COVID-19 vaccine surveillance report

Week 37

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COVID-19 vaccine surveillance report – week 37

Contents
Summary...................................................................................................................................... 3
Vaccine effectiveness ............................................................................................................... 3
Population impact ..................................................................................................................... 3
Vaccine effectiveness .................................................................................................................. 5
Effectiveness against symptomatic disease ............................................................................. 5
Effectiveness against hospitalisation ........................................................................................ 6
Effectiveness against mortality ................................................................................................. 6
Effectiveness against infection ................................................................................................. 6
Effectiveness against transmission .......................................................................................... 7
Population impact ........................................................................................................................ 8
Vaccine coverage ..................................................................................................................... 8
Vaccination status .................................................................................................................. 11
Vaccine impact on proportion of population with antibodies to COVID-19.............................. 19
Direct impact on hospitalisations ............................................................................................ 24
Direct and indirect impact on infection and mortality .............................................................. 27
References................................................................................................................................. 31

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COVID-19 vaccine surveillance report – week 37

Summary
Four coronavirus (COVID-19) vaccines have now been approved for use in the UK.
Rigorous clinical trials have been undertaken to understand the immune response,
safety profile and efficacy of these vaccines as part of the regulatory process. Ongoing
monitoring of the vaccines as they are rolled out in the population is important to
continually ensure that clinical and public health guidance on the vaccination programme
is built upon the best available evidence.

Public Health England (PHE) works closely with the Medicines and Healthcare
Regulatory Agency (MHRA), NHS England, and other government, devolved
administration and academic partners to monitor the COVID-19 vaccination programme.
Details of the vaccine surveillance strategy are set on the Public Health England page
COVID-19: vaccine surveillance strategy (1). As with all vaccines, the safety of COVID-
19 vaccines is continuously being monitored by the MHRA. They conclude that overall,
the benefits of COVID-19 vaccines outweigh any potential risks (2).

Vaccine effectiveness
Several studies of vaccine effectiveness have been conducted in the UK which indicate
that two doses of vaccine are between 65 and 95% effective at preventing symptomatic
disease with COVID-19 with the Delta variant, with higher levels of protection against
severe disease including hospitalisation and death. There is some evidence of waning of
protection against infection and symptomatic disease over time, though protection
against severe disease remains high in most groups at least 5 months after the second
dose.

Population impact
The impact of the vaccination programme on the population is assessed by taking into
account vaccine coverage, evidence on vaccine effectiveness and the latest COVID-19
disease surveillance indicators. Vaccine coverage tells us about the proportion of the
population that have received 1 and 2 doses of COVID-19 vaccines. By 12 September
2021, the overall vaccine uptake in England for dose 1 was 64.8% and 58.9% for dose
2. In line with the programme rollout, coverage is highest in the oldest age groups.

We present data on COVID-19 cases, hospitalisations and deaths by vaccination status.

Based on antibody testing of blood donors, 97.7% of the adult population now have
antibodies to COVID-19 from either infection or vaccination compared to 18.9% that
have antibodies from infection alone. Over 95% of adults aged 17 or older have
antibodies from either infection or vaccination.

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COVID-19 vaccine surveillance report – week 37

The latest estimates indicate that the vaccination programme has directly averted over
230,800 hospitalisations. Analysis on the direct and indirect impact of the vaccination
programme on infections and mortality, suggests the vaccination programme has
prevented between 24.4 and 24.9 million infections and between 108,600 and 116,200
deaths.

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COVID-19 vaccine surveillance report – week 37

Vaccine effectiveness
Large clinical trials have been undertaken for each of the COVID-19 vaccines approved
in the UK which found that they are highly efficacious at preventing symptomatic disease
in the populations that were studied. The clinical trials have been designed to be able to
assess the efficacy of the vaccine against laboratory confirmed symptomatic disease
with a relatively short follow up period so that effective vaccines can be introduced as
rapidly as possible. Nevertheless, understanding the effectiveness against different
outcomes (such as severe disease and onwards transmission), effectiveness in different
subgroups of the population and understanding the duration of protection are equally
important in decision making around which vaccines should be implemented as the
programme evolves, who they should be offered to and whether booster doses are
required.

