These emergency authorizations of use are summarized in the World Health Organization (WHO) Emergency Use Listing: Pfizer/BioNTech (US, EU, UK, WHO), Moderna (US, EU, UK), AstraZeneca (EU, UK), Janssen (US, EU), and Gamaleya (Russian Ministry of Health), Sinopharm and Sinovac (National Medical Products Administration (NMPA), China) 5. As of mid-2021, seven COVID-19 vaccines have received emergency use authorization (EUA) in different countries, including United States (US), European Union (EU), United Kingdom (UK). Within less than two years period, there are more than 300 vaccine candidates globally, 117 vaccines in different clinical stages of development, including 30 of them in phase 3 5. Shortly after the start of the SARS-Cov-2 outbreak, scientists began racing to develop an effective and safe vaccine against SARS-CoV-2, based on new and old vaccines technologies 4. Until recently, vaccine development was considered a long and complicated process, lasting for decades before the product has been approved for clinical use 3. From the beginning of the pandemic, global efforts have been focused on developing safe and efficacious vaccines for COVID-19 prevention. Within a short period, it became clear that the way to deal with the current pandemic is an effective therapy for severe COVID-19 patients together with preventing SARS-Cov-2 spread through population vaccination. Despite numerous global efforts to mitigate the pandemic for almost two years, the SARS-CoV-2 continues to spread, disrupting life's routine, causing very high morbidity (above 225 million confirmed cases) and mortality (more than four and half million deaths) worldwide as of Septem2. It causes highly infectious Coronavirus Disease 2019 (COVID-19) to spread worldwide and became a global pandemic. In December 2019, a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected in Wuhan, China 1. This finding may have importance when deciding which vaccine to use, together with other important factors as availability of the vaccines, costs, logistics, side effects, and patient acceptability. In our indirect comparison, the BNT162b2 and mRNA-1273 vaccines, which use mRNA technology, were associated with the highest efficacy to prevent symptomatic COVID-19 compared to other vaccines. No vaccine was statistically significantly associated with a decreased risk for severe COVID-19 than other vaccines, although mRNA-1273 and Gam-COVID-Vac have the highest P-scores (0.899 and 0.816, respectively), indicating greater protection against severe disease than other vaccines. No statistically significant difference was seen in the ability of the vaccines to prevent symptomatic disease in the elderly population. While each of nine vaccines was tested in the unique clinical trial as compared to control, based on indirect comparison, BNT162b2 and mRNA-1273 vaccines were ranked with the highest probability of efficacy against symptomatic COVID-19 (P-scores 0.952 and 0.843, respectively), followed by Gam-COVID-Vac (P-score 0.782), NVX-CoV23730 (P-score 0.700), CoronaVac (P-score 0.570), BN02 (P-score 0.428), WIV04 (P-score 0.327), and (P-score 0.198). Above 200,000 adult participants from eight phase 3 RCTs were included in NMA, of whom 52% received the intervention (active COVID-19 vaccine). The primary outcomes were the efficacy of the vaccine against symptomatic COVID-19 in adults (PROSPERO registration number: CRD42021235364). We performed a network meta-analysis (NMA) according to PRISMA-NMA 2015 to pool indirect comparisons between different vaccines regarding their relative efficacy. The risk of bias was evaluated using the Cochrane Risk of Bias Assessment Tool. Two reviewers independently evaluated the literature search results and independently extracted summary data. Published phase 3 randomized controlled trials (RCTs) evaluated efficacy of the vaccine to prevent symptomatic and sever COVID-19 in adults were included. Leading medical databases were searched until August 30, 2021. We compared the efficacy of new COVID-19 vaccines to prevent symptomatic and severe disease in the adult population and to prevent symptomatic COVID-19 among the elderly. New Coronavirus Disease 2019 (COVID-19) vaccines are available to prevent the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.
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