Governments need to confront the continued impact of COVID-19 on people who are immunocompromised

For people who are immunocompromised, the COVID-19 pandemic continues to present a danger and concern, leading to preventable deaths and impacting quality of life.

The end of the COVID-19 pandemic is in sight, yet the threat of COVID-19 will never be over for some.¹ The majority of the global population has been able to safely return to living a relatively normal life, primarily due to vaccination programmes.² Yet for 2% of the global population, who are considered immunocompromised and do not tend to mount an optimal immune response to vaccination, the pandemic continues.^{3, 4} They are 42% more likely to die of COVID-19, compared to non-immunocompromised unvaccinated patients, rising to 87% when compared to those who are vaccinated.⁵  In a poll of 150 policymakers from 10 countries, 26% reported shielding programmes for people who are immunocompromised have been discontinued.* However, people who are immunocompromised are continuing to isolate because of their increased risk of catching the disease.⁶This is negatively impacting their ability to work, has an impact on their income, mental health and social life, leaving many uncertain about their future.^{7, 8, 9, 10}  A survey of blood cancer patients found 87% of respondents said their mental health has been impacted by the COVID-19 pandemic.¹¹

People who are immunocompromised are put at greater risk both from an increased circulation of the disease in the general population

The burden on healthcare systems has not gone away, with the emergence of new variants and increased hospitalisation rates.

Emerging COVID-19 variants are continuing to drive ill-health and hospital admissions, placing additional pressures on capacity and resource across an already stretched system.^{12, 13, 14} In Europe, COVID-19 cases tripled throughout July 2022 and hospitalisation rates doubled.¹² 44% (n=20) of those hospitalised with breakthrough infections after vaccination are from people who are immunocompromised. ¹⁵

People who are immunocompromised are put at greater risk both from an increased circulation of the disease in the general population, as well as having to enter the hospital environment to access care for their existing conditions.^{16, 17}People who are immunocompromised have increased healthcare resource utilisation.¹⁸  Evidence also suggests that preventable COVID-19 hospitalisations among unvaccinated cost the US health system over US$13 billion between June and November 2021.¹⁹ This is the type of spend which cannot be maintained, therefore reducing the risk of infection among people who are immunocompromised may help minimise preventable hospitalizations and associated costs. 

There is broad support for specific measures to help people who are immunocompromised, but there is an urgent need for specific action

We welcome the desire for continued support as there is a need for more targeted policies and interventions that are sustainable for people who are immunocompromised to ensure their long-term safety.  This is of particular urgency as countries in the Northern hemisphere approach winter pressures on health systems. Plans are being drafted to help prepare health systems for the busiest periods, and the uncertainty of what is to come from the ongoing spread of COVID-19. This includes acceptance and allowances that vaccinations may not be the most effective measure available to protect people who are immunocompromised.^{20, 21}

87% of policymakers agree that people should have the right to access to protection that prevents prolonged infection and potential emergence of variants

Availability and access to treatment options is impacted by physician and patient awareness of protection levels and lack of consistent clinical guidelines and protocols

There are few national guidelines and protocols for COVID-19 identification, management and treatment for immunocompromised people.²² For those that do exist, cascade down to the regional or clinical level does not always occur. As a result, there is a need for comprehensive global and national guidelines and protocols to support care and treatment of immunocompromised patients.  Other initiatives that enable clinicians to recognise, refer and treat people who are immunocompromised across different specialities should also be prioritised.

There is also a need to educate people who are immunocompromised on understanding their protection levels and protective therapies that are available.  Advice should be provided to encourage people to take more ownership of their health care needs e.g., asking their clinician about suitable protective measures.

The range and access to therapies available to people who are immunocompromised vary from country to country, including a number of agents approved for pre-exposure.^{23, 24} Some health systems have been slow to introduce specific measures for people who are immunocompromised, and patient identification and care pathways for this group are not well understood by clinicians.²³ Yet, 87% of policymakers agree that people should have the right to access to protection that prevents prolonged infection and potential emergence of variants.* This holds even more importance considering that when people who are immunocompromised do get infected, they can be a source of COVID-19 variants.²⁵

The reality of not prioritising people who are immunocompromised patients is alarming.  For this reason, we urge governments to recognise the impact that is still being felt by this vulnerable community and the added pressures faced by health systems across the globe.  Opportunities exist to support people who are immunocompromised as many countries head into the winter months – the ask is for governments to push for clear guidelines, patient education and access to protective measures where vaccines aren’t suitable to stem the tide of the ongoing pandemic impact. We stand ready to continue advocating for this community and providing them with a more certain future.

Please click here for the all the above references

The Call To Action was signed and authored by the below people

• Yvanie Caille, member of the Board of Directors, Renaloo
• Daniel Gallego, President, European Kidney Patient Federation and Association for the Fight Against Kidney Diseases
• Sabrina Hanna, Advocacy Lead, The Leukemia & Lymphoma Society of Canada
• Dr Dorry Segev, Transplant surgeon, Center for Surgical and Transplant Applied Research (CSTAR), NYU Langone Health
• Dr J-Abraham Simon, Clinical Researcher, Internal Medicine, Immunology and Rheumatology, Köhler & Milstein Research
• Dr Anna Sureda, Head of Hematology, Català d'Oncologia Hospital

Note on development process

The above ‘Call to Action’ article was initiated by AstraZeneca to highlight the continued impact of the COVID-19 pandemic on people who are immunocompromised.  The wider advocacy community were invited to support this initiative, who subsequently debated and refined elements of this Call to Action during a virtual discussion held on July 13 2022 organised and funded by AstraZeneca. Seven academic, patient organization and professional group experts discussed the value of establishing a ‘Call to Action’ and provided subsequent written input into the document.

* Survey organised and funded by AstraZeneca and co-developed with Ipsos UK. Poll of 150 policymakers (elected and non-elected governmental officials) from Australia, Canada, France, Germany, Italy, Japan, Mexico, Spain, UK and Brazil. Polling took place between May and August 2022

Veeva ID:Z4-49769

Date of preparation: October 2022