COVID-19 positivity rates are dropping, vaccines and treatments have been produced for keeping many out of the hospitals and suddenly the unwritten social contract many of us agreed to in order to protect our family, friends and neighbors seems less relevant. We in the HIV community know this phenomenon well.
Unfortunately, for those living with immunocompromised systems, our world still looks very similar to those first few months of 2020. While we know that COVID-19 vaccines are effective at helping many people to avoid serious illness and death, we also now know that individuals living with a compromised immune system due to HIV, cancer, organ transplants and a wide variety of diseases, may not be able to build up the necessary level of protective antibody response against the virus.
In fact, a recent study found that fully vaccinated people with weaker immune systems contract COVID-19 three times more often and have more severe illness than those with strong immune systems.
While vaccine innovation took place at a “warp speed,” getting treatments and therapeutics into the market and then into the hands of those who need them has become warped. Antigen testing is still clinically more difficult to use at home than the HIV rapid test. The U.S. Food and Drug Administration (FDA) is still reminding the public and health care providers that results from currently authorized antibody tests should not be used to evaluate a person’s level of immunity or protection from COVID-19 at any time, and especially after the person received a COVID-19 vaccination. And while there have been several treatment options already approved by the FDA Emergency Use Authorization (EUA) process, many of these treatment options, including the two anti-viral treatments which the U.S. government has most heavily invested in, are not proven to be effective for the immunocompromised population and could produce negative interactions with the other medicines these patients must take on a daily basis to remain healthy.
Even at the recommendation level, there was warping. The only monoclonal antibody therapy authorized in the U.S. for pre-exposure prophylaxis preventative, a recommendation for those living with advanced HIV, requires criteria that severely limits access. These are the examples of the system falling behind our needs.
We are confronted almost daily with everchanging guidance on boosters, mask wearing and information on how protected we are (or aren’t) against new variants while we remain at an increased risk for severe COVID-19, due to the fact that many people living with HIV have one or more comorbidities.
Given HIV disproportionately affects communities of color, and those same communities are also at greater risk of dying from COVID-19 than white Americans, we are also only seeing health inequities increase. We cannot allow our nation to continue this backward slide from the important progress we should be making toward closing the gap on basic health care needs for all populations.
Unfortunately, this again is where we as a community are still being left to fall through the cracks and where we need the administration to show its leadership in ensuring that all Americans are provided the opportunity to protect ourselves against this virus.
President Biden has taken some promising first steps through the COVID-19 Preparedness Plan to encourage continued investment into the tools needed to protect all individuals from COVID-19 and future viruses, but there is a growing concern among those in our community that emphasis on encouraging innovation in new treatment options for COVID-19 is losing steam.
We must have options that keep immunocompromised individuals out of the hospital. We must continue to invest in the development of treatments such as monoclonal antibodies, which can be a safe and effective option particularly for those with a compromised immune system and expand delivery methods to ensure timely and equitable access for those who need them most.
As many lawmakers in Congress are questioning the value of injecting more taxpayer dollars into a pandemic response that may no longer feel like a pandemic, we cannot allow that to happen. The administration, health care leaders and members of Congress must recognize this need and take steps now to support ongoing investment into the innovation that is still needed to protect the most vulnerable in our society. This is not only an issue of equity and access, for so many of us it is an issue of life and death.
Brian Hujdich is the executive director at HealthHIV, a national HIV non-profit organization based in Washington, D.C.
Scott Bertani is the director of advocacy at HealthHIV.