), though immunocompromised individuals showed reduced effectiveness of 71%. The safety profile was favorable, with predominantly mild-to-moderate transient reactogenicity, low rates of serious adverse events similar to placebo, and no new safety signals identified with booster doses. These data, derived from randomized controlled trials enrolling over 46,000 participants and real-world studies including up to 6.5 million individuals, provide robust evidence that Tozinameran prevents COVID-19 across diverse populations and variants, with particularly strong protection against severe disease, hospitalization, and death.
Methods
We analyzed 10 sources from an initial pool of 200, using 8 screening criteria. Each paper was reviewed for 8 key aspects that mattered most to the research question.
Paper search
We performed a semantic search across over 138 million academic papers from the Elicit search engine, which includes all of Semantic Scholar and OpenAlex.
Screening
We screened in sources based on their abstracts that met these criteria:
- Primary Intervention: Study investigates Tozinameran as the primary intervention?
- Clinical Efficacy Outcomes: Reports clinical efficacy outcomes for COVID-19 prevention?
- Study Design: Randomized controlled trial, cohort, case-control, systematic review, or meta-analysis?
- Comparative Design: Compares Tozinameran to placebo, other vaccines, or unvaccinated controls?
- Study Population: Includes participants of any age group eligible for Tozinameran vaccination?
- Beyond Safety/Immunogenicity Only: Reports clinical efficacy outcomes?
- Human Clinical Research: Is this a human clinical study?
- Isolatable Tozinameran Effects: Can the effects of Tozinameran be isolated in this study?
Data extraction
We asked a language model to extract each data column below from each paper:
- Study Design: Methodological details that establish strength of clinical efficacy evidence.
- Study Population: Details about the study population relevant to Tozinameran efficacy.
- Prevention Outcomes: Extract outcomes measured for Tozinameran related to COVID-19 prevention.
- Efficacy Results: Quantitative efficacy results for Tozinameran in preventing COVID-19.
- Follow-up Duration: Relevant follow-up duration details.
- Variant Context: Information about SARS-CoV-2 variants during the study period.
- Safety Profile: Safety data relevant to clinical efficacy assessment.
- Subgroup Analysis: Efficacy results for clinically relevant subgroups.
Results
Study Characteristics
| Study | Full text retrieved? | Study Type | Sample Size | Population | Geographic Location | Follow-up Duration | Predominant Variant |
|---|---|---|---|---|---|---|---|
| F. Polack et al., 2020 | Yes | Randomized Controlled Trial, observer-blinded... | 43,548 participants | Persons ≥16 years | Multinational | Median 2 months | Not reported |
| Stephen J. Thomas et al., 2021 | Yes | Randomized Controlled Trial, observer-blinded... | 46,429 participants | Persons ≥12 years | Multinational | 6 months | B.1.351 (beta) in South Africa |
| S. J. Thomas et al., 2021 | Yes | Randomized Controlled Trial (RCT)... | 46,429 participants | Persons ≥12 years | Multinational | Up to 6 months | B.1.351 (beta) in South Africa |
| E. Moreira et al., 2022 | No | Randomized Controlled Trial, placebo-controlled | 10,125 participants | Persons ≥16 years | Not specified | Median 2.5 months | Not reported |
| Eric J Haas et al., 2021 | Yes | Observational study | 6.5 million residents | Residents of Israel ≥16 | Israel | Median 7 weeks | B.1.1.7 (94.5% prevalence) |
| G. Chodick et al., 2021 | Yes | Historical cohort study | 1,178,597 individuals | MHS members ≥16 years | Israel | 7-27 days | Not specified |
| Noa Dagan et al., 2021 | Yes | Cohort study with matched controls | 596,618 per study group | Newly vaccinated persons≥16 | Israel | December 2020... | Not reported |
| R. Frenck et al., 2021 | No | Randomized Controlled Trial, observer-blinded... | 2,260 adolescents | Adolescents 12-15 years | Multinational | Not specified | Not reported |
| V. Hall et al., 2021 | Yes | Prospective cohort study | 23,324 participants | Healthcare workers ≥18 | England | December 2020... | B1.1.7 (dominant) |
| Megan Wallace et al., 2022 | Yes | Systematic review and meta-analysis of observational studies | 26 studies included | Persons ≥16 years | Various countries | Studies through August 2021 | Delta variant predominant in some studies |
The included studies comprised three phase 3 randomized controlled trials of the primary two-dose series, one RCT of a third booster dose, one adolescent-focused RCT, four real-world observational effectiveness studies, and one systematic review. The studies evaluated populations ranging from adolescents to elderly adults across multiple geographic regions, with sample sizes from 2,260 to 6.5 million participants. Follow-up durations ranged from 2 months to 6 months in the RCTs. The observational studies were conducted primarily during periods when B.1.1.7 (alpha) variant was predominant, while one RCT included data from South Africa during B.1.351 (beta) variant predominance.
