ChAdOx1 nCoV-19

A COVID-19 candidate vaccine.

Phase of research

Emergency use authorization

How it helps

Vaccine

Drug status

Experimental

17
Supporting references
1
Contradictory references
38
Clinical trials

General information

ChAdOx1 nCoV-19 is a candidate vaccine being developed by the University of Oxford and AstraZeneca. It is based on the non-replicating viral vector platform, which is also used for non-COVID-19 candidates, such as influenza, TB, Chikungunya, Zika, MenB, and plague.  On Sept. 6, 2020, AstraZeneca put its Phase III clinical trial on hold over safety concerns due to a suspected serious adverse reaction of one participant to the vaccine, but it has since been resumed after the review process. The preliminary findings on safety, reactogenicity, and cellular and humoral immune responses show that ChAdOx1 nCoV-19 appears to be better tolerated in older adults than in younger adults and has similar immunogenicity across all age groups after a boost dose. An interim analysis of phase III trials found the vaccine to be efficacious against symptomatic COVID-19 and to have an acceptable safety profile. 

On December 30, 2020, AstraZeneca's COVID-19 vaccine was authorized for emergency supply in the UK, with vaccination starting on January 4, 2021. On January 6, 2021, AstraZeneca’s COVID-19 vaccine has been granted emergency use authorization in India as well as Argentina, Dominican Republic, El Salvador, Mexico and Morocco for the active immunization of adults. On January 29, 2021, the AstraZeneca vaccine was granted conditional marketing authorization by the European Commission following the European Medicines Agency's recommendation, making it available for all EU member states. On February 15, 2021, AstraZeneca’s COVID-19 vaccine was granted Emergency Use Listing (EUL) by the World Health Organization (WHO) for active immunization to prevent COVID-19 in individuals 18 years of age and older, including those over 65.


Synonyms

COV001; AZD1222


Marketed as

COVISHIELD; VAXZEVRIA


Supporting references

Link Tested on Impact factor Notes Publication date DB entry date
Fusogenicity and neutralization sensitivity of the SARS-CoV-2 Delta sublineage AY.4.2
Spike protein Spike variant Protein factor In vitro Antibody
HEK 293T cells; U2OS cells; Vero E6 cells; various SARS-CoV-2 live and pseudotyped variants, including Delta and the AY.4.2. (2021) Mar/12/2022 Apr/13/2023
SARS-CoV-2 Omicron-B.1.1.529 leads to widespread escape from neutralizing antibody responses
ACE2 Antibody Biophysical assay Crystallization DNA In vitro Mixed substance Protein factor RNA Spike protein Spike variant
sera from vaccinated or convalescent individuals; VeroE6/TMPRSS2 cells; SARS-CoV-2 (various strains) 41.58 (2020)

Although the capacity of sera of vaccinated individuals markedly decreased for the omicron strain after a two-dose regimen, a third (booster) vaccination significantly increased omicron neutralization in vitro. 

Jan/04/2022 Mar/11/2022
The Omicron variant is highly resistant against antibody-mediated neutralization: Implications for control of the COVID-19 pandemic
Spike protein Spike variant Protein factor Viral vector In vitro Antibody
293T cells; A549-ACE2 cells; BHK-21 cells; Vero cells; Huh-7 cells; Calu-3 cells; Caco-2 cells; (VSV) SARS-CoV-2 Spike pseudoviruses (B.1, Alpha, Beta, Gamma, Delta, or Omicron) 41.58 (2020)

The sera of individuals who were primed by this vaccine and boosted by BNT162b2 were more efficient in inhibiting Omicron Spike-mediated cell entry in vitro compared to BNT162b2 prime and boost-vaccinated individuals’ sera. The efficiency was lower compared to the B.1 strain Spike, however. 

Dec/23/2021 Feb/18/2022
Effectiveness of COVID-19 vaccines against the B.1.617.2 variant
Preprint
adults

2 doses of the AstraZeneca vaccine were 60% effective against symptomatic disease from the B.1.617.2 variant compared to 66% effectiveness against the B.1.1.7 variant.

