Real World Effectiveness of COVID-19 mRNA Vaccines against Hospitalizations and Deaths in the United States

Background: Covid-19 has caused significant global mortality. Multiple vaccines have demonstrated efficacy in clinical trials though real-world effectiveness of vaccines against Covid-19 mortality in clinically and demographically diverse populations has not yet been reported. Methods: We used a retrospective cohort assembled from a cross-institution comprehensive data repository. Established patients of the health care system were categorized as not immunized, partially immunized, or fully immunized against SARS-CoV-2 with an mRNA vaccine through April 4, 2021. Outcomes were Covid-19 related hospitalization and death. Results: Of the 91,134 established patients, 70.2% were not immunized, 4.5% were partially immunized and 25.4% were fully immunized. Among the fully immunized 0.7% had a Covid-19 hospitalization, whereas 3.4% among the partially immunized and 2.7% non-immunized individuals were hospitalized with Covid-19. Of the 225 deaths among Covid-19 hospitalizations, 219 (97.3%) were in the not immunized, 5 (2.2%) in the partially immunized, and 1 (0.0041%) in the fully immunized group. mRNA vaccines were 96% (95%CI: 95 - 99) effective at preventing Covid-19 related hospitalization and 98.7% (95%CI: 91.0 - 99.8) effective at preventing Covid-19 related death when participants were fully vaccinated. Partial vaccination was 77% (95%CI: 71 - 82) effective at preventing hospitalization and 64.2% (95%CI: 13.0 - 85.2) effective at preventing death. Vaccine effectiveness at preventing hospitalization was conserved across subgroups of age, race, ethnicity, Area Deprivation Index, and Charlson Comorbidity Index. Conclusions: In a large, diverse cohort in the United States, full immunization with mRNA vaccines was highly effective in the real-world scenario at preventing Covid-19 related hospitalization and death.