Likelihood of infecting or getting infected with COVID-19 as a function of vaccination status, as investigated with a stochastic model for Aotearoa New Zealand for Delta and Omicron variants.

ABSTRACT

AIM: The New Zealand Government has transitioned from the Alert Level framework, which relied on Government action and population level controls, to the COVID-19 Protection Framework, which relies on vaccination rates and allows for greater freedoms (for the vaccinated). Under the COVID-19 Protection Framework with and current widespread community transmission of Omicron, there is significant interest in understanding the relative risk of spreading COVID-19 posed by unvaccinated, vaccinated, and boosted individuals. METHODS: A stochastic branching process model is used to simulate the spread of COVID-19 for outbreaks seeded by unvaccinated, vaccinated, or boosted individuals. The likelihood of infecting or getting infected with COVID-19 is calculated based on vaccination status. The model is applied to both the Delta and Omicron variants. RESULTS: For the Delta variant, a vaccinated traveller infected with COVID-19 is 9x less likely to seed an outbreak than an unvaccinated traveller infected with COVID-19; however, for the Omicron variant, there is little difference between outbreaks seeded by unvaccinated and vaccinated individuals (boosted individuals are slightly less likely to seed large outbreaks). For the Delta variant, unvaccinated individuals are responsible for 87% of all infections whereas only 3% of infections are from vaccinated-to-vaccinated when normalised by population. Therefore, a vaccinated individual is 6.8x more likely to be infected by an unvaccinated individual than by a vaccinated individual. For the Omicron variant, unvaccinated individuals are responsible for 45% of all infections compared to 39% for vaccinated (two doses) and 15% for boosted (three doses) individuals when normalised by population. Despite the vaccine being less effective at preventing breakthrough transmission for Omicron, only 3% of all infections are from boosted-to-boosted individuals when normalised by population, indicating that three doses of the vaccine provides good protection from infection and breakthrough transmission. CONCLUSIONS: This work demonstrates that most new infections are caused by unvaccinated individuals, especially for the Delta variant. These simulations illustrate the importance of vaccination in stopping individuals from becoming infected with COVID-19 and in preventing onward transmission. For Omicron, individuals vaccinated with two doses are only slightly less likely to spread COVID-19 than those who are unvaccinated. This work suggests that for the current Omicron outbreak the COVID-19 Protection Framework be updated to distinguish between those who have received two primary doses of the Pfizer-BioNTech vaccine (vaccinated individuals) and those who have received three doses (boosted individuals).