A review of the safety and efficacy of current COVID-19 vaccines

doi:10.1007/s11684-021-0893-y

Front. Med.

2022, Vol. 16

Issue (1) : 39-55 https://doi.org/10.1007/s11684-021-0893-y

REVIEW

A review of the safety and efficacy of current COVID-19 vaccines

Zehong Huang, Yingying Su, Tianying Zhang, Ningshao Xia(

)

State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen 361102, China

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Abstract

Vaccination is the most effective and feasible way to contain the coronavirus disease 2019 (COVID-19) pandemic. The rapid development of effective COVID-19 vaccines is an extraordinary achievement. This study reviewed the efficacy/effectiveness, immunogenicity, and safety profile of the 12 most progressed COVID-19 vaccines and discussed the challenges and prospects of the vaccine-based approaches in a global crisis. Overall, most of the current vaccines have shown safety and efficacy/effectiveness during actual clinical trials or in the real-world studies, indicating a development of pandemic control. However, many challenges are faced by pandemic control in terms of maximizing the effect of vaccines, such as rapid vaccine coverage, strategies to address variants with immune escape capability, and surveillance of vaccine safety in the medium- and long-terms.

Keywords COVID-19 SARS-CoV-2 vaccine safety efficacy effectiveness immunogenicity

Corresponding Author(s): Ningshao Xia

Just Accepted Date: 23 December 2021 Online First Date: 28 January 2022 Issue Date: 28 March 2022

Cite this article:

Zehong Huang,Yingying Su,Tianying Zhang, et al. A review of the safety and efficacy of current COVID-19 vaccines[J]. Front. Med., 2022, 16(1): 39-55.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-021-0893-y
https://academic.hep.com.cn/fmd/EN/Y2022/V16/I1/39