Vaccine effectiveness is estimated by comparing rates of disease in vaccinated

individuals to rates in unvaccinated individuals. Below we outline the latest real-world
evidence on vaccine effectiveness from studies in UK populations. We focus on data
related to the Delta variant which is currently dominant in the UK. The findings are also
summarised in Table 1.

Effectiveness against symptomatic disease

Vaccine effectiveness against symptomatic COVID-19 has been assessed in England
based on community testing data linked to vaccination data from the National
Immunisation Management System (NIMS), cohort studies such as the COVID Infection
Survey and GP electronic health record data. After 2 doses, observed vaccine
effectiveness against symptomatic disease with the Delta variant reaches approximately
65 to 70% with AstraZeneca Vaxzevria and 80 to 95% with Pfizer-BioNTech Comirnaty
and Moderna Spikevax (3, 4) Vaccine effectiveness is generally slightly higher in
younger compared to older age groups. With both Vaxzevria and and Comirnaty, there
is evidence of waning of protection over time, most notably among older adults. There is
not yet enough follow-up with Spikevax to assess waning (3).

Data (based primarily on the Alpha variant) suggest that in most clinical risk groups,
immune response to vaccination is maintained and high levels of VE are seen with both
the Pfizer and AstraZeneca vaccines. Reduced antibody response and vaccine
effectiveness were seen after 1 dose of vaccine among the immunosuppressed group,
however, after a second dose the reduction in vaccine effectiveness is smaller (5).

Analyses by dosing interval suggest that immune response to vaccination and vaccine
effectiveness against symptomatic disease improves with a longer (greater than 6 week
interval) compared to a shorter interval of 3 to 4 weeks (6, 3)

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COVID-19 vaccine surveillance report – week 37

Effectiveness against hospitalisation

Several studies have estimated vaccine effectiveness against hospitalisation in older all
of which indicate higher levels of protection against hospitalisation with all vaccines
against the Alpha variant (7, 8, 9, 10). Effectiveness against hospitalisation of over 90%
is also observed with the Delta variant with all three vaccines (3). In most groups there is
relatively limited waning of protection against hospitalisation over a period of at least 5
months after the second dose. Greater waning appears to occur among those in clinical
risk groups (3).

Effectiveness against mortality

High levels of protection (over 90%) are also seen against mortality with all three
vaccines and against both the Alpha and Delta variants (7, 11, 3). Relatively limited
waning of protection against mortality is seen over a period of at least 5 months.

Effectiveness against infection

Although individuals may not develop symptoms of COVID-19 after vaccination, it is
possible that they could still be infected with the virus and could transmit to others.
Understanding how effective vaccines are at preventing infection is therefore important
to predict the likely impact of the vaccination programme on the wider population. In
order to estimate vaccine effectiveness against infection, repeat asymptomatic testing of
a defined cohort of individuals is required. Studies have now reported on vaccine
effectiveness against infection in healthcare workers, care home residents and the
general population (12, 13, 14, 15). With the delta variant, vaccine effectiveness against
infection has been estimated at around 65% with Vaxzevria and 80% with Comirnaty (4).

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COVID-19 vaccine surveillance report – week 37

Effectiveness against transmission

As described above, several studies have provided evidence that vaccines are effective
at preventing infection. Uninfected individuals cannot transmit; therefore, the vaccines
are also effective at preventing transmission. Data from Scotland has also shown that
household contacts of vaccinated healthcare workers are at reduced risk of becoming a
case, which is in line with the studies on infection (16). There may be additional benefit,
beyond that due to prevention of infection, if some of those individuals who become
infected despite vaccination are also at a reduced risk of transmitting (for example,
because of reduced duration or level of viral shedding). A household transmission study
in England found that household contacts of cases vaccinated with a single dose had
approximately 35 to 50% reduced risk of becoming a confirmed case of COVID-19. This
study used routine testing data so would only include household contacts that developed
symptoms and went on to request a test via pillar 2. It cannot exclude asymptomatic
secondary cases or mildly symptomatic cases who chose not to request a COVID-19
test (17). Both of these studies relate to a period when the Alpha variant dominated.