May/22/2021 May/24/2021
Efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine against SARS-CoV-2 variant of concern 202012/01 (B.1.1.7): an exploratory analysis of a randomised controlled trial
Spike protein Viral vector Randomized controlled single-blind trial Phase III clinical trial Phase II clinical trial Mixed substance
Adult volunteers 60.39

The vaccine efficacy in preventing symptomatic nucleic acid amplification-positive COVID-19 infection was 70.4% for B.1.1.7 strain infection and 81.5% for non-B.1.1.7 infection (mostly BetaCoV/Australia/VIC01/2020 (“Victoria”)) lineage). The sera of vaccinated adults displayed lower neutralization capacity against the B.1.1.7 strain. Sample size: 4244 + 4290 control (primary efficacy cohort), of which there were 311 confirmed SARS-CoV-2 infections. Dosage: Two dose regimen. Primary outcome: Symptomatic COVID-19.



Mar/30/2021 Apr/13/2021
Evidence of escape of SARS-CoV-2 variant B.1.351 from natural and vaccine-induced sera
Antibody Biophysical assay DNA In vitro Mixed substance Protein factor RNA Spike protein Spike variant
in vitro biophysical assay; plasma of COVID-19 (Beta strain) convalescent patients or vaccinated adults; Vero cells; SARS-CoV-2 (SARS-CoV-2/human/AUS/VIC01/2020 and SARS-CoV-2/B.1.351) 41.58 (2020)

Neutralization titres against the Beta strain of SARS-CoV-2 were significantly lower compared to the original strain. A majority of samples still neutralized the virus, however. 

Feb/23/2021 Mar/11/2022
Single-dose administration and the influence of the timing of the booster dose on immunogenicity and efficacy of ChAdOx1 nCoV-19 (AZD1222) vaccine: a pooled analysis of four randomised trials
DNA Mixed substance Phase I clinical trial Phase II clinical trial Phase III clinical trial Randomized controlled double-blind trial Randomized controlled single-blind trial Viral vector
Adult volunteers 60.39

The overall vaccine efficacy >14 days post second dose was 66.7%. The efficacy for a time interval of 22-90 days after a single dose was 76% (the value is not directly comparable with the two-dose regimen due to the trial format). In the subjects who had received 2 doses the efficacy was higher (81.3%) for a longer prime-boost interval (≥12 weeks) than for a shorter one (55.1%; <6 weeks). No hospital admissions were reported in the vaccinated group. Sample size: 8,597 + 8,581 control. Primary outcome: Confirmed symptomatic infection more than 14 days after the second dose.


Feb/19/2021 Mar/07/2021
Reduced neutralization of SARS-CoV-2 B.1.1.7 variant by convalescent and vaccine sera
Spike protein RNA Viral vector In vitro Mixed substance Cohort study
Sera of vaccinated subjects; SARS-CoV-2 strain SARS-CoV-2/human/AUS/VIC01/2020 (“Victoria”); SARS-CoV-2 B.1.1.7 38.64

Although a 2.5-fold decrease in neutralization titres against B.1.1.7 strain was observed compared to an early Wuhan-related strain, the neutralization remained robust, and no evidence of vaccine escape was observed.

Feb/18/2021 Apr/03/2021
Reduced neutralization of SARS-CoV-2 B.1.1.7 variant by convalescent and vaccine sera
Spike protein Spike variant Crystallization Protein factor In vitro Mechanism Antibody
in vitro biophysical assay; crystallization; sera of COVID-19 convalescent patients or vaccinated adults; Vero cells; SARS-CoV-2 (SARS-CoV-2/human/AUS/VIC01/2020 and SAR-CoV-2/B.1.1.7) 41.58 (2020)

Sera from vaccinated individuals were capable of B.1.1.7 strain neutralization in vitro, despite a modest decrease in neutralization capacity compared to the Victoria strain. 