Vaccine (alternative name)	Sponsor	Vaccine type	Storage	Regimen	Countries in use [10,114]	Efficacy of phase 3
Vaccine (alternative name)	Sponsor	Vaccine type	Storage	Regimen	Countries in use [10,114]	Days after vaccination	Sample size	Efficacy for COVID-19, VE (%) (95% CI)
Gam-COVID-Vac (Sputnik V) [17]	Gamaleya Research Institute; Health Ministry of the Russian Federation	Viral vector (Non-replicating)	Frozen: stable at –18 °C; Lyophilized: stable at 2–8 °C	2 doses, 0/21 days	70 countries including Hungary, Serbia, UAE, Belarus, Russia, etc.	21 days after dose 1	27 530	Symptomatic diseases: 91.6 (85.6–95.2) (RUS) Moderate to severe disease: 100 (94.4–100) (RUS)
AZD-1222 (Covishield, Vexzevria) [18,83,115]	Oxford Universty/AstraZeneca		Stable at 2–8 °C	2 doses, 0/4–12 weeks	121 countries including Argentina, Brazil, India, Mexico, UK, etc.	14 days after dose 2	7548 (GBR) 4088 (BRA) 1467 (RSA)	Symptomatic diseases: 73.5 (55.5–84.2) (GBR) 64.2 (30.7–81.5) (BRA) 21.9 (–49.9 to59.8) (RSA) 76 (68–82) (USA) Severe diseases: 100 (GBR)^a 100 (USA)
Ad5-nCoV [7,116]	CanSino Biological Inc./Beijing Institute of Biotechnology		Stable at 2–8 °C	1 dose	8 countries including Chile, China, Hungary, Mexico, Pakistan, etc.	14 days after dose 1	Approximately 40 000	Symptomatic diseases: 68.83 Severe diseases: 95.47
Ad26.COV2.S [19]	Janssen Pharmaceutical		Stable at –20 °C; 2–8 °C for 3 months	1 dose	59 countries including Brazil, Italy, Spain, Thailand, USA, etc.	28 days after dose 1	39 058	Symptomatic diseases: 66.5 (55.5–75.1) (USA/BRA/RSA) Severe diseases: 85.4 (54.2–96.9) (USA/BRA/RSA)
BBIBP-CorV [20]	Sinopharm/China National Biotec Group Co./Beijing Institute of Biological Products	Inactivated virus	Stable at 2–8 °C	2 doses, 0/21 days	59 countries including Bahrain, China, Pakistan, Peru, UAE, etc.	14 days after dose 2	25 463	Symptomatic diseases: 78.1 (64.9–86.3) (UAE/BRN/EGY/JOR) Severe diseases: 100 (NE–100) (UAE/BRN/EGY/JOR)
WIV04 [20]	Sinopharm/China National Biotec Group Co./Wuhan Institute of Biological Products		Stable at 2–8 °C	2 doses, 0/21 days	China and UAE	14 days after dose 2	25 480	Symptomatic diseases: 72.8 (58.1–82.4) (UAE/BRN/EGY/JOR) Severe diseases: 100 (NE–100) (UAE/BRN/EGY/JOR)
COVAXIN (BBV152) [21]	Bharat Biotech International Limited		Stable at 2–8 °C	2 doses, 0/28 days	9 countries including India, Mexico, Nepal, Paraguay, Philippines, etc.	14 days after dose 2	25 753	Symptomatic diseases: 77.8 (65.2–86.4) (IND) Severe diseases: 93.4% (57.1–99.8) (IND)
CoronaVac [22–25]	Sinovac Research and Development Co., Ltd.		Stable at 2–8 °C	2 doses, 0/14 days	39 countries including Brazil, China, Chile, Turkey, Indonesia, etc.	14 days after dose 2	10 214 (TUR) 1603 (INA) 12 396 (BRA)	Symptomatic diseases: 83.5 (65.4–92.1) (TUR) 65.30 (18.95–85.10) (INA) 50.7 (35.9–62.0) (BRA) Severe diseases: 100 (16.9–100) (BRA)
BNT162b2 (Comirnaty) [15]	BioNTech/ Pfizer/Fosun Pharma	RNA based vaccine	Stable at –80 °C to –60 °C; 2–8 °C for 1 month	2 doses, 0/21 days	97 countries including Argentina, Mexico, Saudi Arabia, Canada, USA, UK, etc.	7 days after dose 2	43 548	Symptomatic diseases: 95.0 (90.3–97.6) (USA) Severe diseases: 88.9 (20.1–99.7) (USA)^b
mRNA-1273 [14]	Moderna/National Institute of Allergy and Infectious Diseases (NIAID)		Stable at –50 °C to –15°C; 2–8 °C for 30 days; 8–25 °C for 24 h	2 doses, 0/28 days	65 countries Canada, Israel, Switzerland, USA, UK, etc.	14 days after dose 2	30 420	Symptomatic diseases: 94.1 (89.3–96.8) (USA) Severe diseases: 100 (NE–100) (USA)^a
CVnCoV [16]	CureVac AG		Stable at 2–8 °C	2 doses, 0/28 days	Not approved	NA	Approximately 40 000	Symptomatic diseases: 48 Moderate to severe diseases: 77^c,d
NVX-CoV2373 [26,27,94]	Novavax	Protein subunit	Stable at 2–8 °C	2 doses, 0/21 days	Not approved	7 days after dose 2	14 039 (GBR); 2684 (RSA) 29 960 (USA/MEX)	Symptomatic diseases: 89.7 (80.2–94.6) (GBR) 90.4 (82.9–94.6) (USA/MEX) 49.4 (6.1–72.8) (RSA) Moderate or severe disease: 100 (87–100) (USA/MEX) Severe diseases: 100 (GBR)^a 100 (RSA)^a

Tab.1 Efficacy, effectiveness, and basic information of vaccine

Fig.1 Comparison of neutralizing antibody titers after vaccination with different vaccines in younger and older participants. (A) Comparison in younger adult participants. (B) Comparison in elderly participants. The colors green, red, blue, and mustard yellow represent adenovirus vector vaccines, RNA-based vaccines, inactivated virus vaccines, and protein subunit vaccines and respectively..