Table 1. Summary of evidence on vaccine effectiveness against different outcomes

Delta

Vaccine effectiveness*
Outcome Pfizer-BioNTech AstraZeneca Moderna
Cominarty Vaxzevria Spikevax
Infection 75-85% 60-70%
Symptomatic
80-90% 65-75% 90-99%
disease
Hospitalisation 95-99% 90-99% 95-99%
Mortality 90-99% 90-95%

High Evidence from multiple studies which is consistent

Confidence and comprehensive
Medium Evidence is emerging from a limited number of
Confidence studies or with a moderately level of uncertainty
Low Little evidence is available at present and results are
Confidence inconclusive

* Estimates of initial vaccine effectiveness in the general population after a 2 dose

course. This typically applies for at least the first 3 to 4 months after vaccination. For
some outcomes there may be waning of effectiveness beyond this point.

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COVID-19 vaccine surveillance report – week 37

Population impact
Vaccines typically have both direct effects on those who are vaccinated and indirect
effects on the wider population due to a reduced probability that people will come
into contact with an infected individual. The overall impact of the vaccination programme
may therefore extend beyond that estimated through vaccine effectiveness analysis.

Estimating the impact of a vaccination programme is challenging as there is no

completely unaffected control group. Furthermore, the effects of the vaccination
programme need to be differentiated from that of other interventions (for example,
lockdowns or outbreak control measures), changes in behaviour and any seasonal
variation in COVID-19 activity.

PHE and other government and academic partners monitor the impact of the of the
vaccination programme on levels of COVID-19 antibodies in the population and different
disease indicators, including hospitalisations and mortality. This is done through
population-based testing and through modelling which combines vaccine coverage rates
in different populations, estimates of vaccine effectiveness and disease surveillance
indicators.

Vaccine coverage
The data in this week’s report covers the period from 8 December 2020 to 12 September
2021 (week 36) (Figure 1). It shows the provisional number and percentage of people in
England who have had received 1 dose or 2 doses of a COVID-19 vaccination by age
group and week since the start of the programme.

Up to 31 August 2021 81,532 women of child-bearing age in England (under 50) who
reported that they were pregnant or could be pregnant at the time, received at least 1
dose of COVID-19 vaccination and of these, 65,579 have received their second dose.
This is in response to the self-reported pre-screening question “Are you or could you be
pregnant?”. The true number of pregnant women who have had a COVID-19 vaccination
is likely to be greater than this.

Please note that pregnant women are not a separate priority group as defined by JCVI
who have advised that “women who are pregnant should be offered vaccination at the
same time as non-pregnant women, based on their age and clinical risk group” therefore
comparing vaccine uptake in pregnant women to other vaccination programmes is not
currently appropriate. The MHRA closely monitors the safety of COVID-19 vaccine
exposures in pregnancy, including Yellow Card reports for COVID-19 vaccines used in
pregnancy, for the latest information please see the webpage Coronavirus vaccine –
weekly summary of Yellow Card reporting.

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COVID-19 vaccine surveillance report – week 37

Figure 1. Cumulative weekly vaccine uptake by age

a) Dose 1
Over 80 75 to under 80 70 to under 75 65 to under 70 60 to under 65 55 to under 60 50 to under 55 45 to under 50
40 to under 45 35 to under 40 30 to under 35 25 to under 30 18 to under 25 16 to under 18 Under 16
100.0

90.0

80.0

70.0

60.0
% vaccine uptake

50.0

40.0

30.0

20.0

10.0

0.0
50 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

Week number
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COVID-19 vaccine surveillance report – week 37

b) Dose 2

Over 80 75 to under 80 70 to under 75 65 to under 70 60 to under 65 55 to under 60 50 to under 55 45 to under 50

40 to under 45 35 to under 40 30 to under 35 25 to under 30 18 to under 25 16 to under 18 Under 16

100.0

90.0

80.0

70.0

60.0
% vaccine uptake

50.0

40.0

30.0

20.0

10.0

0.0
50 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

Week number

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COVID-19 vaccine surveillance report – week 37

Vaccination status
Vaccination status of COVID-19 cases, deaths and hospitalisations by week of
specimen date over the past 4 weeks up to week 36 (up to 12 September 2021) are
shown in Table 2 to 4 and Figure 2.

Methods
COVID-19 cases and deaths identified through routine collection from the Second
Generation Surveillance System (SGSS) and from PHE EpiCell's deaths data as
described here, were linked to the National Immunisation Management System (NIMS)
to derive vaccination status, using an individual’s NHS number as the unique identifier.

