“Mr. President …”: the call for help from immunocompromised patients facing the Delta variant

“Mr. President …”: the call for help from immunocompromised patients facing the Delta variant
“Mr. President …”: the call for help from immunocompromised patients facing the Delta variant

Sylvie turned off the TV, feeling like she had been forgotten. Again, “them” was not mentioned. On TF1 this Wednesday, Jean Castex unrolled his answers, alerted to the Delta variant, called for mass vaccination. But nothing, not a word on the severely immunocompromised who experience a deconfinement against the tide. “At the same time, we only represent a small minority, only 250,000 patients,” the excuse of this young retiree from Chambéry (Savoie), “dialysis, kidney transplant, redialysis and re-transplant”.

While France is divided between the double injected, the hesitant and the fervent opponents, it is part of another little-known camp, that of the unprotected vaccinated. One, two, three doses from January to April, and still no antibodies. “My serological tests show that there is nothing, zero”, despairs this 61-year-old patient who, like a snub to the disease, has become a doctor.

The paradox comes from his anti-rejection treatment which, to allow his body to accept this foreign and fragile kidney, lowers his immunity. “It’s the double penalty, the vaccine does not protect me from the Covid but if I catch the virus, it risks sending me out and killing me”, breathes Sylvie, whose kidneys have stopped working there is 44 years old, because of an inflammatory disease. While the French live again, she finds herself trapped between two waters, in semi-freedom. She flees transport, goes to the theater with an FFP2 and on the terrace with a drop. The Prime Minister’s latest decision could further shrink his world: “The end of the compulsory mask in places where there is a health pass? Sylvie jumped up. It’s scary ! We are condemned to social death. “

“We ask you to renounce this measure”, enjoins the Head of State Nathalie Mesny, the president of the Renaloo association, dedicated to kidney patients. In a letter in the form of a call for help, sent this Thursday, and that we publish exclusively, the activist calls on Emmanuel Macron. In transplant recipients, the death rate linked to Covid reaches 15 to 20% and with the Delta variant, it climbs to 30% in the United Kingdom. Concerns swirl from line to line: “We must not be abandoned to our plight and the threat of the Delta variant. After all the efforts and sacrifices we have already made to survive, have we thus lost our place in society? “

Like Sylvie, a third of transplant recipients do not react to the vaccine. However, there is hope, claims the association, which asks the president to accelerate the arrival on the market of monoclonal antibodies as a preventive measure to boost immunity. “Their interest is to protect very fragile people by treating them very early”, explains Alain Fischer, the “Mister vaccine” of the government. The promise is beautiful, Renaloo wants to believe it. “An emergency procedure to access this drug is underway but the decision will not fall until September, worries Yvanie Caillé, the founder of the association. We have to go faster. “

The entrenched, naked in the face of the virus, no longer have time. Contacted, the High Authority for Health (HAS) confirms having received a request from a laboratory and awaiting the last data which will complete the file. “We can then educate him as soon as possible. “And while vaccine protection is insufficient in the majority of transplant recipients, Renaloo is asking for a 4th dose. Without delay, not after the summer, it is a question of survival.

For now, a recall campaign is planned for the start of the school year, without knowing who will be, precisely, concerned. “The scientific authorities are working on it,” the Ministry of Health tells us. The Delta variant has further set back the life of Sylvie, who reads books and takes English lessons from a distance in the hope of a future trip. “I would like to see the Australian desert and the Sydney Opera House”, cowardly, dreamy, this optimistic fighter. One day, she will take full advantage of her retirement.

Here is the letter sent this Thursday to the President of the Republic, Emmanuel Macron, by the Renaloo association, dedicated to kidney patients.

“We must not be abandoned”

” Mr. President of the Republic,

We are speaking to you about the critical situation in which the 250,000 severely immunocompromised people find themselves, including the transplant and dialysis patients that our association represents. Their mortality in the event of contamination by Covid19 is of the order of 15 to 20%, significantly higher than that of nursing home residents, yet much older. Numerous studies around the world, including the EPIPHARE study in France, have confirmed that dialysis and transplantation figure in the leading group of pathologies leading to the highest risk of severe disease and death. The highlighting of this very great vulnerability notably justified our inclusion in the list of ultra-priority patients for anti-Covid-19 vaccination regardless of their age, from January 2021. Unfortunately:

– 20% of transplant patients and 18% of dialysis patients were still not vaccinated as of June 30.

– Vaccination has often very reduced efficacy for us, which justified the use of a 3rd systematic dose from April 2021.

This 3rd dose seems sufficient for the majority of dialysis patients, but a third of transplant patients still do not have antibodies at its end, and nearly three quarters of them remain insufficiently protected. These findings are very worrying in the context of the emergence of the delta variant, three times more contagious and leading to a doubled risk of hospitalization in the general population.

Alarming information is coming to us from the UK. In the vicinity of Bolton, which experienced significant circulation of the Delta variant in May / June, the number of contaminated transplant patients is comparable to that of March April 2020. All had received two doses of the vaccine. Their mortality would have reached the dramatic rate of 30%. Trials are well planned in France to explore different vaccine reinforcement strategies (increase in doses, use of other platforms, etc.), but their start will not take place before the start of the 2021 school year. Their results will therefore not be available for several months. . While experts agree in considering that the realization of a 4th dose would strengthen the protection of a large part of us, its access to this day remains extremely limited and is not the subject of any recommendation. official.

While more than 70% of transplant patients have received their vaccines at the vaccination center, it is not yet planned for the 4th dose to be administered there. An alternative to vaccination, consisting in using preventive (prophylactic) antibodies to protect us from the virus, seems very promising, but the regulatory deadlines are incompatible with rapid access to these treatments, which could, at better, to be available during September.

Worse, the High Authority for Health has spoken out against the use and reimbursement of serological tests to measure our post-vaccine antibody titers. The lack of access to these tests prevents the implementation of any personalized vaccination reinforcement strategy. The meaning of this decision is simple: we are now arbitrarily condemned, whatever our response to vaccination, to continue the total voluntary confinement to which we have been required since the beginning of the crisis, without any hope of exit being us. leash. This situation of confinement and deprivation of social interaction has obviously become untenable. Its psychological, family, professional and human consequences are devastating. While France has always affirmed the primacy of the protection of the most vulnerable, that it was a pioneer by offering us a 3rd dose very early on, after all the efforts and sacrifices we have already made to survive, we would thus have lost our place in society?

We are not ready for resignation. We must not be abandoned to our plight and the threat of the Delta Variant. Mr. President of the Republic, every day, every week, count. You alone are in a position to ensure that effective protection is provided to us within a timeframe compatible with this emergency. The means to be implemented are simple: it is a question of shaking up the inertia and the summer torpor, of vaccinating those of us who are not yet, of allowing us without delay and in an equitable way, to access, according to our needs, to a 4th dose of vaccine in the vaccination center and / or to monoclonal antibodies in pre-exposure.

It is also a matter of prioritizing public and private research on strengthening vaccines for immunocompromised people, so that it becomes a shared collective issue, which will make it possible to respond to the future challenges of the epidemic and for which all stakeholders, including manufacturers have their role to play.

Finally, while waiting for these strategies to work, the non-obligation to wear a mask in places accessible with a health pass would mean that we are totally excluded. We ask you to renounce this measure, which would legalize our social death. We are counting on you to affirm that we will not be ignored, forgotten, left aside, in our immense vulnerability, but that, on the contrary, our lives are precious and that our country will mobilize to save them. “

Nathalie Mesny, President of Renaloo


President call immunocompromised patients facing Delta variant

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