For many people around the world, the COVID-19 pandemic is not over yet. This is especially true for patients who have underlying health conditions that compromise or suppress their immune systems. Many immunocompromised patients are isolating from friends and family, and grappling with the ongoing practical and emotional toll on their quality of life.
This group comprises 2 percent of the population – that’s about 14.5 million people in the European Union – and often remains at increased risk of severe COVID-19, regardless of vaccination.1 2 3 4 5 While vaccines are the strongest defense for the general population, immunocompromised individuals are often unable to mount a strong enough immune response following a COVID-19 vaccine.4 6 In fact, more than 40 percent of those hospitalized with successful infection after vaccination are people who are immunized.4 7
With a compromised immune system, a person is more likely to develop a serious life-threatening illness and may harbor an infection for a longer period of time, which, according to recent data, could lead to the emergence of new forms.8 Additional therapeutic options exist, yet access, awareness and COVID regulations differ between European Member States and even the States themselves.
Politico Studio spoke to a mix of health care professionals, patient advocacy groups, and patients to gauge their insights on the issue. The conversation covered the continuing impact of the COVID-19 pandemic on immunocompromised patients, and what they believe policymakers should do now and in the future to protect these patients.
Viva ID: Z4-46834 | Date of Preparation: August 2022 , Reference for introduction , AstraZeneca. about
nick yorkChairman, CLL Advocates Network (CLLAN) Steering Committee and Chronic Lymphocytic Leukemia Patients
Nick York is chairman of the steering committee within the CLL Advocates Network: a global network of patient organizations that supports chronic lymphocytic leukemia (CLL) worldwide. Nick York has been living with Chronic Lymphocytic Leukemia for the past 10 years.
Politico Studios: What impact has COVID-19 had on you personally and on the CLLAN patient community?
I myself have been living with Chronic Lymphocytic Leukemia for the past 10 years. It is every immunocompromised patient’s nightmare to hear about an epidemic approaching, because our inherent weakness is our inability to be able to defend against infection.1 2 3 4 There is rhetoric in society at the moment that we always have to live with this issue, but it was a completely different experience with the pandemic.
The impact on me has been isolation from society, from my social circle, from my support network. This has resulted in distancing themselves from most activities and being unable to live in an environment in close proximity to other individuals. So you can’t go out for your shopping. You are relying on the delivery of services, and this can be very inefficient. And over time – for 2 1/2 years – it has become extremely mentally challenging.
PS: What continuing challenges or problems do you see among the community of patients you support as the pandemic develops?
If we look at where the pandemic is now, the restrictions and safeguards for the general population have been removed. This is fantastic, something to celebrate.
However, this has not been the case for patients living with chronic lymphocytic leukemia or immunocompromised patients. We have been left behind.
Immunocompromised people are now living with the cumulative emotional and psychological effects of dealing with these challenges, being separated from family and friends and no longer able to participate in local society.5 6 7 8 9
If you’re like me, I’ve had five vaccinations, and I still haven’t reacted to them. Now it really is a game of Russian roulette if you want to try and navigate the society. We now have to spend money on high quality clinical grade masks (FFP3s) to gain some protection when interacting in this new environment.1 1 I’ve never felt so isolated in my entire life, and I’m a friendly person! I loved being in the thick of things. I have to go to the pub, see a gig, listen to music, meet my friends, it’s all off the table at the moment.
PS: Does COVID-19 continue to impact health care systems and resources in Europe? If so, how is it affecting you and the patient community?
The pandemic and COVID-19 are having a negative impact on health systems today. Healthcare workers are contracting COVID, reducing capacity. Most of the healthcare workers I talk to are having to cancel appointments because they are too many – those resources have been massively limited.12 13
PS: In your opinion, what measures should the EU, national governments and/or health system leaders take to ensure that immunocompromised patients, or those who are medically vulnerable to COVID-19, are not left behind, as we are exposed to COVID-19? learn to live with
The measure of a society is how it takes care of its weaknesses. If there are treatment options14 15Make sure they are provided. This is a no brainer for policy makers.
The immunocompromised is more likely to retain a condition over a longer period of time, which allows more variants to be generated.16 17 There is now some data emerging that new variants are indeed arising in the immunocompromised.
PS: Looking to the future, what policy measures are needed to continue to tackle COVID-19? Are there new approaches, beyond tests and vaccines, that could help reduce the number of hospitalizations in the future? How can we better prepare for future health crises with respect to immunocompromised patients?
I think if we look to the future and prepare for the health crisis, we have to keep in mind that this health crisis is not over yet. And it certainly isn’t over for the immunocompromised.
So one thing that the pandemic has done is that it has encouraged R&D and awareness in terms of immunity. If technologies are available that can help improve the quality of life of immunocompromised patients, policy makers should do everything possible to ensure that.
Viva ID: Z4-46956 | Date of Preparation: August 2022 , References to Nick York
AstraZeneca. about
AstraZeneca (LSE/STO/Nasdaq: AZN) is a global, science-led biopharmaceutical company focused on drug discovery, development and commercialization in oncology, rare diseases and biopharmaceuticals, including cardiovascular, renal and metabolic and respiratory. and immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries and its innovative drugs are used by millions of patients worldwide.