Attendance to emergency care at NHS trusts was derived from the Emergency Care
DataSet (ECDS) managed by NHS Digital. The same data source was used to identify
COVID-19 cases where the attendance to emergency care resulted in admission to an
NHS trust.

ECDS is updated weekly, and cases are linked to these data twice weekly. Data from
ECDS are subject to reporting delays as, although NHS trusts may update data daily,
the mandatory deadline for submission is by the 21st of every month. This means that
for weeks immediately following the 21st of a month, numbers may be artificially low and
are likely to be higher in later versions of the report.

Data from ECDS also only report on cases who have been presented to emergency care
and had a related overnight patient admission and do not show those who are currently
in hospital with COVID-19. As such, it is not appropriate for use for surveillance of those
currently hospitalised with COVID-19. In addition, these data will not show cases who
were directly admitted as inpatients without presenting to emergency care.

The outcome of overnight inpatient admission following presentation to emergency care,

was limited to those occurring within 28 days of the earliest specimen date for a COVID-
19 case.

Deaths include those who died (a) within 28 days of the earliest specimen date or (b)
within 60 days of the first specimen date or more than 60 days after the first specimen
date with COVID-19 mentioned on the death certificate.

The rate of COVID-19 cases, hospitalisation, and deaths in fully vaccinated and
unvaccinated groups was calculated using vaccine coverage data for each age group
extracted from the National Immunisation Management Service.

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COVID-19 vaccine surveillance report – week 37

Results
The rate of a positive COVID-19 test varies by age and vaccination status. The rate of a
positive COVID-19 test is substantially lower in vaccinated individuals compared to
unvaccinated individuals up to the age of 39, and in those aged greater than 80. In
individuals aged 40 to 79, the rate of a positive COVID-19 test is higher in vaccinated
individuals compared to unvaccinated. This is likely to be due to a variety of reasons,
including differences in the population of vaccinated and unvaccinated people as well as
differences in testing patterns.

The rate of hospitalisation within 28 days of a positive COVID-19 test also increases with
age, and is substantially greater in unvaccinated individuals compared to vaccinated
individuals.

The rate of death within 28 days or within 60 days of a positive COVID-19 test increases
with age, and again is substantially greater in unvaccinated individuals compared to fully
vaccinated individuals.

Interpretation of the data

These data should be considered in the context of vaccination status of the population
groups shown in the rest of this report. The vaccination status of cases, inpatients and
deaths is not the most appropriate method to assess vaccine effectiveness and there is
a high risk of misinterpretation. Vaccine effectiveness has been formally estimated from
a number of different sources and is described earlier in this report.

In the context of very high vaccine coverage in the population, even with a highly
effective vaccine, it is expected that a large proportion of cases, hospitalisations and
deaths would occur in vaccinated individuals, simply because a larger proportion of the
population are vaccinated than unvaccinated and no vaccine is 100% effective. This is
especially true because vaccination has been prioritised in individuals who are more
susceptible or more at risk of severe disease. Individuals in risk groups may also be
more at risk of hospitalisation or death due to non-COVID-19 causes, and thus may be
hospitalised or die with COVID-19 rather than because of COVID-19.

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COVID-19 vaccine surveillance report – week 37

Table 2. COVID-19 cases by vaccination status between week 33 and week 36 2021

Received Received
Second Rates among
one dose one dose, Rates among
Cases reported by dose ≥14 persons
Not (1-20 days ≥21 days persons not
specimen date between Total Unlinked* days before vaccinated
vaccinated before before vaccinated
week 33 and week 36 2021 specimen with 2 doses
specimen specimen (per 100,000)
date (per 100,000)
date) date
Under 18 190,863 16,825 161,418 9,812 1,999 809 458.2 1,362.3
18-29 145,087 15,923 44,455 3,280 50,338 31,091 633.3 1,284.9
30-39 105,839 11,081 31,577 1,225 17,273 44,683 795.9 1,069.8
40-49 98,990 8,593 14,570 426 5,215 70,186 1,157.3 852.6
50-59 84,468 6,559 7,215 145 2,080 68,469 972.1 699.2
60-69 46,557 3,462 2,592 51 766 39,686 699.5 477.7
70-79 26,937 2,012 918 8 260 23,739 512.3 371.1
80+ 12,563 1,142 540 9 256 10,616 412.3 424.5

*individuals whose NHS numbers were unavailable to link to the NIMS

** Interpretation of the case rates in vaccinated and unvaccinated population is particularly susceptible to changes in
denominators and should be interpreted with extra caution.

