The death of Colin Powell from complications of COVID-19, despite being fully vaccinated, represents a rare but potential tragedy that can occur when the coronavirus infects someone with a severely compromised immune system, experts say.
Before developing COVID-19, the 84-year-old former four-star general and secretary of State was suffering from an acute cancer of the blood, known as multiple myeloma. Not only can that cancer lead to a weaker immune system, but treatments can sap it further.
“People who are immunocompromised don’t get the full benefit from vaccines,” said Dr. Kirsten Bibbins-Domingo, chair of UC San Francisco’s Department of Epidemiology and Biostatistics.
Federal officials estimate people with compromised immune systems account for 3% of the population nationwide.
Experts say Powell’s death should not be interpreted as a failure of COVID-19 vaccines in the broader population.
“This, to me, is not a story of the vaccines not working,” Bibbins-Domingo said. For Powell, “the vaccines were never going to work as well as they might’ve in a healthy person because of his immunocompromised state.”
One piece of misinformation widely circulated by those who oppose the COVID-19 vaccine is that the shots are not effective in reducing the risk of transmission. That idea is false, Bibbins-Domingo said, adding that the COVID-19 vaccine is considered highly effective when compared with other vaccines.
Still, any vaccine works better with a healthy immune system, according to Dr. Peter Chin-Hong, a UC San Francisco infectious diseases expert.
“When you give a vaccine, you have to have an active and agile immune system to respond,” Chin-Hong said.
But the kind of blood cancer Powell had is particularly dastardly: It targets the cells needed to make antibodies, and it’s the antibodies that are a key part of the immune system’s response to a future coronavirus infection.
As a result, Powell’s health was likely hit with a “triple whammy” — an immune system weakened not only by cancer, but also probably from cancer treatments and his age, said Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla.
COVID-19 vaccines remain highly effective for most people. Among adults without compromised immune systems, effectiveness against COVID-19 hospitalizations between March and August was 93% for the Moderna vaccine, 88% for the Pfizer-BioNTech shots and 71% for the shot made by Johnson & Johnson, according to a report published by the U.S. Centers for Disease Control and Prevention.
But concern has been growing over the immunity of immunocompromised and elderly people. The CDC in August recommended that people with moderately and severely compromised immune systems who have received the two-dose Pfizer or Moderna vaccinations get a third dose at least 28 days after their second shot.
Last month, the CDC recommended that seniors 65 and over, those 50 to 64 with underlying medical conditions and residents of long-term care settings get a Pfizer booster shot at least six months after receiving their initial two-dose series. Also eligible for the booster are younger adults with underlying medical conditions and those who live or work in settings that may place them at higher risk for exposure to the virus, such as hospitals, schools or grocery stores.
An aide for Powell told the New York Times the former secretary of State received his second Pfizer dose in February and had been scheduled to get a third dose last week, before he got sick.
“Data indicates that boosters will extend and enhance protection against COVID-19,” U.S. Surgeon Gen. Dr. Vivek Murthy said last month. “This is especially important for those who are at increased risk of bad outcomes with COVID.”
Fully vaccinated patients who require hospitalization for COVID-19 are generally 80 or older or have compromised immune systems, Chin-Hong said.
Of people hospitalized primarily because of COVID-19 in Los Angeles County’s massive public hospital system between mid-June and late September, 92% were not fully vaccinated.
As of mid-September, there has been only one death of someone who was fully vaccinated and suffered a breakthrough coronavirus infection. The patient was 67 and was taking multiple immunosuppressive medications because of a serious underlying medical condition, L.A. County Health Services Director Dr. Christina Ghaly told the Board of Supervisors in September.
“So while technically fully vaccinated, this individual was simply not able to mount an immune response from the vaccine,” Ghaly said.
People with certain underlying medical conditions “remain extremely vulnerable,” she said.
Of more than 5.7 million fully vaccinated residents in L.A. County, just 0.036% have been hospitalized and 0.005% have died due to COVID-19, data show.