Efficacy Against Laboratory-Confirmed COVID-19
Primary Two-Dose Series Efficacy
| Study | Outcome | Time Point | Efficacy (95% CI) | Cases (Vaccine/Placebo) |
|---|---|---|---|---|
| F. Polack et al., 2020 | Laboratory-confirmed COVID-19 | ≥7 days after dose 2 | 95% (90.3-97.6) | 8/162 |
| Stephen J. Thomas et al., 2021 | Laboratory-confirmed COVID-19 | Through 6 months | 91.3% (89.0-93.2) | Not specified |
| S. J. Thomas et al., 2021 | Laboratory-confirmed COVID-19 | Through 6 months | 91% (89.0-93.2) | Not specified |
| Eric J Haas et al., 2021 | SARS-CoV-2 infection | ≥7 days after dose 2 | 95.3% (94.9-95.7) | Incidence: 3.1 vs 91.5 per 100,000 person-days |
| Eric J Haas et al., 2021 | Symptomatic COVID-19 | ≥7 days after dose 2 | 97.0% (96.7-97.2) | Incidence: 0.8 vs 32.5 per 100,000 person-days |
| G. Chodick et al., 2021 | SARS-CoV-2 infection | 7-27 days after dose 2 | 90% (79-95) | Incidence: 5.4 vs 54.8 per 100,000 |
| G. Chodick et al., 2021 | COVID-19 | 7-27 days after dose 2 | 94% (88-97) | Not specified |
| Noa Dagan et al., 2021 | Documented infection | ≥7 days after dose 2 | 92% (88-95) | Not specified |
| Noa Dagan et al., 2021 | Symptomatic COVID-19 | ≥7 days after dose 2 | 94% (87-98) | Not specified |
| V. Hall et al., 2021 | SARS-CoV-2 infection (PCR-confirmed) | ≥7 days after dose 2 | 85% (74-96) | Incidence: 4 vs 14 per 10,000 person-days |
The primary two-dose series demonstrated consistently high efficacy against laboratory-confirmed COVID-19 across both randomized controlled trials and real-world observational studies. The pivotal RCT by Polack et al. showed 95% efficacy, which was closely replicated in the Israeli national observational studies at 95.3% and 90%. Efficacy against symptomatic COVID-19 was particularly high at 94-97%. The meta-analysis of 8 studies confirmed pooled efficacy of 92.4% against symptomatic COVID-19. Among healthcare workers in England, where B1.1.7 variant was dominant, effectiveness was 85% seven days after the second dose.
Temporal Trends in Efficacy
| Time Interval | Efficacy (95% CI) | Study |
|---|---|---|
| Dose 1 to dose 2 | 58.4% (40.8-71.2) | Stephen J. Thomas et al., 2021 |
| 7 days to <2 months after dose 2 | 96.2% (93.3-98.1) | Stephen J. Thomas et al., 2021 |
| 2 months to <4 months after dose 2 | 90.1% (86.6-92.9) | Stephen J. Thomas et al., 2021 |
| ≥4 months after dose 2 | 83.7% (74.7-89.9) | Stephen J. Thomas et al., 2021 |
There was evidence of gradual waning in vaccine efficacy over time. Efficacy peaked at 96.2% in the first two months after the second dose, declined to 90.1% between 2-4 months, and decreased further to 83.7% after 4 months. This represented approximately 6% decline in efficacy every 2 months, though protection remained substantial throughout the 6-month follow-up period.
Third (Booster) Dose Efficacy
The study by Moreira et al. evaluated a third booster dose administered a median of 10.8 months after the second dose. Among participants without evidence of previous SARS-CoV-2 infection, COVID-19 occurred in 6 vaccine recipients versus 123 placebo recipients, yielding a relative vaccine efficacy of 95.3% (95% CI: 89.5-98.3). This efficacy was assessed over a median follow-up of 2.5 months and demonstrated restoration of high-level protection comparable to the initial two-dose series.
