The continued burden of COVID-19 for the immunocompromised

ORIGINALLY PUBLISHED:
26 October 2023

Topic:

COVID-19


With the World Health Organization (WHO) declaring an end to the global public health emergency in May 2023, much of the world has moved on from COVID-19. Government and healthcare organisations have reduced their sense of urgency, and much of the general public has embraced a return to pre-pandemic life. However, the risks from COVID-19 are far from over, especially for those most vulnerable, such as the immunocompromised.

COVID-19 burden remains high

Now considered an endemic disease, COVID-19 continues to result in serious health consequences globally, such as hospitalisation, intensive care unit (ICU) admissions and death.1–3

  • Hospitalisation rates remain higher for COVID-19 than other seasonal respiratory illnesses, such as flu and respiratory syncytial virus (RSV).4,5
  • WHO reported nearly 10,000 deaths from COVID-19 in December 2023, and there was a 42% increase in hospitalisations and a 62% increase in ICU admissions compared with November 2023.6  
  • In the US alone, 2023 ended with about 35,000 weekly hospitalisations and more than 1,500 people per week dying from COVID-19.3,7

The immunocompromised shoulder a disproportionate burden

Many who are immunocompromised often have a diminished immune response to COVID-19 vaccination, and therefore remain at higher risk for severe COVID-19, hospitalisation and death than the general population.8-10  

New real-world evidence from large-scale studies in England and the US highlight that despite representing a small percentage of the general population, immunocompromised individuals accounted for a disproportionally large percentage of severe COVID-19 outcomes.10,11 These studies showed that:

  • More than a quarter of the COVID-19 burden is born by immunocompromised individuals, despite being vaccinated against the virus;10
  • Among the immunocompromised, the risk of hospitalisation is disproportionately high for people with people with blood/bone marrow cancers, end-stage kidney disease, solid organ transplant recipients and those taking immunosuppressive medications for certain conditions, despite being vaccinated;10,11
  • The cost of taking steps to protect immunocompromised patients may be lower than the high costs associated with poor COVID-19-related outcomes.12,13




Protection is essential for the immunocompromised who remain vulnerable to COVID-19

Vaccines require a healthy immune system and help jumpstart the body’s natural ability to produce infection-fighting cells.14 Thus, individuals with compromised immune systems, such as people with cancer, organ transplant recipients, or people taking immunosuppressive medicines, may not be as well protected against COVID-19, even when vaccinated.10 In fact, more than one in 10 immunocompromised patients do not develop the antibodies needed for protection even after five or more COVID-19 vaccinations.15

Scientific advances have made it possible to provide passive immunity with monoclonal antibodies, independent of the recipient’s immune status.16-18 Monoclonal antibodies are generated in a lab to target a specific bacteria or virus.19 The antibodies are administered into the body where they can provide near immediate protection against infection by recognising and binding to the target pathogen.16-18

With the rapid evolution of Omicron variants that reduced or removed authorised therapies for COVID-19 prevention, many immunocompromised individuals are left without active or passive protection while potential new therapies are being studied.20,21

 

Vaccination alone is often not enough to protect immunocompromised individuals from potential devastating consequences of COVID-19. We must work together to find solutions so that this vulnerable population can move on from the pandemic.

Paul Moss, Professor of Haematology, University of Birmingham, UK

Reducing the preventable burden of disease

The World Health Organization acknowledges that while COVID-19 has become endemic to many areas, the immunocompromised continue to face an ongoing risk from the virus.22 A deeper understanding and recognition of this diverse group to help foster access to tailored, appropriate care and treatment remains an urgent unmet need. Without effective, long-term protection, the burden of COVID-19 falls on both immunocompromised patients and healthcare systems.12,13 A 2022 study suggests that more than 14,500 hospitalisations in England could have been prevented if a prophylactic intervention with 80% effectiveness had been used alongside vaccination in immunocompromised individuals.10

At AstraZeneca, we are committed to following the science to protect the most vulnerable patients, ensuring no patient is left behind. One area where we see promise is with monoclonal antibodies as passive immunisation for infectious respiratory disease. We believe innovating in this field will help deliver on our ambition to provide long-lasting immunity to millions of people, where the burden of disease is greatest.


