BREATHE - Health Data Research Hub for Respiratory Health


Delta variant increases hospitalisation, but vaccine continues to protect

The Delta variant of COVID-19 is associated with approximately double the risk of hospitalisation compared with the Alpha variant, according to a new nationwide EAVE II study.

Two vaccine doses still provide strong protection against the Delta variant – which was first identified in India – but it may be at a lower level compared with the Alpha variant, early evidence suggests.

The Delta variant

Based on EAVE II data analysed from 5.4 million people in Scotland, the Delta variant is now the dominant form of COVID-19 cases in the country, overtaking the Alpha variant, which was first identified in Kent.

During the period studied – 1st April to 6th June 2021 – there were 19,543 community cases and 377 hospitalisations where a specific variant of COVID-19 was confirmed.

Of these totals, 7,723 cases and 134 hospitalisations were found to have the Delta variant. People with underlying conditions were more at risk of being hospitalised, researchers said.


Vaccines were found to reduce the risk of being admitted to hospital, but strong protective effects against the Delta variant were not seen until at least 28 days after the first vaccine dose.

In community cases at least two weeks after the second dose, the Pfizer-BioNTech vaccine was found to provide 79% protection against infection from the Delta variant, compared with 92% against the Alpha variant.

For the same scenario, the Oxford-AstraZeneca vaccine offered 60% protection against infection with the Delta variant compared with 73% for the Alpha variant. This lower vaccine effect may reflect that is takes longer to develop immunity with Oxford-AstraZeneca, experts say.

Delta variant cases were identified through initial PCR testing results, which reveal whether what is known as the S gene is present. Delta variant cases are positive for the S gene whilst Alpha variant cases tend to be S gene negative.


The results are published as a research letter in The Lancet. Research letters are externally peer-reviewed, and their findings are usually preliminary or exploratory.  

The researchers say to increase confidence in these early findings, the research needs repeated in other countries and settings.

The team say that because of the observational nature of the study, data about vaccine effectiveness should be interpreted with caution and it is not possible to make a direct comparison between both vaccines.

Over a matter of weeks, the Delta variant has become the dominant strain of SARS-CoV-2 in Scotland. It is unfortunately associated with increased risk of hospitalisation from COVID-19.

Whilst possibly not as effective as against other variants, two doses of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines still offer substantial protection against the risk of infection and hospitalisation. It is therefore crucially important that, when offered second doses, people take these up both to protect themselves and to reduce household and community transmission.

Professor Aziz SheikhDirector of BREATHE and EAVE II Study Lead

These results provide early encouragement that two doses of either Pfizer-BioNTech or Oxford-AstraZeneca vaccines significantly reduce the risk of infection against both the Alpha or new Delta variants. They also show the vaccines offer protection against the risk of hospitalisation with the new Delta variant. Though no vaccine can be 100% protective, they provide the best protection against COVID-19 and it remains important to get both doses when offered.

Dr Jim McMenaminCOVID-19 National Incident Director for Public Health Scotland

It is important to recognize that these are preliminary results using rapidly accessible data.  A fuller understanding will come when the results presented here are combined with similar analyses from other data sets in the UK.

Professor Chris RobertsonUniversity of Strathclyde

This is another outstanding example of why rapid, safe and secure linkage of health data across entire care journeys, including information from GPs, vaccinations, viral genetics and hospital admissions data, is essential for research that makes a difference to people’s lives. These results will inform decision making internationally. HDR UK and the UKRI National Core Studies are working in partnership with the EAVE II team and the public to accelerate more trustworthy research that will be essential to this and future pandemics.

Professor Andrew MorrisDirector of Health Data Research UK (HDR UK) and Vice Principal of Data Science at the University of Edinburgh

Read the letter

SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness 

Further information

Visit EAVE II for more information: EAVE II | The University of Edinburgh

Cite as

Sheikh, A., McMenamin, J., Taylor, B., Robertson, C. SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness. The Lancet (June 14, 2021).