Sponsored by AstraZeneca
Authored by Iskra Reic, Executive Vice President, Vaccines and Immune Therapies, AstraZeneca
Vaccinations have proved to be one of the most significant public health interventions of modern times, saving millions of lives every year across more than 20 infectious diseases, including COVID-19.1 While the vast majority of us benefit from the enduring protection of vaccinations, some of the most vulnerable people such as the immunocompromised need additional protective options. In particular, many people with weakened immune systems, such as cancer patients or organ transplant recipients do not mount an adequate response to vaccination,2 and as a result they face a far higher likelihood of serious outcomes from infectious diseases.3,4
This increased vulnerability can have a devastating impact on physical health. For example, despite vaccination, the immunocompromised have a 40 percent higher chance of being admitted to the ICU and a nearly 90 percent higher chance of dying in the hospital from COVID-19 than the general population.3 Further, recent evidence from a large real-world study showed that 24% of immunocompromised people were hospitalized for COVID-19, half of whom had severe or critical disease, and the mean length of stay across disease severity was 15 days.5 Additionally, there is mounting evidence that COVID-19 can impact a patient’s primary condition through missed hospital appointments and treatment interruptions/ delays.6–8
What’s more, as seen during the COVID-19 pandemic, the burden of infectious diseases can be crippling for healthcare systems, many of which have been taken to a breaking point trying to manage outbreaks, while still providing routine care.
The need for scientific innovation in the tracking, prevention and treatment of serious infectious diseases has never been greater – both to reduce patient morbidity and mortality, and to boost the resilience and effectiveness of the healthcare systems.
The power of passive immunization using antibodies
At AstraZeneca, our ambition is to help protect millions of people where the burden of disease is highest and unmet needs are greatest. One area where we see promise is monoclonal antibodies (mAbs) for passive immunization for infectious respiratory diseases. This means administering infection-fighting antibodies directly to those who may not generate enough on their own after vaccination and can provide rapid protection for those at risk for the most serious outcomes from infectious diseases.9
We are therefore leaning into our deep experience and heritage in vaccines and immunotherapies to drive forward innovative antibody development, including engineering antibodies with potential to provide an extended duration of protection compared to traditional mAbs.10,11 By using novel half-life extension technology, our goal is to deliver antibodies that may offer longer-lasting protection when patients need it most.
We are also working to stay ahead of challenging viral pathogens by investigating a range of innovative platforms and technologies that accelerate delivery and cost-effectiveness of mAbs for patients and healthcare systems. For example, we are harnessing the latest AI technology to rapidly sequence billions of antibodies, allowing us to rapidly select the most promising molecules that may unlock the possibility of predictable protection or a swift response to a mutating virus.
A new approach to public health
Scientific innovation is not enough on its own. The potential of passive immunization must be backed by flexible and evolved access frameworks, including positive recommendations from national bodies and specialty guidelines, and a mindset in which mAbs are the “go to” option for the most vulnerable. It also requires mAb protection be embedded into patient-centered pathways through consistent access policies that improve patient care – a strategy advocated by clinical and patient representative groups.
Supporting health systems and driving improvements in public health also requires academic collaborations, local partnerships, commercial initiatives and advanced manufacturing that accelerates scientific progress and brings passive immunization into the mainstream for the most vulnerable. This must happen alongside education and other public health initiatives that help improve understanding and action in tackling infectious diseases.
Research and disease management should form the bedrock of resilient and sustainable healthcare systems, ensuring timely provision of prevention and treatment solutions as well as effective preparedness for future outbreaks. Government investment in programs and technologies will help protect specific at-risk populations against endemic and pandemic diseases.
No one left behind
In today's era of endemic and pandemic diseases, we must be ready and able to protect those unable to mount effective immune responses – for their own health and to preserve the effectiveness and resilience of our healthcare systems.
Passive immunization could provide a paradigm shift in the prevention and management of infectious diseases that may offer vulnerable people longer lasting immunity than conventional mAbs against a wide range of pathogens. Supported by the right tools and policies, we could respond more quickly and effectively to control future outbreaks, alleviating the pressure on healthcare systems.
More than ever, we need a global public health approach that combines vaccines for the majority with complementary passive immunization for those most at risk. We are all in this together – and we must ensure no one is left behind.
References
1. World Health Organization Vaccines and Immunization. https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1 [Last accessed: September 2023]
2. Centers for Disease Control and Prevention. COVID-19 Vaccines for People Who Are Moderately or Severely Immunocompromised. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html [Last accessed: September 2023]
3. 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):878-884
4. Cancer Research UK. Flu Vaccine and Cancer Treatment. https://www.cancerresearchuk.org/about-cancer/treatment/cancer-drugs/flu-vaccine [Last accessed: September 2023]
5. 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. Published online July 17, 2023:1-16. doi:10.1080/03007995.2023.2233819
6. Kareff SA et al. Prevalence and Outcomes of COVID-19 among Hematology/Oncology Patients and Providers of a Community-Facing Health System during the B1.1.529 (“Omicron”) SARS-CoV-2 Variant Wave. Cancers. 2022;14(19):4629
7. American Society of Transplant Surgeons. Re-Engaging Organ Transplantation in the COVID-19 Era. https://asts.org/advocacy/advocacy-library/covid-19-library [Last accessed: September 2023]
8. Di Iorio M et al. DMARD Disruption, Rheumatic Disease Flare, and Prolonged COVID-19 Symptom Duration after Acute COVID-19 among Patients with Rheumatic Disease: A Prospective Study. Semin Arthritis Rheum. 2022;55:152025
9. Centers for Disease Control and Prevention Immunity Types. Published online 2021. https://www.cdc.gov/vaccines/vac-gen/immunity-types.htm [Last accessed: September 2023]
10. Robbie GJ et al. A Novel Investigational Fc-Modified Humanized Monoclonal Antibody, Motavizumab-YTE, Has an Extended Half-Life in Healthy Adults. Antimicrob Agents Chemother. 2013;57(12):6147-6153
11. House R V. et al. Evaluation of Strategies to Modify Anti-SARS-CoV-2 Monoclonal Antibodies for Optimal Functionality as Therapeutics. PLoS One. 2022;17(6):e0267796
October 2023 Z4-58625