Reference for introduction
1AstraZeneca data on file (REF-129335)
2Brosch-Nisimov T, Orenbuch-Haroch E, Chauvers M, et al. BNT162b2 vaccine breakthrough: clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel. Clin Microbial Infection. 2021; 27:1652-1657.
3Abbasi J. Researchers linked severe immunosuppression to chronic COVID-19 and virus variants. Jama. 2021; 325:2033-2035.
4Oliver, S MD. Data and clinical considerations for additional dosing in immunocompromised people. ACIP meeting July 22, 2021. Available from: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-07/07-COVID-Oliver-508.pdf [Last accessed: 03 August 2022],
5European Cancer Patient Coalition. Joint statement on the safety of immunized patients during the COVID-19 pandemic. Available from: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-07/07-COVID-Oliver-508.pdf [Last accessed: 03 August 2022]
6Belsky J, Tullius B, Lamb M, et al. COVID-19 in immunocompromised patients: a systematic review of cancer, hematopoietic cell and solid organ transplant patients. J infection. 2021; 82(3):329-338.
7Shields AM et al. Outcomes after SARS-CoV-2 infection in patients with primary and secondary immunodeficiency in the UK. Clinical and Experimental Immunology 2022. Available at: https://academic.oup.com/cei/advance-article/doi/10.1093/cei/uxac008/6515671
8Khatamjas E, Rehn A, Muenchoff M, Helmuth J et al. Emergence of multiple SARS-CoV-2 mutations in an immunocompromised host. medRxiv, 2021. Available from: https://www.medrxiv.org/content/10.1101/2021.01.10.2024871v1 [Last accessed: 03 August 2022],
References to Nick York
1Yale Medicine. What does it mean to be immunocompromised? Available at: https://www.yalemedicine.org/news/what-does-immunocompromised-mean#:~:text=with%20so%20much%20attention%20on,between%20normal%20and%20foreign%20cells.[Accessed July 2022]
2Boyarsky BJ, et al. Immunogenicity of a single dose of SARS-CoV-2 Messenger RNA vaccine in solid organ transplant recipients. jama, 2021;325(17):1784-1786.
3CDC. ACIP Changed Immunity Guidelines for Immunization. Available at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html#:~:text=Persons%20with%20altered%20immunocompetence%20Generally, if%20the%20vaccine%20is %20withheld, [Accessed July 2022]
4 Rabinovich L, et al. Low immunoreactivity to SARS-CoV-2 vaccination among liver transplant recipients. Journal of Hepatology2021;75(2), 435-438.
5Kidney Care UK – Lifting lockdown – The impact of COVID-19 for kidney patients as a pandemic. Available at: https://ukkidney.org/sites/renal.org/files/KQuIP/Kidney_Care_UK_patient_survey_report_March_2021.pdf [Accessed July 2022]
6AstraZeneca. Joint statement on the impact of COVID-19 on immunized patients. Available at: https://www.astrazeneca.com/media-centre/statements/2022/joint-statement-on-the-impact-of-covid-19-on-immunocompromised-patients.html, [Accessed July 2022]
7European Patients’ Forum. Alliance of organizations of patients with chronic diseases in Romania. Available at: https://www.eu-patient.eu/Members/The-EPF-Members/Full-Membership/The-Coalition-of-Patients-Organizations-with-Chronic-Diseases-from-Romania/, [Accessed July 2022]
8Blood Cancer UK. Impact of COVID-19 on people with blood cancer. Available at: https://media.bloodcancer.org.uk/documents/Blood_Cancer_UKs_Covid-19-Survey-Report-February-2021.pdf, [Accessed July 2022]
1 1Lepelletier, D., French Society for Hospital Hygiene and High Council for Public Health (2020), Which face mask to use in the context of the COVID-19 pandemic? French guidelines. Journal of Hospital Infection, 105(3), 414–418. Advance online publication.
12WHO. Impact of the COVID-19 pandemic on non-communicable disease resources and service. Available at: https://www.who.int/publications/i/item/9789240010291 [Accessed July 2022]
13Kaye, A. D., et al (2021). The economic impact of the COVID-19 pandemic on healthcare facilities and systems: an international perspective. Best practices and research. Clinical Anesthesiology, 35(3), 293-306.
14Tackle Study Group (2022). Efficacy and safety of intramuscular administration of tixagevimab-cilgavimab for the initial outpatient treatment of COVID-19 (TACKLE): a phase 3, randomized, double-blind, placebo-controlled trial. the Lancet. Respiratory Medicine, S2213-2600(22)00180-1. Advance online publication.
15Levine MJ, et al. Intramuscular AZD7442 (Tixagevimab-Cilgavimab) for the prevention of covid-19. The New England Journal of Medicine. 2022; 386 (23), 2188-2200.
16Abbasi J. (2021). Researchers linked severe immunosuppression to chronic COVID-19 and virus variants. JAMA, 325(20), 2033-2035.
17Kreiswirth, BN (2021). Emergence of multiple SARS-CoV-2 antibody escape variants in an immunocompromised host undergoing convalescent plasma treatment. amsphere, 6(4), E0048021.