Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study

Eleftheria Vasileiou, Colin R Simpson, Ting Shi, Steven Kerr, Utkarsh Agrawal, Ashley Akbari, Stuart Bedston, Jillian Beggs, Declan Bradley, Antony Chuter, Simon de Lusignan, Annemarie B Docherty, David Ford, Fd Richard Hobbs, Mark Joy, Srinivasa Vittal Katikireddi, James Marple, Colin McCowan, Dylan McGagh, Jim McMenaminEmily Moore, Josephine Lk Murray, Jiafeng Pan, Lewis Ritchie, Syed Ahmar Shah, Sarah Stock, Fatemeh Torabi, Ruby Sm Tsang, Rachael Wood, Mark Woolhouse, Chris Robertson, Aziz Sheikh* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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BACKGROUND: The BNT162b2 mRNA (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines have shown high efficacy against disease in phase 3 clinical trials and are now being used in national vaccination programmes in the UK and several other countries. Studying the real-world effects of these vaccines is an urgent requirement. The aim of our study was to investigate the association between the mass roll-out of the first doses of these COVID-19 vaccines and hospital admissions for COVID-19.

METHODS: We did a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19-EAVE II-database comprising linked vaccination, primary care, real-time reverse transcription-PCR testing, and hospital admission patient records for 5·4 million people in Scotland (about 99% of the population) registered at 940 general practices. Individuals who had previously tested positive were excluded from the analysis. A time-dependent Cox model and Poisson regression models with inverse propensity weights were fitted to estimate effectiveness against COVID-19 hospital admission (defined as 1-adjusted rate ratio) following the first dose of vaccine.

FINDINGS: Between Dec 8, 2020, and Feb 22, 2021, a total of 1 331 993 people were vaccinated over the study period. The mean age of those vaccinated was 65·0 years (SD 16·2). The first dose of the BNT162b2 mRNA vaccine was associated with a vaccine effect of 91% (95% CI 85-94) for reduced COVID-19 hospital admission at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 88% (95% CI 75-94). Results of combined vaccine effects against hospital admission due to COVID-19 were similar when restricting the analysis to those aged 80 years and older (83%, 95% CI 72-89 at 28-34 days post-vaccination).

INTERPRETATION: Mass roll-out of the first doses of the BNT162b2 mRNA and ChAdOx1 vaccines was associated with substantial reductions in the risk of hospital admission due to COVID-19 in Scotland. There remains the possibility that some of the observed effects might have been due to residual confounding.

FUNDING: UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK.

Original languageEnglish
Pages (from-to)1646-1657
Number of pages12
JournalThe Lancet
Issue number10285
Early online date23 Apr 2021
Publication statusPublished - 1 May 2021

Bibliographical note

EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE—The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Additional support has been provided through Public Health Scotland and the Scottish Government's director-general of Health and Social Care. FDRH acknowledges part support from the National Institutes of Health Research (NIHR) School for Primary Care Research, the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford, and the NIHR Oxford Biomedical Research Centre. We thank Dave Kelly from Albasoft for his support with making primary care data available, and James Pickett, Wendy Inglis-Humphrey, Vicky Hammersley, Maria Georgiou, and Laura Gonzalez Rienda for their support with project management and administration. SVK acknowledges funding from an NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and Scottish Government Chief Scientist Office (SPHSU13).


  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19/epidemiology
  • COVID-19 Vaccines
  • Female
  • Hospitalization/statistics & numerical data
  • Humans
  • Male
  • Mass Vaccination
  • Middle Aged
  • Pandemics/prevention & control
  • Prospective Studies
  • Risk Factors
  • Scotland/epidemiology
  • Social Class
  • Young Adult


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