Efficacy Against Severe Disease Outcomes
| Study | Outcome | Efficacy (95% CI) | Time Point |
|---|---|---|---|
| F. Polack et al., 2020 | Severe COVID-19 | Not quantified | ≥7 days after dose 2 |
| Stephen J. Thomas et al., 2021 | Severe disease | 96.7% (80.3-99.9) | Through 6 months |
| S. J. Thomas et al., 2021 | Severe disease | 97% (80.3-99.9) | Through 6 months |
| Eric J Haas et al., 2021 | Severe or critical COVID-19... | 97.5% (97.1-97.8) | ≥7 days after dose 2 |
| Eric J Haas et al., 2021 | COVID-19-related hospitalization | 97.2% (96.8-97.5) | ≥7 days after dose 2 |
| G. Chodick et al., 2021 | Hospitalization (age 45-64) | 55% reduction (HR 0.45)... | 7-27 days after dose 2 |
| G. Chodick et al., 2021 | Hospitalization (age ≥75) | 44% reduction (HR 0.56)... | 7-27 days after dose 2 |
| Noa Dagan et al., 2021 | Hospitalization | 87% (55-100) | ≥7 days after dose 2 |
| Noa Dagan et al., 2021 | Severe disease | 92% (75-100) | ≥7 days after dose 2 |
| Megan Wallace et al., 2022 | Hospitalization due to COVID-19 | 94.3% (87.9-97.3) | Meta-analysis (8 studies) |
Efficacy against severe disease outcomes consistently exceeded 90% across multiple studies. The Israeli national surveillance data demonstrated 97.2% efficacy against COVID-19-related hospitalization and 97.5% against severe or critical hospitalization. The 6-month RCT follow-up confirmed 96.7% efficacy against severe disease. The meta-analysis pooled estimate showed 94.3% efficacy against hospitalization. Notably, protection against severe outcomes appeared more durable than protection against infection, with high efficacy maintained throughout the 6-month follow-up period.
Efficacy Against Death
| Study | Outcome | Efficacy (95% CI) | Time Point |
|---|---|---|---|
| Eric J Haas et al., 2021 | COVID-19-related death | 96.7% (96.0-97.3) | ≥7 days after dose 2 |
| Eric J Haas et al., 2021 | Deaths | 98.1% | ≥14 days after dose 2 |
| Eric J Haas et al., 2021 | Deaths | 77.0% | 14-21 days after dose 1 |
| G. Chodick et al., 2021 | Deaths during protection period | Not quantified | 7-27 days after dose 2 |
| Noa Dagan et al., 2021 | Death from COVID-19 | 72% (19-100) | Days 14-20 after dose 1 |
| Megan Wallace et al., 2022 | Death due to COVID-19 | 96.1% (91.5-98.2) | Meta-analysis (4 studies) |
Efficacy against COVID-19-related death was exceptionally high. The Israeli national data showed 96.7% efficacy at 7 or more days after the second dose, increasing to 98.1% at 14 or more days. The meta-analysis of four studies confirmed 96.1% pooled efficacy against death. Even after a single dose, efficacy against death reached 72-77%, demonstrating substantial early protection against the most severe outcome.
Efficacy Against Asymptomatic Infection
| Study | Outcome | Efficacy (95% CI) | Time Point |
|---|---|---|---|
| Eric J Haas et al., 2021 | Asymptomatic SARS-CoV-2 infection | 91.5% (90.7-92.2) | ≥7 days after dose 2 |
| Megan Wallace et al., 2022 | Asymptomatic SARS-CoV-2 infection | 89.3% (88.4-90.1) | Meta-analysis (2 studies) |
The vaccine demonstrated high efficacy against asymptomatic infection, with Israeli surveillance data showing 91.5% efficacy and the meta-analysis confirming 89.3% pooled efficacy. This finding from healthcare workers undergoing regular asymptomatic testing suggests the vaccine substantially reduces transmission potential by preventing asymptomatic carriage.
Variant-Specific Efficacy
The B.1.351 (beta) variant, which showed reduced neutralization by vaccine-induced sera in laboratory studies, remained susceptible to clinical protection. In South Africa, where beta variant was predominant, vaccine efficacy was 100% (95% CI: 53.5-100). All sequenced COVID-19 cases in South Africa were confirmed to be B.1.351 lineage. The B.1.1.7 (alpha) variant was the dominant strain during the Israeli observational studies, with an estimated prevalence of 94.5%. For the Delta variant, variant-specific efficacy of 81.2% (95% CI: 50.2-92.9) against symptomatic COVID-19, 96% against hospitalization, and 36-74% against asymptomatic infection.
