Evusheld is a combination of two long-acting antibodies (tixagevimab and cilgavimab). It’s a drug designed to protect clinically vulnerable people against Covid in cases where vaccines don’t work. A good example is people who have been on the chemotherapy drug Rituximab, which causes much worse Covid outcomes and also reduces vaccine efficacy. Another example is people with primary or secondary immunodeficiency. Evusheld is given prophylactically (that is: in advance) to stop people in this situation developing severe Covid in the first place.
As of 2023, the efficacy of Evusheld against circulating variants has been questioned. On the one hand, in vitro results (in experiments/lab conditions) show reduced neutralization. On the other hand, real-world studies continue to show protection.
The second version of Evusheld is currently in clinical trials (dubbed: SUPERNOVA).
Monoclonal antibodies should be administered to all vulnerable people who are less likely to have mounted a response to vaccination. We believe that everybody listed in the NHS England RAPID-C19 report ‘Defining the Highest-Risk Clinical Subgroups upon Community Infection with SARS-CoV-2 When Considering the Use of Neutralising Monoclonal Antibodies (NMABs) and Antiviral Drugs: Independent Advisory Group Report’ should receive Evusheld or other prophylactic monoclonal antibody therapy as they become available.
Evusheld was authorised by the UK’s MHRA on the 17th March 2022. This means that it met the UK regulatory standards of safety, quality and effectiveness. As a result, we were told, “the decision to grant approval for this treatment was endorsed by the government’s independent expert scientific advisory body, the Commission on Human Medicines, after carefully reviewing the evidence”. You would think this would mean that vulnerable people would, by now, have access to this lifesaving drug.
Evusheld can only be obtained privately in the UK.
Evusheld was available in other comparable countries, such as France, Canada, Israel, and the US. Indeed, Kuala Lumpur has announced its intention to protect its population using Evusheld.
The UK government, however, made no moves towards purchasing Evusheld.
A frequent response from MPs has been that they cannot discuss Evusheld because the negotiations are “commercially sensitive”.
However, the Policy and Communications Lead of Vaccines for Astra Zeneca said:
“AstraZenca does not recognise any limit on discussing the decision-making regarding prophylaxis due to commercial sensitivity. […] AstraZeneca has not yet been asked to enter negotiations on supply. Whilst some information exchanged is confidential there is no commercial sensitivity which restricts policy discussion regarding prophylaxis.”
One of the responses that our members have had is that there is no need for Evusheld given that we have anti-viral treatments. Indeed, one reply even went so far as to suggest that these treatments are better than preventing Covid in this cohort and that the government’s strategy does not involve prophylaxis (going against the well-known medical axiom that “prevention is better than cure”.)
This is clearly not the case. First, the government’s strategy of vaccination is prophylactic and designed to prevent infection. To say that there is no prophylaxis is simply not true.
Second, antiviral treatments have proved difficult to access in a timely fashion and are contra-indicated with many health conditions. These therapies also put vulnerable people in the position of risking serious illness before they are treated, while the rest of the population has prophylactic treatments in vaccines.
MPs from all parties have been engaged with this cause, including Graham Stuart, Vicky Foxcroft, Caroline Lucas, Andrew Gwynne, Daisy Cooper, Catherine West, Flick Drummond, Layla MOran, Stephen Crabb, Paul Davies, Munira Wilson, and Daniel Zeichner. Lord Mendelsohn has also been a champion in the House of Lords and we have also had supportive engagement from Baroness Morgan and Baroness Brinton.
Previously, our group was called Evusheld for the UK and we campaigned exclusively for this drug. As things have moved on, our focus has broadened, but Evusheld and successor drugs remain crucial to the protection of immunocompromised individuals in the pandemic.