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COVID-19 vaccine surveillance report – week 37

Table 3. COVID-19 cases presenting to emergency care (within 28 days of a positive specimen) resulting in an
overnight inpatient admission by vaccination status between week 33 and week 36 2021

Cases presenting to
emergency care (within Received Received Second
Rates among
28 days of a positive one dose one dose, dose ≥14 Rates among
persons
test) resulting in Not (1-20 days ≥21 days days persons not
Total Unlinked* vaccinated
overnight inpatient vaccinated before before before vaccinated
with 2 doses
admission, by specimen specimen specimen specimen (per 100,000)
(per 100,000)
date between week 33 date) date date
and week 36 2021
Under 18 539 29 494 13 3 0 0.0 4.2
18-29 635 19 414 17 86 99 2.0 12.0
30-39 848 17 608 14 66 143 2.5 20.6
40-49 903 26 551 10 50 266 4.4 32.2
50-59 1,147 12 533 6 41 555 7.9 51.7
60-69 1,239 14 403 7 50 765 13.5 74.3
70-79 1,517 2 239 3 25 1,248 26.9 96.6
80+ 1,528 2 183 1 42 1,300 50.5 143.9

*individuals whose NHS numbers were unavailable to link to the NIMS

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COVID-19 vaccine surveillance report – week 37

Table 4. COVID-19 deaths (a) within 28 days and (b) within 60 days of positive specimen or with COVID-19 reported
on death certificate, by vaccination status between week 33 and week 36 2021

(a)

Received Received
Second Rates among
Death within 28 days of one dose one dose, Rates among
dose ≥14 persons
positive COVID-19 test by Not (1-20 days ≥21 days persons not
Total Unlinked* days before vaccinated
date of death between vaccinated before before vaccinated
specimen with 2 doses
week 33 and week 36 2021 specimen specimen (per 100,000)
date (per 100,000)
date) date

Under 18 4 1 3 0 0 0 0.0 0.0

18-29 18 0 13 0 1 4 0.1 0.4
30-39 50 2 36 0 3 9 0.2 1.2
40-49 114 3 75 0 7 29 0.5 4.4
50-59 240 5 126 0 16 93 1.3 12.2
60-69 391 9 132 1 18 231 4.1 24.3
70-79 742 2 156 0 28 556 12.0 63.1
80+ 1,402 7 185 4 34 1,172 45.5 145.4

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COVID-19 vaccine surveillance report – week 37

(b)

Received Received
Second Rates among
Death within 60 days of one dose one dose, Rates among
dose ≥14 persons
positive COVID-19 test** Not (1-20 days ≥21 days persons not
Total Unlinked* days before vaccinated
by date of death between vaccinated before before vaccinated
specimen with 2 doses
week 33 and week 36 2021 specimen specimen (per 100,000)
date (per 100,000)
date) date

Under 18 5 1 4 0 0 0 0.0 0.0

18-29 26 0 16 1 4 5 0.1 0.5
30-39 63 2 44 0 4 13 0.2 1.5
40-49 149 3 93 0 14 39 0.6 5.4
50-59 294 5 151 0 17 121 1.7 14.6
60-69 474 10 171 1 22 270 4.8 31.5
70-79 841 2 173 0 33 633 13.7 69.9
80+ 1,604 7 198 4 46 1,349 52.4 155.7

*individuals whose NHS numbers were unavailable to link to the NIMS

** Number of deaths of people who had had a positive test result for COVID-19 and either died within 60 days of the first
positive test or have COVID-19 mentioned on their death certificate

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COVID-19 vaccine surveillance report – week 37

Figure 2. Rates (per 100,000) by vaccination status from week 33 to week 36 2021

(a) COVID-19 cases

1,600.0

1,400.0

1,200.0
Rate per 100,000

1,000.0

800.0

600.0

400.0

200.0

0.0
Under 18 18-29 30-39 40-49 50-59 60-69 70-79 80+
Age group

Vaccinated with at least 2 doses Unvaccinated

(b) Cases presenting to emergency care (within 28 days of a positive test) resulting in
overnight inpatient admission
160.0

