The role of mild and asymptomatic infections on COVID-19 vaccines performance: A modeling study.

Introduction: Different COVID-19 vaccine efficacies are reported, with remarkable effectiveness against severe disease. The so called sterilizing immunity, occurring when vaccinated individuals cannot transmit the virus, is still being evaluated. It is also unclear to what extent people with no symptoms or mild infection transmit the disease, and estimating their contribution to outbreaks is challenging.

Objective: With an uneven roll out of vaccination, the purpose of this study is to investigate the role of mild and asymptomatic infections on COVID-19 vaccine performance as vaccine efficacy and vaccine coverage vary.

Methods: We use an epidemiological SHAR (Susceptible-Hospitalized-Asymptomatic-Recovered) model framework to evaluate the effects of vaccination in different epidemiological scenarios of coverage and efficacy. Two vaccination models, the vaccine V protecting against severe disease, and the vaccine V, protecting against infection as well as severe disease, are compared to evaluate the reduction of overall infections and hospitalizations.

Results: Vaccine performance is driven by the ability of asymptomatic or mild disease cases transmitting the virus. Vaccines protecting against severe disease but failing to block transmission might not be able to reduce significantly the severe disease burden during the initial stage of a vaccination roll out programme, with an eventual increase on the number of overall infections in a population.

Conclusion: The different COVID-19 vaccines currently in use have features placing them closer to one or the other of these two extreme cases, V and V, and insights on the importance of asymptomatic infection in a vaccinated population are of a major importance for the future planning of vaccination programmes. Our results give insights on how to best combine the use of the available COVID-19 vaccines, optimizing the reduction of hospitalizations.