Coronavirus (COVID-19) information & research hub

Absolutely. Despite lower case numbers, COVID-19 hospitalisations and deaths in the general population compared with the height of the pandemic remain a concern. Although the World Health Organization declared an end to the global public health emergency in May 2023, COVID-19 continues to carry a high burden of disease globally.^1,3,4 WHO reported substantial increases in COVID-19 hospitalisations and ICU admissions in late 2023.⁵ COVID-19 remains one of the leading causes of death and respiratory virus hospitalisations in the US, where 2023 ended with about 35,000 weekly hospitalisations and over 2,000 people per week dying from COVID-19.^​6 New real-word 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.¹ So, we all – health professionals, scientific societies, governments and the public at large – need to remain vigilant and ensure access to effective protection individually and in our communities.

Most people with healthy immune systems now remain well protected against severe outcomes from COVID-19 through vaccination and previous infection. Immunocompromised individuals typically have a diminished immune response to vaccinations, including those for COVID-19, due to their weakened immune system.​⁷​ To be effective, vaccines require a healthy immune system to jumpstart the body’s natural ability to produce an infection-fighting response.⁸​​ In people who are immunocompromised, the quantity, quality, and durability of protective antibodies produced from COVID-19 vaccinations are lower than in others, and this can leave them at risk of infection and serious outcomes.^9-12 

Despite vaccination, COVID-19 remains a threat for immunocompromised patients. Immunocompromised individuals carry a disproportionately large proportion of the COVID-19 disease burden compared to the general population.​^1,2​ Their risks for breakthrough infections and severe clinical outcomes remain elevated relative to the rest of the population. A recent study conducted in England showed that despite accounting for about 4% of the population, immunocompromised individuals accounted for around a quarter of all COVID-19 hospitalisations, ICU admissions and deaths, even after receiving repeated doses of COVID-19 vaccines.​¹ ​With reduced protection, many in the IC community continue to limit contact with others, practice preventive measures such as mask-wearing and often can’t return to their everyday lives.^13,14​

Looking beyond the impact for patients and their friends and family, a considerable economic burden also remains. A comprehensive US study showed that immunocompromised individuals accounted for about one-third (about $310 million US) of the total COVID-19 US hospitalisation costs in 2022. More than 60% of costs contributed by immunocompromised individuals were due to hospitalisations for severe COVID-19.^​2

Discover what living with the continuing threat of COVID-19 has meant to immunocompromised individuals and their families. 

While the risk of COVID-19-related hospitalisation is elevated across immunocompromised populations, the risk for people with certain conditions or who take immunosuppressive treatments is particularly high. For example, the risk of hospitalisation is even higher for people with blood/bone marrow cancers, end-stage kidney disease, solid organ transplant recipients and those who take certain medications for autoimmune conditions such as multiple sclerosis.¹ Therefore, immunocompromised individuals are advised to get the most recently available COVID-19 vaccines, to use additional preventive measures, such as wearing masks, and be promptly tested and treated at the onset of COVID-19 symptoms.

We believe more needs to be done to protect individuals who are immunocompromised, and we have been committed to this work since the beginning of the COVID-19 pandemic. Immunocompromised patients, and their physicians, need to be aware of the disproportionate risk of COVID-19-related illness and complications, and the fact that vaccination often does not provide adequate protection to immunocompromised individuals.⁷

Learn more from the International Immunocompromised Advocacy Network, a coalition of more than 40 patient groups that issued a Call to Action outlining the unmet needs and challenges of immunocompromised individuals around COVID-19. 

As a supplement to vaccination, monoclonal antibodies may provide additional protection to the immunocompromised as infection-fighting antibodies are given directly to vulnerable individuals who may not generate enough antibodies on their own after vaccination. This approach, known as passive immunisation, may provide near immediate protection against COVID-19.​¹⁵

COVID-19 is still a threat, especially for immunosuppressed people who continue to face significant and disproportionate health impacts from the virus.^1,2 The updated CDC recommendation aims to bring advice for COVID-19 in line with that for other kinds of respiratory infections, such as flu. However, COVID-19 hospitalisations overall in the US remain much higher than for flu.^16,17 As such, everyone who tests positive for COVID-19 should be mindful of the potential to cause serious illness in those who are medically vulnerable. The new recommendation also means that immunosuppressed people should take extra precautions to protect themselves from COVID-19 and seek medical advice and care as needed.

To keep pace with rapidly evolving SARS-CoV-2 variants and to be prepared for future pandemics, rapid clinical development and approval pathways are needed to respond in a timely manner. One way that researchers and health authorities are expediting the process is through immunobridging trials, a scientific approach that has paved the way for vaccine approvals across numerous infectious diseases.​ Immunobridging trials are an established approach used when there is an urgent need for important, new medicines, but full-scale efficacy trials may not be feasible within the timeframe available.​²²​ The trials are designed to demonstrate equivalent activity for an investigational therapy to a similar existing therapy.²²​ This type of trial has been used since the 1990’s to support the introduction of updated vaccines for a variety of infectious diseases, including COVID-19 boosters, flu, human papillomavirus and pneumococcal pneumonia.^18-21  ​

We face an unpredictable world of SARs-CoV-2 variants, and we anticipate that the virus will continue to evolve. What remains true is that immunocompromised patients have few options and need protection in this heterogeneous and ever-changing viral landscape.​²³ This is a key reason we remain committed to protecting and supporting the immunocompromised community and will continue to do so.

We are all adjusting to a new normal, and health experts anticipate we may have to deal with the disruption of COVID-19 for years to come. Our bold ambition is to create a world where the threat of COVID-19 is eliminated for all people. This is part of our larger mission in AstraZeneca’s Vaccines & Immune Therapies to help protect millions of people where the burden of disease is highest and unmet needs are greatest, ensuring no one is left behind.