140.0

120.0
Rate per 100,000

100.0

80.0

60.0

40.0

20.0

0.0
Under 18 18-29 30-39 40-49 50-59 60-69 70-79 80+
Age group

Vaccinated with at least 2 doses Unvaccinated

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COVID-19 vaccine surveillance report – week 37

(c) Death within 28 days of positive COVID-19 test

160.0

140.0

120.0
Rate per 100,000

100.0

80.0

60.0

40.0

20.0

0.0
Under 18 18-29 30-39 40-49 50-59 60-69 70-79 80+
Age group

Vaccinated with at least 2 doses Unvaccinated

(d) Death within 60 days of positive COVID-19 test

180.0

160.0

140.0

120.0
Rate per 100,000

100.0

80.0

60.0

40.0

20.0

0.0
Under 18 18-29 30-39 40-49 50-59 60-69 70-79 80+
Age group

Vaccinated with at least 2 doses Unvaccinated

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COVID-19 vaccine surveillance report – week 37

Vaccine impact on proportion of population with

antibodies to COVID-19
PHE monitors the proportion of the population with antibodies to COVID-19 by testing
samples provided by healthy adult blood donors aged 17 years and older, supplied by
the NHS Blood and Transplant (NHS BT collection). This is important in helping to
understand the extent of spread of COVID-19 infection (including asymptomatic
infection) in the population and the impact of the vaccine programme. 250 samples from
every geographic region in England are tested each week using 2 different laboratory
tests, the Roche nucleoprotein (N) and Roche spike (S) antibody assays. This dual
testing helps to distinguish between antibodies that are produced following natural
COVID-19 infection and those that develop after vaccination. Nucleoprotein (Roche N)
assays only detect post-infection antibodies, whereas spike (Roche S) assays will detect
both post-infection antibodies and vaccine-induced antibodies. Thus, changes in the
proportion of samples testing positive on the Roche N assay will reflect the effect of
natural infection and spread of COVID-19 in the population. Increases in the proportion
positive as measured by S antibody will reflect both infection and vaccination. Antibody
responses reflect infection or vaccination occurring at least 2 to 3 weeks previously
given the time taken to generate an antibody response.

In this report, we present the results using a 4-weekly average, of testing samples up to
3 September 2021, which takes account of the age and geographical distribution of the
English population. Overall, the proportion of the population with antibodies using the
Roche N and Roche S assays respectively were 18.9% and 97.7% for the period 12
August to 3 September (weeks 32 to 35) (Figure 3). This compares with 18.1% Roche N
seropositivity and 97.6% Roche S seropositivity for the period of 12 July to 6 August
(weeks 28 to 31).

The continuing increase in seropositivity using the Roche S assay reflects the growing
proportion of adults who have developed antibodies following vaccination.

Figure 4a and 4b show the proportion of the population with antibodies by age group.
Recent increases in N seropositivity has been observed in some age groups. Roche N
seropositivity in individuals aged 17 to 29 years increased slightly from 27.3% in weeks
28 to 31 to 28.7% in weeks 32 to 35. Small increases were observed in the 30 to 39 year
olds from 19.6% in weeks 28 to 31 to 21.5% in weeks 32 to 35 and in 40 to 49 years
olds from 19.6% in weeks 28 to 31 to 20.4% in weeks 32 to 35. Similarly, small
increases were also observed in 50 to 59 year olds from 17.1% in weeks 28 to 31 to
17.9% in weeks 32 to 35 and in individuals aged 60 to 69 from 11.7% in weeks 28 to 31
to 12.2% in weeks 32 to 35. Roche N seropositivity decreased in 70 to 84 year olds from
8.2% in weeks 28 to 31 to 7.2% in weeks 32 to 35.

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COVID-19 vaccine surveillance report – week 37

The pattern of increases in Roche S seropositivity which are observed follow the roll out
of the vaccination programme with the oldest age groups offered vaccine first. (Figure
4b). Roche S seropositivity increased first in donors aged 70 to 84 and has plateaued
since week 13, reaching 99.0% in weeks 32 to 35. Seropositivity has also plateaued
since week 16 for those aged 60 to 69 reaching 99.1% in weeks 32 to 35. Plateauing in
Roche S seropositivity has been observed since week 19 in those aged 50 to 59
reaching 99.0% in weeks 32 to 35 2021. A plateauing in seropositivity has been
observed in the 40 to 49-year olds since week 23 reaching 97.8% in weeks 32 to 35.
Plateauing has been observed in the 30 to 39 year olds from week 28 reaching 96.6% in
weeks 32 to 35. A plateauing in seropositivity has recently been observed in the 17 to 29
year olds reaching 95.8% in weeks 32 to 35 2021.

