Immunocompromised people should receive treatment that would prevent them from being infected with COVID-19.

[dianthus101]

Many people including cancer patients, people on immunosuppressive medications, transplant recipients, people with primary and secondary remain extremely vulnerable to Covid, even after vaccination. For them lockdown has not ended and if anything, it is even worse than 2020 as COVID-19 infections are very high in the community. Some immunosuppressed people have barely been outside since 2020 and the psychological distress is enormous.

I'm not sure if people realise but an antibody treatment (Evusheld) that would prevent them from being infected was authorised by the UK regulator authority (MHRA) in March this year. Despite the fact that the evidence for this treatment is greater than it was for the COVID-19 vaccines (when they were rolled out) it is still not available in the UK (privately or via the NHs) even though it is available in 32 other countries including the US and many European countries. This is because the UK government have not bought any. There doesn't seem to be much publicity about it and I know many immunocompromised people feel very forgotten.

bloodcancer.org.uk/news/leading-charities-and-clinicians-urge-government-to-secure-evusheld/

Yes

ICNARC data showing how the immune suppressed are by far the largest group admitted to ICU

class="underline">COVID-19Report_2022-07-08.pdf.pdf

Discussion of 77% reduction in severity (NB: effectiveness against omicron has now been established)

britishlivertrust.org.uk/evusheld-approved-to-prevent-covid-19-in-people-whose-immune-response-is-poor/#:~:text=In%20a%20clinical%20trial%20in%20adults%2C%20Evusheld%20was,at%20least%206%20months%20following%20a%20single%20dose.

Those who form no antibodies in response to vaccine will gain about 6 months protection.

NICE agreed that back in March

Good explanation of Evusheld here

bloodcancer.org.uk/news/evusheld-does-it-work-against-omicron/#:~:text=Evusheld%20is%20already%20available%20in%20countries%20like%20the,in%20the%20UK%20are%20unable%20to%20get%20it.

It's not a vaccine, it's pre-exposure prophylaxis.

If you are allergic to all forms of vaccine, or have a condition which means you do not produce antibodies, then this is the only way to mitigate risk

I wish this had been offered to my friend who is currently in a coma after catching Covid :-(

My immune system is sitting at 0.2 currently but I can get access to antivirals within a day of getting Covid via my nurse.

How effective is it, and how much does it cost?

Is this going to be another thing like the vaccines that appear increasingly ineffective?

Oh it's going to stop the pandemic > it won't stop the pandemic but it'll make you less likely to get it > ok it doesn't make you less likely to get it but it reduces the chance you'll pass it on > ok it doesn't reduce the chance you'll pass it on but it reduces the symptoms > ok it doesn't reduce symptoms but it makes you less likely to die. Well, better than nothing I guess.

Cost should be no more than £800

That's roughly the equivalent of 2 nights in hospital (not including the actual treatments the patient receives for whatever lands then in there)

The target group for this treatment is precisely those who currently have "nothing"

Those who are still shielding because they do not make antibodies. This gives them antibodies, and the protection lasts about 6 months.

If you had been in lockdown continuously since March 2020, would you like to be able to rejoin ordinary life?

I agree OP. I don’t understand why it’s not rolled out.

which is a huge amount less than it cost for someone to come round to my house and give me the antibody drip which is what happened when I caught Covid.

£800 per dose seems quite high, the current vaccines cost around £20.

Unfortunately in a public healthcare model they need to balance cost and benefit. I've read OP's link but it doesn't say how much more effective this treatment is compared to the existing vaccines.

The chance of dying from covid is already very low (14.0 deaths per 100,000 people according to ONS) and the increased risk for disabled people is between 1.3 and 1.6x, so maybe 22.4 deaths per 100,000 people, aka 0.024%.

From what I've read OP, I don't think Evusheld is quite the magic treatment you purport it to be.
There have been cases, albeit v few, where folk have had this treatment but still contracted Covid.
As new variants are emerging all the time, in the way that viruses tend to do, some studies have shown that it isn't quite as effective as was hoped, against some of these.
My understanding is that it is still being studied and monitored which is a positive.

I speak as an immunosuppressed person who is not shielding but remains a cautious mask wearing copious handwasher.

I think the numbers of people who would need this are pretty small so the cost wouldn't be the same as a national rollout.
I am immunosuppressed. Caught covid after two vaccines and was pretty ill. Hospital 8 days but not ICU, so that probably cost quite a lot.
I'm not still shielding though. I figure the odds are in my favour, I survived covid once, it's less deadly now and I have had 3 more vaccine doses.

We're not talking about 'disabled people', though.

We're talking about people of all ages who led normal, full lives prior to March 2020 who have been in something akin to perpetual lockdown for two and a half years. Yes, there will be some disabled people who are immunosuppressed/vulnerable, but there will also be tens of thousands of people living with autoimmune diseases, for example, whose lives have been put on hold for years.

It's not just about risk of death. It's also about quality of life, the ability to earn a living, to not worry about sending DC to school, or use public transport.

Vaccines have been brilliant at preventing serious illness and death but if you're immunosuppressed, you won't have the same benefits from them as someone who isn't. A preventative drug would make all the difference to those who would be eligible for it, and would ultimately cost less than hospital stays/days lost to sickness (immunosuppressed people tend to be sicker for longer) and likely reduce strain on MH services, too.

