Real-World Utilization of the Novavax Adjuvanted Recombinant Protein COVID-19 Vaccine in France During the 2022-2024 Period.

Background/objectives: The Novavax COVID-19 vaccine (Nuvaxovid™) was authorized in France in December 2021, assisting in ending the global pandemic and providing an alternative to other COVID-19 vaccines. Understanding Nuvaxovid recipients' profile is essential for guiding vaccination decision-making and maintaining protection amid declining COVID-19 vaccination rates.

Methods: This retrospective, observational study characterizes the evolution of French Nuvaxovid recipients' demographic and clinical characteristics using the Système National des Données de Santé (SNDS) database. Five study seasons (spring 2022, autumn 2022, spring 2023, autumn 2023, spring 2024) were defined based on French vaccination guidelines and Nuvaxovid authorization dates. T-test and Chi-square tests were used to compare between consecutive seasons and subgroups.

Results: Nuvaxovid administration was reported in 9805 recipients during spring 2022, 5601 during autumn 2022, 531 during spring 2023, 980 during autumn 2023, and 909 during spring 2024. Statistically significant increases in the proportions of high-risk (spring 2022: 35.4%, spring 2024: 90.5%) and ≥65-year-old (spring 2022: 19.9%, spring 2024: 84.4%) Nuvaxovid recipients were observed, p < 0.05. Comorbidities, notably cardiovascular disease, became progressively more prevalent (spring 2022: 7.1%, spring 2024: 33.7%, p < 0.05). Nuvaxovid was used nationwide, with a higher proportion of recipients in the southeast, a region typically exhibiting lower vaccine coverage. Most Nuvaxovid recipients increasingly received a heterologous regimen (autumn 2022: 91%, spring 2024: 98.6%, p < 0.05), with Nuvaxovid as the ≥4th dose (55-97.2%, p < 0.05). Meanwhile, higher proportions of <65-year-old and not-at-risk recipients received Nuvaxovid as primary series (autumn 2022: 46.9% <65-year-old vs. 5.6% ≥65-year-old, 53.9% not at risk vs. 11.9% at risk, p < 0.05).

Conclusions: The use of Nuvaxovid evolved in accordance with changing clinical recommendations, and mix-and-match vaccination strategies and heterologous vaccination patterns suggest that it served as an important protein-based alternative for those switching from other COVID-19 vaccines. Nuvaxovid offers a valuable choice, so that the most vulnerable continue to be vaccinated.