The impact of the vaccination programme is clearly evident from the increases in the
proportion of the adult population with antibodies based on Roche S testing. This is was
evident initially amongst individuals aged 50 years and above who were prioritised for
vaccination as part of the phase 1 programme and since week 15 in younger adults and
below as part of phase 2 of the vaccination programme.

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COVID-19 vaccine surveillance report – week 37

Figure 3. Overall population weighted 4-weekly rolling SARS-CoV-2 antibody seroprevalence (% seropositive) in blood
donors from the Roche S and Roche N assays.

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COVID-19 vaccine surveillance report – week 37

Figure 4. Population weighted 4-weekly rolling SARS-CoV-2 antibody seroprevalence (% seropositive) in blood donors
from the Roche S and Roche N assays by a) age groups 17 to 29, 30 to 39 and 40 to 49, b) age group 50 to 59, 60 to 69
and 70 to 84.

a)
100
95
90
85
80
75
70
65
% seropositive

60
55
50
45
40
35
30
25
20
15
10
5
0
35 37 39 41 43 45 47 49 51 53 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34
week (4-week period mid point)
17-29 N 30-39 N 40-49 N
17-29 S 30-39 S 40-49 S

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COVID-19 vaccine surveillance report – week 37

b)

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COVID-19 vaccine surveillance report – week 37

Direct impact on hospitalisations

The number of hospitalisations averted by vaccination, can be estimated by considering
vaccine effectiveness against hospitalisation, vaccine coverage and observed
hospitalisations and through modelling using a range of parameters.

For the week 35 report the vaccine effectiveness estimates used in the model were
updated to use more recent vaccine effective estimates. The vaccine effectiveness
estimates used in previous reports were slightly lower than the current estimates,
therefore an increase in the number of hospitalisations averted was seen in the week 35
report compared to previous reports.

PHE estimates to 5 September 2021 based on the direct effect of vaccination and
vaccine coverage rates, are that around 178,900 hospitalisations have been prevented
in those aged 65 years and over in England (approximately 46,500 admissions in those
aged 65 to 74, 73,800 in those aged 75 to 84, and 58,600 in those aged 85 and over) as
a result of the vaccination programme (Figure 5).

From week 36, we are adding the analysis on hospitalisations averted in 45 to 64 years.
PHE estimates to 5 September 2021 based on direct effects of vaccination and
coverage rates show that around 51,900 hospitalisations have been prevented in this
age group. This age group is inclusive of healthy individuals and at risk groups, the
latter prioritised earlier in the campaign.

In total, around 230,800 hospitalisations have been prevented in those aged 45 years
and over up to 5 September 2021.

There is increasing evidence that vaccines prevent infection and transmission. The
indirect effects of the vaccination programme will not be incorporated in this analysis,
therefore the figure of 230,800 hospitalisations averted is likely to be an underestimate.

Please note this analysis will be updated every 2 weeks.

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COVID-19 vaccine surveillance report – week 37

Figure 5. Plot of daily observed and expected COVID-19 hospitalisations in (a) adults aged 65 and over (b) adults aged
45 to 64
(a)
4000 100%

Percentage vaccine coverage (cumulative)

90%
3500
80%
3000
70%
Number of hospitalisations

2500
60%

2000 50%

40%
1500
30%
1000
20%
500
10%

0 0%

Date
Observed Expected
D1 Coverage 85+ (25 days earlier) D2 Coverage 85+ (11 days earlier)
D1 Coverage 75-84 (25 days earlier) D2 Coverage 75-84 (11 days earlier)
D1 Coverage 65-74 (25 days earlier) D2 Coverage 65-74 (11 days earlier)

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COVID-19 vaccine surveillance report – week 37

(b)
1400 100%

Percentage vaccine coverage (cumulative)

90%
1200
80%
1000 70%
Number of hospitalisations

60%
800
50%
600
40%

400 30%

20%
200
10%

0 0%

Date
Observed Expected

D1 Coverage 45-64y (25 days earlier) D2 Coverage 45-64y (11 days earlier)

