How much protection you get from one shot of Pfizer, J&J, and others, according to the best available data
- Millions of people worldwide have had one shot of two-dose Covid-19 vaccines.
- Pfizer and Moderna vaccines are likely 80% effective against symptomatic Covid-19 after one dose.
- A single AstraZeneca shot is probably at least 70% effective at preventing symptomatic Covid-19.
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The US has authorised vaccines from Moderna and Pfizer-BioNTech – the only vaccine currently being administered in South Africa – while the UK has authorised Pfizer's shot as well as one made by AstraZeneca and Oxford University. The US has also authorised Johnson & Johnson's vaccine, which is a single dose, and was used in South Africa's Phase 1 rollout, and is expected to return to use locally soon.
The UK is delaying the second dose of the vaccines for up to 12 weeks to prioritise giving people their first shot. In the US, the Centers for Disease Control and Prevention has recommended giving second doses of Pfizer's vaccine 21 days after the first, and 28 days after the first for Moderna, with an interval of up to six weeks in "unavoidable" situations.
The data for how well the vaccines work after one dose isn't always clear cut - it depends on what you're measuring, and when you're measuring it. Stephen Evans, a professor of medical statistics at the London School of Hygiene & Tropical Medicine and a former drug-safety committee member at the European Medicines Agency, helped Insider break down the data.
Evans said the US Food and Drug Administration presentation of the data from late-stage trials of each vaccine was generally the best data available. This is how much protection one shot of each vaccine gives you, based on that data.
Pfizer-BioNTech: at least 80%
Pfizer's shot was 52.4% effective at protecting against Covid-19 with symptoms between the first and second dose, according to the FDA documents. But the 52.4% figure includes the 11 days before protection kicks in after the first dose, so the real percentage could well be higher.
The true value lies between 29.5% and 84.5%, according to the FDA documents. There was a wide range because not many people caught Covid-19 in the trial during this time period.
Pfizer's shot was 100% effective at protecting against hospitalisation and death. This was based on a small number though - only four people got severe Covid-19 in the trial after receiving placebo rather than the vaccine.
Evans said there was "pretty clear evidence" that you get at least 80% protection - and "probably" better than 90% - for Pfizer's vaccine against Covid-19 with symptoms after a single dose. He said you couldn't be absolutely sure what happens after 21 days because it hadn't been fully tested.
Evans said this was based on his overall reading of the trial data used by the FDA in their briefing document before authorisation.
Moderna: at least 80%
Moderna's vaccine was 69.5% effective at preventing Covid-19 with symptoms between the first and second dose, with a true value between 43.5% and 84.5%. There was a fairly wide range because the number of people that caught Covid-19 in the trial during this time period was low.
The 69.5% figure includes the 13 days before protection starts, so the real percentage could be higher.
There were a small number of people in Moderna's trial - about 7% - that didn't get their second dose for unknown reasons. In this group, the shot was 50.8% effective at preventing Covid-19 with symptoms for up to 14 days after the first dose and 92.1% effective after 14 days.
It is unclear how well one shot of the vaccine protects against hospitalisation and death because not many people got severe Covid-19 - two in the vaccine group and four in placebo.
Evans said that you get at least 80% protection - and probably better than 90% - for Moderna's vaccine against Covid-19 with symptoms after a single dose for 28 days. After 28 days it was unclear because it hadn't been tested. Again, this was based on his overall reading of the FDA data, he said.
AstraZeneca: more than 70%
Evans said it was harder to ascertain a figure for AstraZeneca's vaccine because late-stage trials used differing study designs, and a large US study was ongoing. The FDA also has not yet presented the data for the shot in the same way it has done for other vaccines.
A single dose of AstraZeneca's shot was 76% effective at protecting against Covid-19 with symptoms for at least 90 days, according to late-stage-trial data published in The Lancet on February 19. The study authors also reported that one dose provided 100% protection against hospitalisation, but the numbers were small.
Based on his reading of existing studies, Evans said the single-dose efficacy for AstraZeneca's vaccine was probably at least 70% against Covid-19 with symptoms for the first 90 days. After this time period, it's unclear, he said.
Johnson & Johnson: 66% – and 64% in South Africa
Protection kicked in at 14 days and was 66.1% effective at 28 days. The vaccine's efficacy varied depending on the country it was used in - it was 72% effective in the US but 64% and 68% effective in South Africa and Brazil, respectively, where variants that could partially evade antibodies are circulating.
What percentage efficacy means
Percentage efficacy for vaccines refers to the proportion of people that get full protection after a vaccine. With 80% efficacy, 80% of people have full protection, and 20% don't.
For those who get full protection the first time around, the second shot improves the quality of the immune response and its durability.
For the people who don't get full protection with the first shot, some will get full protection after the second dose. Some people won't ever get full protection from a vaccine because their immune system doesn't respond at all.
Real-world data: One shot significantly reduces infections and transmission
Real-world data from a survey of about 375,000 people in the UK, posted as a pre-print study on April 23, found that either Pfizer or AstraZeneca's vaccine cut Covid-19 infections with symptoms by 72%. Protection from a single dose probably holds up for at least 10 weeks, based on measurements of antibody levels, the study said.
The study authors said the data supported the UK strategy of delaying the second dose, but that people must get their second dose. Protection from Pfizer's vaccine rose to 90% after two doses. There's not enough data yet to draw any conclusions on the AstraZeneca shot.
Another real-world study from Scotland published in the Lancet on April 23 found that a single dose of Pfizer's vaccine was 91% effective against hospitalisation at 28 to 34 days following vaccination. One dose of AstraZeneca's vaccine was 88% effective against hospital admissions after the same time period, the study found.
A real-world study from England posted as a pre-print on April 28 found a single dose of either Pfizer of AstraZeneca's vaccine cut spread of symptomatic Covid-19 within a household by up to 50%.
South Korean health officials said on Twitter on May 5 that real-world data showed one dose of Pfizer's vaccine was 89.7% effective at preventing Covid-19 in South Koreans aged over 60, at least two weeks after vaccination. AstraZeneca's vaccine was 86% effective at preventing Covid-19 after one dose, it said. The agency didn't provide a breakdown of how many people received each shot or the severity of illness - COVID-19 vaccines are generally more effective at preventing Covid-19 infections that cause hospitalisation or death.
Newest data: Second shot provides better protection against variants
Real-word data from the UK posted Sunday May 23 by Public Health England showed that Pfizer's and AstraZeneca's Covid-19 vaccines worked better against the variants when two doses were given rather than just one. Both vaccines were 30% effective against COVID-19 with symptoms caused by the variant first identified in India, three weeks after the first dose.
This was boosted to between 60% and 88% effectiveness two weeks after the second dose. The two vaccines were 50% effective against Covid-19 with symptoms against the variant first found in the UK, B.1.1.7, three weeks after the first dose. This increased to between 66% and 93% two weeks after the second dose.