Feb/18/2021 Mar/11/2022
T cell and antibody responses induced by a single dose of ChAdOx1 nCoV-19 (AZD1222) vaccine in a phase 1/2 clinical trial
Cohort study Mechanism Mixed substance Phase I clinical trial Phase II clinical trial Spike protein Viral vector
Healthy adults 36.13

After a single dose of vaccine cellular and humoral responses were observed. The response was Th1-biased, with strong interferon gamma and tumor necrosis factor alpha secretion by CD4+ T cells. IgG1 and IgG3 subclasses dominated the antibody response. Various CD8+ T cells were also induced.

Dec/17/2020 Dec/25/2020
A Booster Dose Enhances Immunogenicity of the COVID-19 Vaccine Candidate ChAdOx1 nCoV-19 in Aged Mice
Spike protein Viral vector Animal model Mixed substance
C57BL/6Babr mice N/A (new)

A single intramuscular dose elicited a SARS-CoV-2 Spike-specific immune response in adult mice characterized by specific B- and T-cell responses, with formation of plasma cells, germinal centres, and follicular Th cells. In aged mice, the response was similar, but an impairment in germinal centre formation and production of CD8+ T-cells secreting granzyme B was observed. Boosting reduced this impairment.

Dec/15/2020 Feb/03/2021
Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK
Phase III clinical trial
Healthy adults 60.39

ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials.

Dec/08/2020 Dec/09/2020
Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial
Phase II clinical trial Phase III clinical trial Randomized controlled single-blind trial Mixed substance Viral vector
Adults (not infected) 60.39 2019

Systemic adverse effects were less common in adults aged ≥56 years. No serious adverse effect related to the vaccine were observed. Median anti-spike protein (SARS-CoV-2) IgG and neutralising antibody levels 28-days post boost immunization were similar across all age cohorts. >99% of boosted patients had neutralising antibodies by day 14 post boost. T-cell responses peaked at day 14 after a single standard dose. The vaccine is recommended for further efficacy assessment in all age groups and individuals with comorbities. Sample size: Low dose: 50 + 49 control (two doses, 18-55 age group); 30 + 10 control (one dose, 56-69 age group); 30 + 10 control (two doses, 56-69 age group); 50 + 10 control (one dose, 70+ age group); 46 + 10 (two doses, 70+ age group); Standard dose:  49 + 9 control (two doses, 18-55 age group); 30 + 10 control (one dose, 56-69 age group); 30 + 10 control (two doses, 56-69 age group); 50 + 10 control (one dose, 70+ age group); 49 + 10 (two doses, 70+ age group). Dosage: Low dose: 2.2e10 virus particles; standard dose: 3.5–6.5e10 virus particles; cohorts received a single or two doses 28 days apart (see Sample size). Endpoints: Safety and humoral and cellular immunogenicity; efficacy (symptomatic COVID-19 cases).



Nov/18/2020 Nov/19/2020
ChAdOx1 nCoV-19 vaccination prevents SARS-CoV-2 pneumonia in rhesus macaques rhesus macaques 42.78 Jul/30/2020 May/14/2020
Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial healthy adults

showed an acceptable safety profile and induced both humoral and cellular immune responses

Jul/20/2020 Jul/30/2020
Evaluation of the immunogenicity of prime-boost vaccination with the replication-deficient viral vectored COVID-19 vaccine candidate ChAdOx1 nCoV-19
Preprint Animal model
mice and pigs Jun/20/2020 Jun/23/2020
DRAFT landscape of COVID-19 candidate vaccines – 26 March 2020 in vitro Mar/26/2020 Apr/03/2020

Contradictory references

Link Tested on Impact factor Notes Publication date DB entry date
Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the B.1.351 Variant
Mild severity Mixed substance Moderate severity Phase I clinical trial Phase II clinical trial Randomized controlled double-blind trial Spike protein Viral vector
Adults (aged 18–65) 74.70

The vaccine efficacy against mild to moderate COVID-19 caused by the B.1.31 (“South Africa”) variant was only 10.4%. The vaccine was safe. Sample size for the primary analysis: 884 + 865 placebo. Dosage: Two full doses 21 to 35 days apart. Primary outcomes: Safety and efficacy (against symptomatic COVID-19 ≥14 days post second dose).