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COVID-19 vaccine surveillance report – week 37

Direct and indirect impact on infection and mortality

The PHE and Cambridge real-time model has been used to track the COVID-19
infection throughout the pandemic, providing key epidemic insights, including estimation
of the reproduction number, R, to the Scientific Pandemic Influenza subgroup on
Modelling (SPI-M) and to the Scientific Advisory Group on Emergencies (SAGE). The
application to data from the first wave has been published in Real-time nowcasting and
forecasting of COVID-19 dynamics in England: the first wave (18). Since the first wave,
the model has been constantly improved to capture the pandemic activity as it develops,
in particular to account for the impacts, both direct and indirect, of the vaccination
programme. The direct impact of vaccination is the number of deaths saved in those that
get infected, whereas the indirect effect incorporates the additional prevention of
infections. The history of real-time modelling outputs can be found at Nowcasting and
Forecasting of the COVID-19 Pandemic (19), with the most recent results on which the
figures here are based is currently available at COVID-19: nowcast and forecast (20).

Vaccination rates in the model are based on the actual number of doses administered,
and the vaccine is assumed to reduce susceptibility to COVID-19 as well as mortality
once infected. Estimates for vaccine efficacy are based on the best available published
results (21). The model is fitted to both ONS prevalence and daily COVID-19 mortality
data in England, resulting in posterior samples for a range of epidemiological
parameters. To infer the impact of vaccination, the posterior samples are used to
simulate the number of infections and deaths that would have occurred without
vaccination (Figure 6). The total impact is then calculated by comparing the infection and
mortality estimates with vaccination versus the simulated outcomes without vaccination
(Figure 7; Table 5).

The no-vaccination scenario assumes that no other interventions are implemented to

reduce incidence and mortality. Therefore, the findings presented here should be
interpreted as the impact of the vaccination programme on infection and mortality
assuming no additional non-pharmaceutical interventions were implemented. In practice,
it is impossible to predict what interventions would have been implemented in the
absence of vaccination, although it is reasonable to assume that lockdown measures
would have remained in place for substantially longer and that new lockdown measures
would have been put into place to reduce the pandemic's impact. Similarly, it is likely
that people's behaviour would have changed in response to the rising cases and deaths.

Consequently, over time the state of the actual pandemic and the no-vaccination
pandemic will become increasingly less comparable. For example, recent results from
the no-vaccination scenario show that the pandemic in the absence of vaccination and
additional interventions would have peaked due to natural immunity. Therefore,
reinfections will become more important, but data on the risk and severity of reinfections
is still lacking. Similarly, the arrival and spread of new strains will be different in the 2
scenarios, making it harder to predict what would have happened in the no-vaccination

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COVID-19 vaccine surveillance report – week 37

scenario. This means that the comparison shown here becomes less meaningful as time
goes on.

In conclusion, this means that the no-vaccination scenario captures what would have
happened in the absence of additional interventions to mitigate the pandemic, public
behaviour had stayed the same, and the timing of the introduction of new viral strains
(that is, the delta variant) had not changed. Results should be interpreted accordingly.

The work presented in this section is joint work completed by PHE and Cambridge
University’s MRC Biostatistics Unit.

Estimates suggest that 112,300 deaths and 24,702,000 infections have been prevented
as a result of the COVID-19 vaccination programme, up to 27 August. Please note this
analysis has not been updated since last week’s report.

Table 5. Inferred reduction in infections and mortality as the result of vaccination

up to 27 August 2021. (Infections are rounded to the nearest 1,000, deaths to the
nearest 100).

Model Outcome Reduction

ONS/Death Infection 24,702,000 [ 24,465,000 to 24,966,000]

ONS/Death Mortality 112,300 [ 108,600 to 116,200]

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COVID-19 vaccine surveillance report – week 37

Figure 6. Inferred and predicted incidence, mortality and prevalence with and without vaccination in England. This is presented
on a log scale

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COVID-19 vaccine surveillance report – week 37

Figure 7. Averted number of infections (left) and deaths (right) due to vaccination (cumulatively)

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COVID-19 vaccine surveillance report – week 37

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infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort

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Website: www.gov.uk/phe
Twitter: @PHE_uk
Facebook: www.facebook.com/PublicHealthEngland

© Crown copyright 2021

Published: 16 September 2021

PHE gateway number: GOV-9794

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