The tragic death of Gen. Colin Powell from COVID-19 reveals not the failure of vaccines but the inability of his fragile immune system to protect him from those who are unvaccinated, health care experts said Monday.
“No matter how good our vaccines — if we have a raging forest fire of infections among unvaccinated It will spill over and kill vulnerable vaccinated folks,” wrote Dr. Ashish Jha, dean of the Brown University School of Public Health, on Twitter.
Powell, 84, the first Black U.S. secretary of state whose leadership helped shape American foreign policy, suffered from a form of white blood cell cancer, according to reports.
This cancer, called multiple myeloma, damages the immune system. So despite full vaccination, his body was unable to produce enough antibodies to fend off the COVID-19 virus. And this weak response may have waned during the months since his initial shots. He was scheduled to receive a vaccine booster last week, a spokeswoman told the New York Times, but it was postponed when Powell fell ill. He died early Monday at Walter Reed National Military Medical Center outside Washington, D.C.
People with weakened immune systems, such as Powell, rely on “herd immunity” for protection. As long as some people remain unvaccinated, the virus continues to circulate — and can cause infection in the most vulnerable.
They’re insulated only when so many other people are fully vaccinated that the virus can’t find enough people to infect, then stops its spread.
“This is why we must all be vaccinated,” tweeted Dr. Shikha Jain, who treats blood cancers at the University of Illinois Cancer Center in Chicago. “When enough people are vaccinated, even those who the vaccine can’t fully protect will be protected.”
Infections among vaccinated people are much less common than infections among unvaccinated people — and when these so-called “breakthrough” cases occur, they tend to be milder. People have fewer symptoms that are less severe and tend to be ill for fewer days.
That’s because vaccines train the immune system’s white blood cells to fight infection. It’s the job of these cells, our first line of defense when a pathogen strikes, to create antibodies.
Soon after infection, the cells go into high gear. Most people don’t develop severe disease and recover within days.
As of Oct. 12, the U.S. Centers for Disease Control and Prevention had reports of 7,178 deaths from COVID-19 breakthrough infections. That represents 0.004% of the more than 187 million fully vaccinated Americans.
Of those, 85% were aged 65 or older, like Powell. As we age, our immune response weakens and is less well-regulated. Additionally, like Powell, they may have suffered from other immune-related illnesses. Perhaps they took immunosuppressant drugs for diseases such as rheumatoid arthritis.
For these vulnerable people, vaccines are helpful — but require “boosting.” To protect those who do not respond well to the initial series of vaccines, the U.S. Food and Drug Administration has authorized third doses of Pfizer-BioNTech’s and Moderna’s vaccines.
Yet vaccines are often not enough. How well the vaccine works can depend upon each patient’s overall state of immunosuppression.
Also at risk are the very small group of people who cannot be vaccinated for medical reasons, such as those with a history of severe allergic reaction to an ingredient in the vaccines.
“All vulnerable people rely on the rest of their community to be vaccinated to protect them from encountering someone infected with the virus,” said Dr. Kelly Moore of the Immunization Action Coalition, which partners with the U.S. Centers for Disease Control and Prevention to distribute vaccine information. “They need us to protect them, as we protect ourselves.”
With Powell’s cancer, the fast-growing malignant cells pushed out the healthy immune cells. Powell was also being treated for Parkinson’s disease.
His wife, Alma, also contracted COVID-19 despite being vaccinated but responded well to the monoclonal antibody treatment Regeneron, according to CBS News.
One recent study found that 55% of multiple myeloma patients failed to fully respond to COVID-19 vaccination. This research, led by Dr. Samuel D. Stampfer of the Emory University School of Medicine in Atlanta and published in the journal Leukemia, found that the Moderna vaccine triggered higher antibody levels than the Pfizer vaccine in these patients.
Additionally, there is a growing body of evidence showing that chemotherapy and other cancer treatments knock down immunity. One study of people hospitalized with COVID-19 found that those who have any type of cancer or had cancer before were several times more likely to die or need ventilation.
Also at risk are elders with heart or kidney disease, according to Jha.
“Those two days of fever can precipitate a heart attack or kidney failure,” he wrote. “And that heart attack or kidney failure can kill them.”
When there are high levels of community transmission due to unvaccinated people, “even small percentage of vaccine-breakthrough infections will be severe,” said Jha. “A small percentage of a very large number is still a large number.”
“Protecting vulnerable people means … reducing the spread of the virus in the community,” he wrote.
