Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

INTRODUCTION

The mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in phase 3 clinical trials, including among older adults. To inform coronavirus disease 2019 (COVID-19) vaccine selection, this systematic literature review (SLR) and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 in older adults.

METHODS

We systematically searched for relevant studies reporting COVID-19 outcomes with mRNA vaccines in older adults aged ≥ 50 years by first cross-checking relevant published SLRs. Based on the cutoff date from a previous similar SLR, we then searched the WHO COVID-19 Research Database for relevant articles published between April 9, 2022, and June 2, 2023. Outcomes of interest were SARS-CoV-2 infection, symptomatic SARS-CoV-2 infection, severe SARS-CoV-2 infection, COVID-19-related hospitalization, and COVID-19-related death following ≥ 2 vaccine doses. Random effects meta-analysis models were used to pool risk ratios (RRs) across studies. Heterogeneity was evaluated using chi-square testing. Evidence certainty was assessed per GRADE framework.

RESULTS

Twenty-four non-randomized real-world studies reporting clinical outcomes with mRNA vaccines in individuals aged ≥ 50 years were included in the meta-analysis. Vaccination with mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR 0.72 [95% confidence interval (CI) 0.64‒0.80]), symptomatic SARS-CoV-2 infection (RR 0.72 [95% CI 0.62‒0.83]), severe SARS-CoV-2 infection (RR 0.67 [95% CI 0.57‒0.78]), and COVID-19-related hospitalization (RR 0.65 [95% CI 0.53‒0.79]) but not COVID-19-related death (RR 0.80 [95% CI 0.64‒1.00]) compared with BNT162b2. There was considerable heterogeneity between studies for all outcomes (I2 > 75%) except death (I2 = 0%). Multiple subgroup and sensitivity analyses excluding specific studies generally demonstrated consistent results. Certainty of evidence across outcomes was rated as low (type 3) or very low (type 4), reflecting the lack of randomized controlled trial data.

CONCLUSION

Meta-analysis of 24 observational studies demonstrated significantly lower risk of asymptomatic, symptomatic, and severe infections and hospitalizations with the mRNA-1273 versus BNT162b2 vaccine in older adults aged ≥ 50 years.

Fear and Trembling While Working in a Pandemic: an Exploratory Meta-Analysis of Workers' COVID-19 Distress

The global COVID-19 pandemic has disrupted the lives of workers and taken its toll on health and well-being. In line with recent calls for more inductive and abductive occupational health science research, we exploratorily meta-analyzed workers' COVID-19 distress, defined as psychological and psychosomatic strain contextualized to experiencing the virus and pandemic broadly. We identified many existing COVID-19 distress measures (e.g., Fear of COVID-19 Scale by Ahorsu et al., International Journal of Mental Health and Addiction, 2020; Coronavirus Anxiety Scale by Lee, Death Studies, 44(7), 393-401, 2020a) and correlates, including demographic variables (viz., gender, marital status, whether worker has children), positive well-being (e.g., quality of life, perceived social support, resilience), negative well-being (e.g., anxiety, depression, sleep problems), and work-related variables (e.g., job satisfaction, burnout, task performance). Additionally, we found preliminary evidence of subgroup differences by COVID-19 distress measure and country-level moderation moderators (viz., cultural values, pandemic-related government response) as well as COVID-19 distress's incremental validity over and above anxiety and depression. The findings-based on k = 135 independent samples totaling N = 61,470 workers-were abductively contextualized with existing theories and previous research. We also call for future research to address the grand challenge of working during the COVID-19 pandemic and ultimately develop a cumulative occupational health psychology of pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41542-022-00131-x.

Antecedents and outcomes of work-family conflict: A mega-meta path analysis

This study examines the mediating role of work-to-family conflict and family-to-work conflict between the Big Five personality traits and mental health thereby enhancing theoretical development based upon empirical evidence. Integrating Conservation of Resources theory with the self-medication hypothesis, we conducted a mega-meta analytic path analysis examining the relationships among employees’ Big Five traits, work-to-family conflict and family-to-work conflict, anxiety and depression, and substance use. We produced a ten-by-ten synthetic correlation matrix from existing meta-analytic bivariate relationships to test our sequential mediation model. Results from our path analysis model showed that agreeableness and conscientiousness predicted substance use via mediated paths through both work-to-family conflict and family-to-work conflict and sequentially through depression as well as through family-to-work conflict followed by anxiety. Extroversion and openness-to-experience had relatively weaker influences on substance use through work-to-family conflict, anxiety, and depression. Neuroticism was the strongest driver of the two forms of conflict, the two mental health conditions, and substance use. From this model it can be inferred that work-to-family conflict and family-to-work conflict may be generative mechanisms by which the impact of personality is transmitted to mental health outcomes and then to substance use when analyzed via a Conservation of Resources theory lens.

Recommendations for Reviewing Meta-Analyses in Organizational Research

This article encourages transparency in the reporting of meta-analytic procedures. Specifically, we highlight aspects of meta-analytic search, coding, data presentation, and data analysis where published meta-analyses often fall short in presenting sufficient information to allow replication. We identify opportunities where reviewers can request additional information or analyses that will enhance transparent reporting practices and facilitate the evaluation of quality in meta-analytic reporting. We focus on concerns specific to (or prevalent in) meta-analyses conducted in organizational research. In doing so, we reference a number of existing and emerging techniques, highlighting their contribution to meta-analysis while emphasizing key information reviewers may request. Our focus is primarily on meta-analyses, but secondary uses of meta-analytic data are also considered. We conclude by providing a checklist for reviewers in an effort to facilitate the review process as it pertains to the goals of transparency and replicability.