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Two doses of the Pfizer-BioNTech Covid-19 vaccine provide more than 95% protection against infection, hospitalisation, severe illness, and death, including among the elderly, according to the first national-level observational assessment of its effectiveness in Israel, published in The Lancet.

Israel is the first country to report national data on the Pfizer-BioNTech vaccine, with observational analysis showing that two doses provide more than 95% protection against Covid-19 infection, hospitalisation, and death, including among the elderly, at a time when the B.1.1.7 variant was the dominant strain.

A single dose was associated with 58% protection against infection, 76% against hospitalisation, and 77% against death, emphasising the importance of fully vaccinating adults.

The analysis also reveals for the first time the public health benefits of a national vaccination programme, which was found to be the key driver of a decline in Covid-19 infections in Israel. While the findings are encouraging, the authors stress that a number of challenges to controlling the pandemic remain. The duration of immunity – both from infection and immunisation – remains unknown, and it is possible that new, vaccine-resistant variants could emerge in the future. In addition, achieving herd immunity will require a continued increase of vaccination coverage worldwide.

Preliminary vaccine effectiveness estimates of one dose of the Pfizer-BioNTech vaccine — approved for emergency use in Israel in December 2020 — have been reported in the UK, Denmark, Israel, and the USA. VE estimates for two doses have also been carried out in a subset of the population in Israel. However, until now, national-level VE estimates of two doses of the Pfizer-BioNTech vaccine – the only Covid-19 vaccine available in Israel during the study period of January 24 to April 3 – were not available for a range of key outcomes, including VE among the elderly.

Lead author Dr Sharon Alroy-Preis, of the Israel Ministry of Health, has been quoted as saying: “As the country with the highest proportion of its population vaccinated against Covid-19, Israel provides a unique real-world opportunity to determine the effectiveness of the vaccine and to observe wider effects of the vaccination programme on public health. Until this point, no country in the world had described the national public health impact of a nationwide COVID-19 vaccination campaign. These insights are hugely important because, while there are still some considerable challenges to overcome, they offer real hope that COVID-19 vaccination will eventually enable us to control the pandemic.”

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