Vaccine (reference)	VOC				VOI
Vaccine (reference)	Alpha (B.1.1.7)	Gamma (P.1)	Beta (B.1.351)	Delta (B.1.617.2)	Epsilon (B.1.429)	Iota (B.1.526) (E484K)	Iota (B.1.526) (S477N)
Neutralization
Gam-COVID-Vac [76]	Increase by 1.8×	NA	Decrease by 6.1×	NA	NA	NA	NA
BBIBP-CorV [78,82]	Increase by 1.4×	NA	Decrease by 1.55× Decrease by 2.5 ×	NA	NA	NA	NA
BBIBP-CorV [78,82]	Increase by 1.4×	NA	Decrease by 1.55× Decrease by 2.5 ×	NA	NA	NA	NA
BNT162b2 [75,79,85–88]	Increase by 1.3×	Decrease by 3.8×	Decrease by 10.3×	Decrease by 1.4×	NA	Decrease by 3.6×	similar to D614G
	Decrease by 3.3×	Decrease by 2.6×	Decrease by 7.6×	Decrease by 1.4×
	Decrease by 3.3×	Decrease by 2.6×	Decrease by 3.4×	Decrease by 5.8×
mRNA-1273 [77,79,84–86,89]	Increase by 1.6×	Decrease by 4.8×	Decrease by 9.7×	Decrease by 2.1×	Decrease by 2.0×	Decrease by 3.6×	similar to D614G
	Decrease by 2.0×	Decrease by 4.8×	Decrease by 12.4×
	Decrease by 1.2×	Decrease by 3.2×	Decrease by 3.8×
AZD-1222 [75,83,90]	Decrease by 2.3×	Decrease by 2.9×	Decrease by 11× Decrease by 9×	Decrease by 3.2×	NA	NA	NA
AZD-1222 [75,83,90]	Decrease by 2.3×	Decrease by 2.9×	Decrease by 11× Decrease by 9×	Decrease by 3.2×	NA	NA	NA
COVAXIN [80]	Decrease by 1.06×	NA	NA	Decrease by 1.95×	NA	NA	NA
CoronaVac [78,81]	Decrease by 2×	Decrease by 3.92×	Decrease by 3.3×	NA	Decrease by 1.25×	Decrease by 4.03×^a
CoronaVac [78,81]	Decrease by 1.51×	Decrease by 3.92×	Decrease by 5.27×	NA	Decrease by 1.25×	Decrease by 4.03×^a
WIV04	NA	NA	NA	NA	NA	NA	NA
Ad5-nCoV	NA	NA	NA	NA	NA	NA	NA
Ad26.COV2.S [117]	Decrease by 0.9×	Decrease by 3.4×	Decrease by 3.6×	Decrease by 1.6×	NA	NA	NA
NVX-CoV2373 [77,84]	Decrease by 2.1×	NA	Decrease by 14.5×	NA	Decrease by 2.5×	NA	NA
CVnCoV	NA	NA	NA	NA	NA	NA	NA
Efficacy/effectiveness
Ad26.COV2.S [19]	NA	NA	Moderate to severe COVID-19: 64.0% (95% CI 41.2%– 78.7%) Severe COVID-19: 81.7% (95% CI 46.2%– 95.4%)	NA	NA	NA	NA
NVX-CoV2373 [94,118]	Symptomatic COVID-19:86.3% (95% CI 71.3%–93.5%)	NA	Symptomatic COVID-19: 60.1% (95% CI 19.9%–80.1%)^c	NA	NA	NA	NA
AZD-1222 [35,36,83,91]	Symptomatic COVID-19:70.4% (95% CI 43.6%–84.5%) Hospitalization: 86% (95% CI 53%–96%)	NA	Mild-to-moderate COVID-19:10.4% (95% CI –76.8% to 54.8%)	Symptomatic COVID-19: 59.8% (95% CI 28.9%–77.3%) Hospitalization: 92% (95% CI 75%–97%)	NA	NA	NA
CoronaVac [95]	NA	Symptomatic COVID-19: 49.6% (95% CI 11.3%–71.4%)^b	NA	NA	NA	NA	NA
BNT162b2 [35,36,92]	SARS-CoV-2 infection: 89.5% (95% CI 85.9%–92.3%) Symptomatic COVID-19: 92% (95% CI 88%–94%) Severe, critical, or fatal COVID-19: 100.0% (95% CI 81.7%– 100.0%) Hospitalization: 95% (95% CI 78%–99%)	NA	SARS-CoV-2 infection: 75.0% (95% CI 70.5%–78.9%) Severe, critical, or fatal COVID-19: 100.0% (95% CI 73.7%–100.0%)	Symptomatic COVID-19: 87.9% (95% CI 78.2%–93.2%) Hospitalization: 96% (95% CI 86%–99%)	NA	NA	NA
mRNA-1273[93]	SARS-CoV-2 infection: 100% (95% CI 91.8%–100%)	NA	NA	SARS-CoV-2 infection: 96.4% (95% CI 91.9%–98.7%)	NA	NA	NA
COVAXIN ([21])	NA	NA	NA	Symptomatic COVID-19: 65.2% (95% CI 33·1%–83·0%)	NA	NA	NA
CVnCoV [16]	Symptomatic COVID-19: 55% (95% CI 24%–74%)^d	Symptomatic COVID-19: 67% (95% CI 30%–85%)^d	NA	NA	NA	NA	NA

Tab.2 Vaccine implications of variants

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