How effective is the BNT162b2 mRNA vaccine against SARS-CoV-2 transmission and infection? A national programme analysis in Monaco, July 2021 to September 2022.

BACKGROUND: We quantified SARS-CoV-2 dynamics in different community settings and the direct and indirect effect of the BNT162b2 mRNA vaccine in Monaco for different variants of concern (VOC). METHODS: Between July 2021 and September 2022, we prospectively investigated 20,443 contacts from 6320 index cases using data from the Monaco COVID-19 Public Health Programme. We calculated secondary attack rates (SARs) in households (n = 13,877), schools (n = 2508) and occupational (n = 6499) settings. We used binomial regression with a complementary log-log link function to measure adjusted hazard ratios (aHR) and vaccine effectiveness (aVE) for index cases to infect contacts and contacts to be infected in households. RESULTS: In households, the SAR was 55% (95% CI 54-57) and 50% (48-51) among unvaccinated and vaccinated contacts, respectively. The SAR was 32% (28-36) and 12% (10-13) in workplaces, and 7% (6-9) and 6% (3-10) in schools, among unvaccinated and vaccinated contacts respectively. In household, the aHR was lower in contacts than in index cases (aHR 0.68 [0.55-0.83] and 0.93 [0.74-1.1] for delta; aHR 0.73 [0.66-0.81] and 0.89 [0.80-0.99] for omicron BA.1&2, respectively). Vaccination had no significant effect on either direct or indirect aVE for omicron BA.4&5. The direct aVE in contacts was 32% (17, 45) and 27% (19, 34), and for index cases the indirect aVE was 7% (- 17, 26) and 11% (1, 20) for delta and omicron BA.1&2, respectively. The greatest aVE was in contacts with a previous SARS-CoV-2 infection and a single vaccine dose during the omicron BA.1&2 period (45% [27, 59]), while the lowest were found in contacts with either three vaccine doses (aVE - 24% [- 63, 6]) or one single dose and a previous SARS-CoV-2 infection (aVE - 36% [- 198, 38]) during the omicron BA.4&5 period. CONCLUSIONS: Protection conferred by the BNT162b2 mRNA vaccine against transmission and infection was low for delta and omicron BA.1&2, regardless of the number of vaccine doses and previous SARS-CoV-2 infection. There was no significant vaccine effect for omicron BA.4&5. Health authorities carrying out vaccination campaigns should bear in mind that the current generation of COVID-19 vaccines may not represent an effective tool in protecting individuals from either transmitting or acquiring SARS-CoV-2 infection.

Participatory approaches to reaching the Sustainable Development Goals: Monaco: “Vers Monaco sans sida”: an integrated policy on HIV/AIDS

Monaco has been implementing an integrated policy on combating HIV/AIDS since 1988 and continues to expand it. The policy has resulted in setting up a free, anonymous screening centre, organizing prevention and screening campaigns in schools and businesses and through the media, and mobilizing civil society through associations, such as Fight Aids Monaco, which is chaired by H.S.H. Princess Stéphanie in partnership with the public authorities. In 2018, Monaco became a member of the Fast Track Cities network and signed the Paris Declaration “Vers Monaco sans sida”, committing to the pursuit and implementation of new action towards achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 90-90-90 treatment for all to help end the AIDS epidemic. It is hoped that “Vers Monaco sans sida” will surpass its objectives. Monaco’s integrated policy to combat HIV/AIDS mainly addresses Sustainable Development Goal (SDG) 3 (good health and well-being), specifically target 3.3. It also covers four of the five strategic directions of the “Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being”, namely: advancing governance and leadership, by working towards making links between all relevant stakeholders; leaving no one behind, by opening up access to screening and treatment for all and focusing on providing support and social follow-up for patients; preventing diseases and promoting a multisectoral and lifelong approach with the involvement of stakeholders from different sectors, as well as starting early, targeting youth; and strengthening the road to universal health coverage by offering free-of-charge services for all.