When accessibility becomes a clinical variable
A patient with suspected transthyretin amyloidosis has often waited years before landing on an awareness site. In ATTRwt amyloidosis, the average diagnostic delay from symptom onset is roughly two years overall, and up to five years in women under 70. A 2025 real-world study of ATTR-CM patients went further, showing that longer diagnostic delay is directly associated with more heart failure hospitalisations and higher mortality. The website meant to shorten that journey cannot afford to add friction of its own.
Promedia recently completed a WCAG 2.2 audit of amyloidose.be, Pfizer's Belgian awareness platform on ATTR amyloidosis. The site is visually clean, the medical content is sound, and the intent behind it is right. But when the same pages are measured against WCAG 2.2 Level AA, the gaps appear precisely where this audience cannot afford them: older patients with age-related vision loss, caregivers reading on phones, and HCPs scanning between consultations.
This article walks through what a WCAG audit on a pharma patient website actually looks like, which failures repeat across the sector, and why digital accessibility now sits on the same risk register as regulatory copy review.
How to conduct a WCAG audit on a pharma awareness website
A credible WCAG 2.2 audit is not an automated scan followed by a PDF. Automated tools catch perhaps a third of real issues. The rest surface only through manual review with a keyboard, a screen reader, and a checklist mapped to the four WCAG principles: perceivable, operable, understandable, robust.
On amyloidose.be, the working method combined four passes:
- An automated baseline (axe-core, Lighthouse, WAVE) to flag machine-detectable failures like contrast ratios and missing labels.
- Keyboard-only navigation of every user flow, including the symptom checker and PDF downloads.
- Screen reader testing with NVDA and VoiceOver on the main patient journey and the HCP resource area.
- A content review against WCAG 2.2 success criteria, with particular attention to the new 2.2 additions such as focus appearance (2.4.11) and dragging movements (2.5.7).
For a pharma site, one extra layer matters: mapping each failure to the audience segment it hurts most. A contrast failure on a symptom list is not equivalent to a contrast failure in a cookie banner. Audit findings should be triaged by clinical impact, not by technical severity alone.
What WCAG 2.2 failures are most common on pharma websites
Across patient-facing pharma sites, the same five failures keep surfacing. They appeared on amyloidose.be, and they appear on most awareness platforms Promedia has reviewed.
- Colour contrast below AA thresholds. Body text and button labels frequently fail the 4.5:1 ratio. For a site addressing older patients with possible age-related macular changes, this is the failure that most directly cancels the site's purpose.
- Missing focus indicators. Keyboard users, including anyone using assistive switches, lose their position on the page. WCAG 2.2 tightened this criterion with 2.4.11 Focus Appearance.
- Generic or empty alt text on informative images. Diagrams that carry the actual clinical message are announced as "image" or skipped entirely by screen readers.
- Symptom checkers built on visual logic alone. Interactive tools that rely on colour, position, or drag interactions without a text-based alternative exclude anyone using assistive technology.
- Untagged PDFs for HCPs. Downloadable resources are treated as flat images by screen readers, which means the HCP journey collapses at the point of reference material.
A 2020 JMIR study of 693 rare disease information websites found that zero provided content in simple language, only a third cited sources, and fewer than a third adequately marked conflicts of interest. Accessibility failures compound this existing quality gap. Patients arrive already exhausted by uneven information and land on sites that are technically live but functionally closed.
Why web accessibility matters for rare disease patients
The average time to diagnosis across rare diseases in Europe is 4.7 years. Delays correlate with misdiagnosis and with the number of clinicians a patient sees before someone connects the dots. In ATTR-CM specifically, one national cohort found a median 490 days between incident heart failure and diagnosis, with a quarter of patients waiting more than three years.
This is why Promedia treats a rare disease awareness site as a diagnosis acceleration product rather than a content property. The relevant KPIs are referral intent, test discussion intent, and expert-centre discovery, not pageviews. Every accessibility failure on the path from symptom to referral is a leak in that funnel. A patient who cannot read the symptom list, or an HCP who cannot open the tagged PDF between two appointments, is a lost diagnostic opportunity.
The design consequence is that a rare disease site should carry two clearly separated journeys: a "for families" pathway (symptom, next step, support) and a "for HCPs" pathway (recognise, refer, resources). Accessibility applies to both, but the failure modes differ. Families need contrast, plain language, and text alternatives. HCPs need keyboard-operable tools, tagged PDFs, and predictable navigation on mobile between consults.
How the European Accessibility Act changes the risk picture
Until recently, digital accessibility in pharma was framed as a UX ambition. The European Accessibility Act moved it into legal risk. The primary compliance deadline was 28 June 2025; new products and services introduced to the EU market after that date must meet EAA requirements, with older services covered by a transition period running to 28 June 2030.
The technical benchmark is EN 301 549, which currently incorporates WCAG 2.1 Level AA as the minimum. WCAG 2.2 is not yet mandated but is recommended as forward-looking best practice, which is why Promedia audits against 2.2 rather than 2.1. Non-compliance penalties reach up to €100,000 or 4% of annual revenue depending on member state implementation. Enforcement is already active: French disability advocacy organisations issued formal legal notices to major retailers within days of the June 2025 deadline, followed by emergency injunctions in November 2025 where remediation was judged insufficient.
For pharma affiliates running patient awareness platforms across EU markets, this shifts accessibility from a nice-to-have into the same category as regulatory and pharmacovigilance sign-off.