Topic:



You may also like

References:

1.  World Health Organization. Statement on the fifteenth meeting of the IHR (2005) Emergency Committee on the COVID-19 pandemic. [cited Feb 2024]. Available from: http://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic

2.  Our World in Data. Coronavirus (COVID-19) Hospitalizations . 2022 [cited Feb 2024]. Available from: http://ourworldindata.org/covid-hospitalizations#citation

3.  Centers for Disease Control. COVID Data Tracker: Trends by Geographic Area (deaths). [cited Feb 2024]. Available from: http://covid.cdc.gov/covid-data-tracker/#trends_weeklydeaths_select_00

4.  Centers for Disease Control and Prevention. Laboratory-Confirmed Influenza Hospitalizations. [cited Feb 2024]. Available from: http://gis.cdc.gov/grasp/fluview/fluhosprates.html

5.  Centers for Disease Control and Prevention. RSV-NET Interactive Dashboard. [cited Feb 2024]. Available from: http://www.cdc.gov/rsv/research/rsv-net/dashboard.html

6.  World Health Organization. WHO press conference on global health issues – 10 January 2024. [cited Feb 2024]. Available from: http://www.who.int/multi-media/details/who-press-conference-on-global-health-issues-10-january-2024

7.  Centers for Disease Control. COVID Data Tracker: Trends by Geographic Area (hospitalisation). [cited Feb 2024]. Available from: http://covid.cdc.gov/covid-data-tracker/#trends_weeklyhospitaladmissions_select_00

8.  Centers for Disease Control and Prevention. COVID-19 Vaccines for People who are Moderately or Severely Immunocompromised. [cited Feb 2024]. Available from: http://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html

9.  Singson JRC et al. Factors Associated with Severe Outcomes Among Immunocompromised Adults Hospitalized for COVID-19 — COVID-NET, 10 States, March 2020–February 2022. MMWR Morb Mortal Wkly Rep. 2022. 71(27):878–84. Available from: http://www.cdc.gov/mmwr/volumes/71/wr/mm7127a3.htm

10. Evans RA et al. Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study. The Lancet Regional Health – Europe. 2023 Oct. 0(0):100747. doi:10.1016/j.lanepe.2023.100747

11. Ketkar A et al. Assessing the Burden and Cost of COVID-19 Across Variants in Commercially Insured Immunocompromised Populations in the United States: Updated Results and Trends from the Ongoing EPOCH-US Study. Adv Ther. doi:10.1007/s12325-023-02754-0

12. Ketkar A et al. Assessing the risk and costs of COVID-19 in immunocompromised populations in a large United States commercial insurance health plan: the EPOCH-US Study. Curr Med Res Opin. 2023 Jul 17. doi:10.1080/03007995.2023.2233819

13. Willems SH et al. Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity. JMIR Mhealth Uhealth 2021;9(6):e25021. doi:10.2196/25021

14. Centers for Disease Control and Prevention. Understanding How COVID-19 Vaccines Work. [cited Feb 2024]. Available from: http://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/how-they-work.html

15. Pearce FA et al. Antibody prevalence after 3 or more COVID-19 vaccine doses in 23,000 immunosuppressed individuals: a cross-sectional study from MELODY. medRxiv. 2023 Feb 14. doi:10.1101/2023.02.09.23285649v1

16. Wodi AP, Morelli V. Pinkbook | Principles of Vaccination | Epidemiology of VPDs | CDC. [cited Feb 2024]. Available from: http://www.cdc.gov/vaccines/pubs/pinkbook/prinvac.html

17. Wu WL et al. Monoclonal antibody targeting the conserved region of the SARS-CoV-2 spike protein to overcome viral variants. JCI Insight [Internet]. 2022 Apr 227(8).  doi:10.1172/jci.insight.157597

18. Centers for Disease Control and Prevention. Immunity Types. 2021 [cited Feb 2024]; Available from: http://www.cdc.gov/vaccines/vac-gen/immunity-types.htm

19. Ovacik M, Lin K. Tutorial on Monoclonal Antibody Pharmacokinetics and Its Considerations in Early Development. Clin Transl Sci. 2018 Nov 1;11(6):540–52

20. National Institutes of Health. Anti-SARS-CoV-2 Monoclonal Antibodies | COVID-19 Treatment Guidelines. [cited Feb 2024]. Available from: http://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/anti-sars-cov-2-monoclonal-antibodies/

21. Brii Biosciences Press Release. [cited Feb 2024]. Available from: http://www.briibio.com/en/media/press-release/20230324/

22. World Health Organization. Statement on the fourteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic. [cited Feb 2024]. Available from: http://www.who.int/news/item/30-01-2023-statement-on-the-fourteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic


Veeva ID: Z4-63191
Date of preparation: March 2024