The vaccine demonstrated a significant of 94.3% efficacy in clinical trials for preventing SARS-CoV-2 infections in different stages of severity. With this efficacy, herd immunity may have been achieved through mass vaccination in this population. This vaccine’s effectiveness study in a predominantly indigenous population is similar in size to the phase III studies conducted in Turkey and Brazil, in which between 7000 and 13,000 participants were evaluated [11].

SARS-CoV-2 infections among those vaccinated were mild, and their management was ambulatory. In addition, it has been seen that vaccination with the immunogen from the pharmaceutical company Sinovac has prevented the appearance of complicated infections and fatal outcomes [12]. These findings are consistent with those reported by phase III studies carried out in Brazil, where it was shown that this vaccine reduces the risk of hospitalization and death between 84 to 100% of individuals vaccinated with CoronaVac® [12]. However, our results in the older than 60 years show differences with what was published in Brazilian older adults by Ranzani et al. [13], who found protection of 49.4%. The vaccine’s reduction could be explained because 83% of their cases were infected with the P.1 variant of SARS- CoV-2.

Furthermore, it is essential to analyze the course of infection over time and the impact of vaccination against SARS-CoV-2. In April 2021, the third wave of COVID-19 cases began in Colombia. However, the incidence was much lower than observed in the first peak of the pandemic between April and June 2020. The new cases presented in 2021 in the vaccinated population could be due to the Brazilian variant P.1 of SARS-CoV-2 [14]. However, the morbidity and mortality of this new variant seem to be controlled with the CoronaVac® vaccine.

Regarding the effectiveness of this vaccine, it was observed that it was 94.3% against mild disease and 99.9% against severe infection in this population. Our findings are similar to Turkey’s phase III study for CoronaVac®, in which efficacy of 91% was observed. In contrast to studies in Brazil and Chile, which reported low overall efficacy of 50.38 and 65%, respectively. However, it is essential to highlight that this vaccine reduced 90% of the proportion of hospitalization in an intensive care unit (ICU) and 86%mortality from SARS-CoV-2 [15, 16] in the Chilean population. The epidemiological moments of vaccination must also be taken into account. For example, Chile began vaccination with a low viral transmission different from the epidemiological scenario studied in Brazil. When the transmission is lower, there is less chance that vaccination will fail [17]. Our study is similar to perform in the small city of Serrana, Brazil, that vaccinated using CoronaVac®. In Serrana, 95% of the city’s adult population was vaccinated, a reduction of 80% in symptomatic cases and hospitalizations dropped by 86% and mortality by 95% [5].

So far, SARS-CoV-2 is a virus that is efficiently transmitted and quickly infects the unvaccinated population. Due to the lack of genotypic information for the Mitú municipality, we do not know if the P1 variant (Brazil) managed to spread or if the action of the vaccine contained it. On the other hand, one of the limitations of this work could be in a possible under-registration of the mild infections registered in this vaccine population, since it was not possible due to the type of study that was proposed to carry out a strict follow-up by RT- qPCR to this population cluster.

The primary outcome of this study was to evaluate the effectiveness of CoronaVac® in reducing mortality and severe illness due to SARS-CoV-2. On the other hand, one of the limitations of this work could be in a possible under-registration of the mild infections registered in this vaccine population, since it was not possible due to the type of study that was proposed to carry out a strict follow-up by RT- qPCR to this population cluster.

Finally, we can infer that to date, herd immunity has been achieved through mass vaccination in this population, which has impacted the reduction of complicated cases and the mortality rate from COVID-19. However, pediatric populations remain unvaccinated, which could cause few breakthrough infections with an increase in the number of cases at a given epidemiological moment. It is also necessary to know if the CoronaVac® will protect against the new delta strain in Colombia. It will be a real challenge for the vaccine in a couple of months when it is believed that Delta could be predominant in Colombia. Public health must continue long-term surveillance to measure the effect of vaccination in the studied population. It is unknown if the vaccine’s immunity will be maintained over time and if a booster of this immunogen is needed in the short or medium term. There is still a long way to walk on this exciting research topic that will be key to controlling and mitigating the pandemic caused by SARS-CoV-2.