The continued burden of COVID-19 for the immunocompromised

26 October 2023



With the World Health Organization (WHO) declaring an end to the global public health emergency in May 2023, much of the world has moved on from COVID-19. Government and healthcare organisations have reduced their sense of urgency, and much of the general public has embraced a return to pre-pandemic life. However, the risks from COVID-19 are far from over, especially for those most vulnerable, such as the immunocompromised.

COVID-19 burden remains high

Now considered an endemic disease, COVID-19 continues to result in serious health consequences globally such as hospitalisation, intensive care unit (ICU) admissions and death.1–3

  • Hospitalisation rates remain higher for COVID-19 than other seasonal respiratory illnesses, such as flu and respiratory syncytial virus (RSV).4,5
  • WHO reported nearly 10,000 deaths from COVID-19 in December 2023, and there was a 42% increase in hospitalisations and a 62% increase in ICU admissions compared with November 2023.6  
  • In the US alone, 2023 ended with about 35,000 weekly hospitalisations and more than 1,500 people per week dying from COVID-19.3,7

The immunocompromised shoulder a disproportionate burden

Many who are immunocompromised often have a diminished immune response to COVID-19 vaccination, and therefore remain at higher risk for severe COVID-19, hospitalisation and death than the general population.8-10  

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.10,11 These studies showed that:

  • More than a quarter of the COVID-19 burden is born by immunocompromised individuals, despite being vaccinated against the virus;10
  • Among the immunocompromised, the risk of hospitalisation is disproportionately high for people with people with blood/bone marrow cancers, end-stage kidney disease, solid organ transplant recipients and those taking immunosuppressive medications for certain conditions, despite being vaccinated;10,11
  • The cost of taking steps to protect immunocompromised patients may be lower than the high costs associated with poor COVID-19-related outcomes.12,13

Protection is essential for the immunocompromised who remain vulnerable to COVID-19

Vaccines require a healthy immune system and help jumpstart the body’s natural ability to produce infection-fighting cells.14 Thus, individuals with compromised immune systems, such as people with cancer, organ transplant recipients, or people taking immunosuppressive medicines, may not be as well protected against COVID-19, even when vaccinated.10 In fact, more than one in 10 immunocompromised patients do not develop the antibodies needed for protection even after five or more COVID-19 vaccinations.15

Scientific advances have made it possible to provide passive immunity with monoclonal antibodies, independent of the recipient’s immune status.16-18 Monoclonal antibodies are generated in a lab to target a specific bacteria or virus.19 The antibodies are administered into the body where they can provide near immediate protection against infection by recognizing and binding to the target pathogen.16-18

With the rapid evolution of Omicron variants that reduced or removed authorised therapies for COVID-19 prevention, many IC individuals are left without active or passive protection while potential new therapies are being studied.20,21


Vaccination alone is often not enough to protect immunocompromised individuals from potential devastating consequences of COVID-19. We must work together to find solutions so that this vulnerable population can move on from the pandemic.

Paul Moss, Professor of Haematology, University of Birmingham, UK

Reducing the preventable burden of disease

The World Health Organization acknowledges that while COVID-19 has become endemic to many areas, the immunocompromised continue to face an ongoing risk from the virus.22 A deeper understanding and recognition of this diverse group to help foster access to tailored, appropriate care and treatment remains an urgent unmet need. Without effective, long-term protection, the burden of COVID-19 falls on both immunocompromised patients and healthcare systems.12,13 A 2022 study suggests that more than 14,500 hospitalisations in England could have been prevented if a prophylactic intervention with 80% effectiveness had been used alongside vaccination in immunocompromised individuals.10

At AstraZeneca, we are committed to following the science to protect the most vulnerable patients, ensuring no patient is left behind. One area where we see promise is with monoclonal antibodies as passive immunisation for infectious respiratory disease. We believe innovating in this field will to help deliver on our ambition is to provide long-lasting immunity to millions of people, where the burden of disease is greatest.


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13. Willems SH et al. Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity. JMIR Mhealth Uhealth 2021;9(6):e25021. doi:10.2196/25021

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22. World Health Organization. Statement on the fourteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic. [cited Feb 2024]. Available from:

Veeva ID: Z4-61447
Date of preparation: March 2024