I haven't said that it is a “magic treatment”. The fact that some people still catch it doesn't mean that it is of no benefit though, particularly if those people get less severe disease than they would have done. The risk of catching COVID is significantly lower in immunocompromised people who've been treated with it.

Regarding “studying and monitoring it” before buying it, do you not think that it's just an excuse for delaying buying it? There is more evidence for Evusheld then there was for covid vaccines (at the time they were rolled out) but they didn't have much problem buying those. No one seems to know what evidence they are waiting for and why the UK seems require more evidence than the 32 other countries that are using it including the US. This letter from leading clinicians and charities states:

“There is strong clinical support for Evusheld across a range of medical specialties. Nonetheless, we are concerned that Evusheld is being held to an impossible standard of evolving evidence. It is unclear what information and concerns the Government hold in relation to Evusheld’s effectiveness, and how these relate to the delays in its procurement. Despite real-world studies showing strong performance against Omicron BA1 and BA2 and subsequent data for BA4 and BA5, there has been a lack of transparency relating to Government testing and how this will influence procurement and rollout.”

media.bloodcancer.org.uk/documents/Evusheld_open_charity_letter_28.07.22.pdf

For those that keep asking about the cost, can I point out that even if you want to argue that it isn't worth the cost (I strongly disagree), people can't even buy it privately in the UK.

The chance of dying from covid is already very low (14.0 deaths per 100,000 people according to ONS) and the increased risk for disabled people is between 1.3 and 1.6x, so maybe 22.4 deaths per 100,000 people, aka 0.024%

This doesn't work as a comparison.

It's not being rolled out to the general population. Or even the 'disabled' population.

It's the severely immune supressed group (about 500,000 people). There have been about 750 covid deaths this year. Around 500 of them from that group.

It has been studied - MHRA has approved it. It's in use in about 40 countries now, so the monitoring is in place and ongoing

I've read OP's link but it doesn't say how much more effective this treatment is compared to the existing vaccines

People who respond to the vaccines would not be offered Evusheld. It's needed for those who do no produce antibodies. So the answer is 'vastly more effective' as it's taking protection from zero to about 77%

Thanks @nether - This is much better than the response I was starting to write! This ^^

Thank you, that's a helpful post. I'm not against it, I just want to understand the cost and the benefit because the information is pretty light in OP's link.

So the cost of the rollout for Evusheld for those 500,000 people at £800 per dose would be £400 million? And could potentially save in the region of 1000 deaths per year from that clinically vulnerable group?

Given the potential savings from not having to treat immunocompromised people with covid, the net cost could be lower than that.

So the cost of the rollout for Evusheld for those 500,000 people at £800 per dose would be £400 million? And could potentially save in the region of 1000 deaths per year from that clinically vulnerable group?

It's not just saving lives. It's reducing the number of covid admissions, especially to ICU. It's making cancer care safe, which will help tackle the backlog. It's about getting people back to their normal economic activity. It's about reducing the strain on services supporting those still shielding (notable MH services).

Hell, its about giving a population the size of Glasgow their lives back

Something that 40 governments think is worthwhile (more countries have announced rollout in recent weeks, so the original figure of 32 is now out of date)

Remember, we're not used to looking at how much drugs cost. The NHS spent over £400mil a year on adalibumab (before the less expensive generic version was available) - and that was to benefit 46,000 people.

One blood cancer patient on a second line TKI can cost around £40k a year on drugs bill only.

Are those lives and quality of lives worth it?

MHRA and NICE say 'yes', just like they say 'yes' to Evusheld

I agree with you (strongly) apart from the fact that we are used to looking at the cost effectiveness of drugs, or at least the NHS is. There has been no suggestion that Evusheld is not cost effective though. In fact no clear reason has been given at all for why the government hasn't procured it.

So well said!

There are an awful lot of people talking about vaccines instead of the issue at hand.

To clarify Evusheld is a protective (prophylactic) measure to help those who
do not or cannot mount an antibody response because the vaccines haven’t worked.

I am one of the people for whom immunosuppressive medication meant that the vaccine wasn’t going to work. I’ve had 5 vaccine jags. It won’t really do much as it relies on part of my immune system that my medication switches off. Evusheld would give me a protective layer against covid meaning I could try to resume normal life again only worrying about the usual bugs like flu & chicken pox/measles etc

That 33% of people think it unreasonable people like me be protected from a virus that has killed 200,000 people in 2.5 years, makes me realise how little society values me & people like me.

That 33% of people think it unreasonable people like me be protected from a virus that has killed 200,000 people in 2.5 years, makes me realise how little society values me & people like me.

I hear you alpenguin. I am tired of living in fear and I know that there is very little sympathy or understanding of what it’s living in a constant state of anxiety wondering if every trip to the supermarket, hospital, interaction you’ve had is going to lead to a covid infection.

Like most of us, are illnesses have already robbed enough from us, Covid had just added a whole new layer.

That 33% of people think it unreasonable people like me be protected from a virus that has killed 200,000 people in 2.5 years, makes me realise how little society values me & people like me.

Yes, you have got to hope that they just didn't understand/read the OP or pressed the wrong button by accident.