Reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is a worldwide challenge; widespread vaccination could be one strategy for control. We conducted a prospective, population-based cohort study of 964,258 residents of Aragon, Spain, during December 2020-May 2021. We used the Cox proportional-hazards model with vaccination status as the exposure condition to estimate the effectiveness of 3 coronavirus disease vaccines in preventing SARS-CoV-2 infection. Pfizer-BioNTech had 20.8% (95% CI 11.6%-29.0%) vaccine effectiveness (VE) against infection after 1 dose and 70.0% (95% CI 65.3%-74.1%) after 2 doses, Moderna had 52.8% (95% CI 30.7%-67.8%) VE after 1 dose and 70.3% (95% CI 52.2%-81.5%) after 2 doses, and Oxford-AstraZeneca had 40.3% (95% CI 31.8%-47.7%) VE after 1 dose. All estimates were lower than those from previous studies. Results imply that, although high vaccination coverage remains critical to protect people from disease, it will be difficult to effectively minimize transmission opportunities.
Keywords: COVID-19; COVID-19 vaccines; SARS-CoV-2; Spain; coronavirus disease; respiratory infections; severe acute respiratory syndrome coronavirus disease 2; treatment outcomes; vaccination; vaccine effectiveness; viruses; zoonoses.