Age-Specific Efficacy
| Age Group | Outcome | Efficacy (95% CI) | Study |
|---|---|---|---|
| 12-15 years | COVID-19 | 100% (75.3-100) | R. Frenck et al., 2021 |
| 16-44 years | Infection | 92% (83-96) | G. Chodick et al., 2021 |
| 45-64 years | Infection | 90% (80-95) | G. Chodick et al., 2021 |
| 65-74 years | Infection | 82% (63-92) | G. Chodick et al., 2021 |
| ≥75 years | Infection | 82% (61-91) | G. Chodick et al., 2021 |
| ≥85 years | All outcomes | Highly effective | Eric J Haas et al., 2021 |
Efficacy was maintained across all age groups from adolescents to the elderly, though some attenuation was observed in older adults. The adolescent trial demonstrated 100% efficacy with no COVID-19 cases among vaccinated participants. Among adults, efficacy against infection was highest in younger age groups at 92% and declined modestly with age to 82% in those 65 years and older. Nevertheless, the vaccine remained highly effective in preventing severe disease across all ages, including those aged 85 years and above.
Efficacy in Special Populations
Immunocompromised Individuals
Vaccine effectiveness was notably reduced in immunocompromised populations. Among immunosuppressed patients, overall effectiveness against infection was 71% (95% CI: 37-87), lower than the 90% observed in the general population.
Healthcare Workers
The prospective cohort study among 23,324 healthcare workers in England showed vaccine effectiveness of 70% (95% CI: 55-85) at 21 days after the first dose and 85% (95% CI: 74-96) at 7 days after the second dose.
Previously Infected vs. Naive Individuals
Among participants with previous SARS-CoV-2 infection, natural infection conferred approximately 72.6% protection. The vaccine was effective in preventing further infections in previously infected individuals.
Safety Profile
The vaccine demonstrated a favorable safety profile across all studies. Reactogenicity was predominantly mild to moderate, with the most common events being injection-site pain, fatigue, and headache. Serious adverse events were rare and occurred at similar rates in vaccine and placebo groups.
Synthesis
The body of evidence for Tozinameran's clinical efficacy in preventing COVID-19 demonstrates remarkable consistency across diverse study designs, populations, and geographic settings. The convergence of findings from phase 3 RCTs and real-world observational studies supports the vaccine's protection against laboratory-confirmed COVID-19. Several apparent heterogeneities in the results can be explained by methodological and contextual factors, including differences in study populations and timing of efficacy assessments among healthcare workers in high-exposure settings versus the general population.
The gradual decline in efficacy over time demonstrated genuine waning immunity, which is addressed by booster doses that restore high-level immunity. The vaccine's favorable safety profile supports its positive benefit-risk profile for preventing COVID-19 across diverse populations.
References
- Eric J Haas, F. Angulo, J. McLaughlin, E. Anis, S. Singer, and 10 more, (2021) Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalizations, and deaths following a nationwide vaccination campaign in Israel: an observational study using national surveillance data. The Lancet.
- F. Polack, Stephen J. Thomas, N. Kitchin, J. Absalon, A. Gurtman, and 24 more (2020) Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. New England Journal of Medicine.
- Stephen J. Thomas, E. Moreira, N. Kitchin, J. Absalon, A. Gurtman, and 27 more (2021) Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months. New England Journal of Medicine.
- S. J. Thomas, E. D. Moreira, N. Kitchin, J. Absalon, A. Gurtman, and 29 more(2021) Six Month Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine. medRxiv.
- G. Chodick, L. Tene, R. Rotem, T. Patalon, S. Gazit, and 6 more (2021) The effectiveness of the TWO-DOSE BNT162b2 vaccine: analysis of real-world data. Clinical Infectious Diseases.
- Noa Dagan, N. Barda, Eldad Kepten, O. Miron, Shay Perchik, and 5 more (2021) BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting. New England Journal of Medicine.
- R. Frenck, N. Klein, N. Kitchin, A. Gurtman, J. Absalon, and 21 more (2021) Safety, Immunogenicity, and Efficacy of the BNT162b2 Covid-19 Vaccine in Adolescents. New England Journal of Medicine.
- E. Moreira, N. Kitchin, Xia Xu, S. Dychter, S. Lockhart, and 27 more (2022). Safety and Efficacy of a Third Dose of BNT162b2 Covid-19 Vaccine. New England Journal of Medicine.
- V. Hall, S. Foulkes, A. Saei, N. Andrews, B. Oguti, and 343 more (2021) COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study. The Lancet.
- Megan Wallace, J. Collins, Heidi L Moline, I. Plumb, Monica Godfrey, and 5 more (2022) Effectiveness of Pfizer-BioNTech COVID-19 vaccine as evidence for policy action: A rapid systematic review and meta-analysis of non-randomized studies. PLoS ONE.