IMPORTANCE: COVID-19 vaccines are effective, but inequities in vaccine administration and waning immunity may limit vaccine effectiveness. OBJECTIVES: To report statewide trends in vaccine administration and vaccine effectiveness in Minnesota. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used COVID-19 vaccine data from the Minnesota Immunization Information Connection from October 25, 2020, through October 30, 2021 that were linked with electronic health record (EHR) data from health systems collaborating as part of the Minnesota EHR Consortium (MNEHRC). Participants included individuals who were seen at a participating health system in Minnesota. EXPOSURES: Individuals were considered fully vaccinated in the second week after receipt of a second dose of a BNT162b2 or mRNA-1273 vaccine or a single dose of an Ad26.COV.2.S vaccine. MAIN OUTCOMES AND MEASURES: A completed vaccination series and vaccine breakthrough, defined as either a positive SARS-CoV-2 polymerase chain reaction (PCR) test or a hospital admission the same week or within the 3 weeks following a positive SARS-CoV-2 PCR test. A test-negative design and incident rate ratio were used to evaluate COVID-19 vaccine effectiveness separately for the BNT162b2, mRNA-1273, and Ad26.COV.2.S vaccines. Rurality and social vulnerability index were assessed at the area level. RESULTS: This study included 4鈥�431鈥�190 unique individuals at participating health systems, and 3鈥�013鈥�704 (68%) of the individuals were fully vaccinated. Vaccination rates were lowest among Minnesotans who identified as Hispanic (116鈥�422 of 217鈥�019 [54%]), multiracial (30鈥�066 of 57鈥�412 [52%]), American Indian or Alaska Native (22鈥�190 of 41鈥�437 [54%]), and Black or African American (158鈥�860 of 326鈥�595 [49%]) compared with Minnesotans who identified as Asian or Pacific Islander (159鈥�999 of 210鈥�994 [76%]) or White (2鈥�402鈥�928 of 3鈥�391鈥�747 [71%]). Among individuals aged 19 to 64 years, vaccination rates were lower in rural areas (196鈥�479 of 308鈥�047 [64%]) compared with urban areas (151鈥�541 of 1鈥�951鈥�265 [77%]) and areas with high social vulnerability (544鈥�433 of 774鈥�952 [70%]) compared with areas with low social vulnerability (571鈥�613 of 724鈥�369 [79%]). In the 9 weeks ending October 30, 2021, vaccine effectiveness as assessed by a test-negative design was 33% (95% CI, 30%-37%) for Ad26.COV.2.S; 53% (95% CI, 52%-54%) for BNT162b2; and 66% (95% CI, 65%-67%) for mRNA-1273. For SARS-CoV-2-related hospitalizations, vaccine effectiveness in the 9 weeks ending October 30, 2021, was 78% (95% CI, 75%-81%) for Ad26.COV.2.S; 81% (95% CI, 79%-82%) for BNT162b2; and 81% (95% CI, 79%-82%) for mRNA-1273. CONCLUSIONS AND RELEVANCE: This cohort study of data from a Minnesota statewide consortium suggests disparities in vaccine administration and effectiveness. Vaccine effectiveness against infection was lower for Ad26.COV.2.S and BNT162b2 but was associated with protection against SARS-CoV-2-related hospitalizations despite the increased prevalence of the Delta variant in Minnesota.
