Omicron sub-variants are resistant to key antibody treatments, putting people with weak immune systems at risk of covid

Emerging Omicron subvariants are resistant to key antibody treatments for HIV patients, kidney transplant recipients and other people with weakened immune systems, making them especially vulnerable to Covid this winter, the White House warned this week.

“With some of the new subvariants emerging, some of the main tools we’ve had to protect the immunocompromised, like Evusheld, may no longer work. And that’s a big challenge,” Dr. Ashish Jha, head of the White House Covid Task Force, told reporters on Tuesday.

President Joe Biden on Tuesday warned the roughly 7 million adults in the U.S. who have compromised immune systems that they are particularly at riskbut he could offer little reassurance beyond telling them to consult their doctor about what precautions to take.

“New variants can render some existing protections ineffective for people with compromised immune systems,” the president said before receiving a booster dose on Tuesday. “Unfortunately, that means you may be at particular risk this winter. I urge you to consult your doctor about the right steps to take to protect yourself, take extra precautions.”

The message contradicts repeated assurances from the White House that the US has all the vaccines and drugs it needs to fight Covid this winter, as public health officials expects a new increase.

While this may be true for the general population, it is not true for people with weak immune systems. These include cancer patients, those who have had organ transplants, people living with HIV, and individuals taking medications for autoimmune diseases.

Evusheld is an antibody cocktail approved by the Food and Drug Administration to prevent Covid in people 12 years of age and older who have a moderately or severely compromised immune system. The medicine is given in two injections, before infection, every six months.

Evusheld, made AstraZeneca, has helped close a gap in protection for those with weak immune systems who cannot respond strongly to vaccines. According to Camilla Kotton, an infectious disease expert who specializes in treating people with weak immune systems, the drug and several rounds of vaccinations have led to a significant reduction in hospitalizations in this cohort over the past few months.

“We’ve been in a good position for several months now because immunocompromised patients have good protection and then good treatment options,” said Kotton, a physician at Massachusetts General Hospital and a member of the independent Centers for Disease Control and Prevention. vaccine advisory committee.

But more immune-evasive omicron sub-variants such as BA.4.6, BA.2.75.2, BF.7, BQ.1 and BQ.1.1 are resistant to Evusheld, according to the National Institutes of Health. For example, scientists at Columbia University found that Evusheld has completely lost its effectiveness against BA.4.6.

BQ.1 and BQ.1.1 are likely resistant to bebtelovimab, a monoclonal antibody developed by Eli Lili to prevent people with weakened immune systems who contract Covid from developing severe disease, according to the NIH.

This makes people with compromised immune systems increasingly vulnerable as these subtypes increase in the US. As omicron BA.5 declines, this swarm of newer subvariants collectively accounts for about 38% of U.S. infections, according to the CDC.

Although Pfizer’s antiviral drug Paxlovid remains effective against omicron subvariants, people who have had organ transplants often can’t take the pill because of the way it interacts with other drugs they need, Kotton said.

“I worry that the near future will be a challenging time for immunocompromised patients,” Kotton said. “Monoclonal antibodies in Evushield will provide less protection, and bebtelovimab will provide ineffective treatment for more emerging variants.”

And help is not on the way right now. Kottonova said she knows of no monoclonal antibodies that are ready to replace those that the subvariants split off. At the White House on Tuesday, Jha acknowledged that the US has fewer and fewer treatment and prevention options for people with weak immune systems as covid develops. He blamed Congress for failing to pass $22.5 billion in funding for the nation’s response to Covid because of opposition from Republicans.

“We had hoped that over time, as the pandemic progressed, as our fight against this virus progressed, we would expand our medicine cabinet,” Jha told reporters. “The lack of congressional funding has actually shrunk the medicine cabinet, putting vulnerable people at risk.”

Andrew Pekosz, a virologist at Johns Hopkins University, said finding ways to protect people with weakened immune systems is the most critical issue of the pandemic right now and needs to be addressed quickly.

“What we really need to work on is getting new antibody drugs out of the lab and into the clinic,” Pekosz said. “In the lab, scientists know what next-generation monoclonal antibodies look like.”

Kotton said people with compromised immune systems should stay current on their vaccines, which means getting a new booster that targets the BA.5 micron. Those who have stayed up-to-date throughout the pandemic have received six vaccines so far.

Those starting from scratch would receive a primary three-dose series from Moderna or Pfizer with older-generation vaccines and then a new booster that targets the omicron, according to CDC guidelines.

People with compromised immune systems should continue to be cautious this winter because immune-resistant subspecies of the omicron could appear in circulation as people gather for the holidays, Kotton said. She noted, however, that the group was more diligent about wearing masks and implementing mitigation measures to avoid the virus than the rest of the population.

The bigger problem is that the general population has largely moved on and is no longer taking basic precautions that could reduce transmission and protect the vulnerable — like wearing masks, Kotton said.

“If everyone wore masks more in public, it would increase their safety and make them more likely to return to many activities more safely,” she said.

NBC News asked Jha on Tuesday if Biden telling people with weak immune systems to consult their doctors about precautions means the burden of responsibility has shifted to individuals instead of the community at large.

“As a society — as a caring society, we care about all Americans, especially the most vulnerable Americans,” Jha said. “I think it remains a collective responsibility for all of us to care for our fellow Americans who are immunocompromised.”

The CDC recommends that people in moderate-risk communities for Covid self-test and wear a high-quality mask before meeting indoors with someone at high risk of getting sick. Those at high risk should wear a high-quality mask when indoors in public.

When the level of covid is high, people in general should consider wearing high-quality masks, and those who are vulnerable should consider avoiding non-essential indoor activities in public, the CDC says. You can check your state’s Covid level on the CDC website.