Mar/16/2021 Mar/28/2021

Clinical trials

ID Title Status Phase Start date Completion date
NCT05135455 VAXZEVRIA Japan Post-Marketing Surveillance (PMS) for the Long-term Safety of VAXZEVRIA Not yet recruiting Apr/29/2022 Jun/30/2022
NCT05283902 Effectiveness, Immunogenicity and Safety of the Second Booster Dose of the Vaccine Against COVID-19 in the Elderly Not yet recruiting Mar/19/2022 Oct/01/2022
NCT05198596 A Study to Evaluate Immunogenicity and Safety of MVC-COV1901 Compared With AZD1222 in Adults Aged 18 Years and Above Not yet recruiting Phase 3 Mar/01/2022 Dec/01/2022
NCT05126992 EU Secondary Data Post-Authorisation Safety Study of AZD1222 Recruiting Feb/18/2022 Apr/15/2023
NCT05057897 A Study of AZD1222, a Vaccine for the Prevention of COVID-19 in Immunocompromised Adults Recruiting Phase 4 Jan/31/2022 Sep/06/2023
NCT05197153 A Study to Evaluate the Safety and Immunogenicity of Booster With AZD1222, mRNA-1273, or MVC-COV1901 Against COVID-19 Not yet recruiting Phase 2 Jan/01/2022 Dec/01/2022
NCT05052307 A Real-world Evidence Study of BNT162b2 mRNA Covid-19 Vaccine in Brazil Recruiting Nov/03/2021 Oct/01/2023
NCT05007275 A Study to Determine Safety and Immunogenicity of the Candidate COVID-19 Vaccine AZD1222 Delivered by Aerosol in Healthy Adult Volunteers Recruiting Phase 1 Oct/10/2021 Sep/01/2022
NCT05011526 A Study to Evaluate Immunogenicity and Safety of MVC-COV1901 Compared With AZD1222 Against COVID-19 in Adults Active, not recruiting Phase 3 Oct/08/2021 Jun/01/2022
NCT05049226 Third Dose Vaccination With AstraZeneca or Pfizer COVID-19 Vaccine Among Adults Received Sinovac COVID-19 Vaccine Enrolling by invitation Phase 2 Sep/24/2021 Sep/01/2023
NCT05054621 Immunogenicity of COVID-19 Vaccine on Heterologous Schedule Recruiting Phase 2 Sep/15/2021 Aug/31/2022
NCT04684446 Study in Adults of AZD1222 and rAd26-S Administered as Heterologous Prime-Boost Regimen for the Prevention of COVID-19 Recruiting Phase 1|Phase 2 Sep/15/2021 Apr/08/2022
NCT04998240 Mix and Match Heterologous Prime-Boost Study Using Approved COVID-19 Vaccines in Mozambique Not yet recruiting Phase 2 Sep/01/2021 Oct/30/2022
NCT04760730 Safety and Immunogenicity Study in Adults of AZD1222 and rAd26-S Administered as Heterologous Prime Boost Regimen for the Prevention of Coronavirus Disease 2019 (COVID-19) Recruiting Phase 1|Phase 2 Jul/13/2021 Jun/30/2022
NCT04730895 Investigating the Role of 13cis Retinoic Acid in the Treatment of COVID-19 and Enhancement of Its Spike Protein Based Vaccine Efficacy and Safety. Not yet recruiting Phase 1|Phase 2 Jul/01/2021 Dec/01/2023
NCT04914832 Effectiveness of Covid-19 Vaccination in Eswatini Against SARS-CoV-2 Associated Hospitalization and Death Not yet recruiting Phase 4 Jun/30/2021 May/31/2022
NCT04973449 Phase II/III Study of AZD2816, for the Prevention of COVID-19 in Adults Active, not recruiting Phase 2|Phase 3 Jun/27/2021 Jun/27/2022
NCT05060861 Safety, Efficacy of Chadox1 Ncov-19 Vaccine: Rapid Systematic Review and Meta Analysis Active, not recruiting Jun/01/2021 Oct/30/2021
NCT05059106 EFFECTIVENESS, SAFETY AND IMMUNOGENICITY OF THE HALF DOSE OF THE VACCINE ChadOx1 nCoV-19 (AZD1222) for COVID-19 Recruiting Phase 2|Phase 3 Jun/01/2021 Oct/30/2022
NCT04877743 Non-Interventional Enhanced Active Surveillance Study of Adults Vaccinated With AZD1222 Terminated May/31/2021 Nov/24/2021
NCT04775069 Antibody Response to COVID-19 Vaccines in Liver Disease Patients Recruiting Phase 4 May/21/2021 Mar/31/2022
NCT04907331 Heterologous SARS-CoV-2 Vaccination With ChAdOx-1 and BNT162b2 Recruiting Phase 2 May/10/2021 Dec/30/2021
NCT04864561 Study To Compare The Immunogenicity Against COVID-19, Of VLA2001 Vaccine To AZD1222 Vaccine Recruiting Phase 3 Apr/26/2021 Mar/16/2023
NCT04860739 Vaccination With COMIRNATY in Subjects With a VAXZEVRIA First Dose Active, not recruiting Phase 2 Apr/24/2021 Apr/30/2022
NCT04816019 A Study of Intranasal ChAdOx1 nCOV-19 Recruiting Phase 1 Apr/01/2021 Mar/31/2022
NCT04834869 COVID-19 Vaccines Safety Tracking (CoVaST) Recruiting Apr/01/2021 Jan/31/2022
NCT04794946 Safety and Efficacy of a Non-replicating ChAdOx1 Vector Vaccine AZD1222 (COVISHIELD), for Prevention of COVID-19 in Patients With Liver Cirrhosis Recruiting Not Applicable Mar/19/2021 Mar/19/2022
NCT04686773 Open-label, Non-randomized, Non-comparative, Phase II Study of Safety and Immunogenicity of Combination of AZD1222 and rAd26-S for COVID-19 Prevention Active, not recruiting Phase 2 Mar/05/2021 Mar/07/2022
NCT05145348 Prospective Monitoring of Antibody Response Following COVID-19 Vaccination in Patients With Down Syndrome. Recruiting Feb/03/2021 Jun/30/2023
NCT05133609 COVID-19 VACCINE SAFETY AND EFFECTIVENESS Recruiting Phase 1|Phase 2 Jan/15/2021 Dec/30/2023
NCT04540393 AZD1222 Vaccine for the Prevention of COVID-19 Withdrawn Phase 3 Sep/02/2020 May/11/2022
NCT04516746 Phase III Double-blind, Placebo-controlled Study of AZD1222 for the Prevention of COVID-19 in Adults Active, not recruiting Phase 3 Aug/28/2020 Feb/14/2023
NCT04568031 Study of AZD1222 for the Prevention of COVID-19 in Japan Completed Phase 1|Phase 2 Aug/23/2020 Nov/22/2021
NCT04444674 COVID-19 Vaccine (ChAdOx1 nCoV-19) Trial in South African Adults With and Without HIV-infection Active, not recruiting Phase 1|Phase 2 Jun/24/2020 Dec/01/2021
NCT04536051 A Study of a Candidate COVID-19 Vaccine (COV003) Recruiting Phase 3 Jun/02/2020 Sep/01/2021
NCT04400838 Investigating a Vaccine Against COVID-19 Active, not recruiting Phase 2|Phase 3 May/28/2020 Mar/31/2023
NCT04324606 A Study of a Candidate COVID-19 Vaccine (COV001) Active, not recruiting Phase 1|Phase 2 Apr/23/2020 Mar/31/2023
NCT05110911 Does Repeat Influenza Vaccination Constrain Influenza Immune Responses and Protection Recruiting Apr/02/2020 Nov/01/2023