Despite being fully vaccinated against COVID-19, Colin Powell’s age and medical history put him at risk of severe disease and death.
Powell, who was the first Black Secretary of State and chairman of the Joint Chiefs of Staff, died from complications of the virus on Monday, his family said in a statement.
He was 84 years old, severely immunocompromised because he had been treated for multiple myeloma – a cancer of white blood cells in bone marrow – and suffering from Parkinson’s disease.
‘The main issue is that he had an unlucky confluence that gave him a perfect storm for being at severe risk despite being fully vaccinated,’ said Dr Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco.
Doctors say that although Powell’s breakthrough infection resulted in his death, cases such as these are quite rare.
They explained to DailyMail.com why his conditions put him at increased risk of death – and why it doesn’t mean that COVID-19 vaccines are ineffective.
Colin Powell, the first black Secretary of State, died of COVID-19 complications on Monday, despite being fully vaccinated, at age 84. Pictured: Then-Secretary of State Powell listens to a question during a news conference in Beijing, China, October 2004
Doctors say his age, his battle with multiple myeloma – a type of blood cancer – and Parkinson’s contributed to his heightened risk of death. Pictured: Powell, then-Chairman of the Joint Chiefs of Staff, holds a news briefing at the Pentagon, January 1991
‘Colin Powell’s death illustrates the complex layers of managing COVID-19 risk,’ Dr Stuart Ray, a professor of medicine at Johns Hopkins University, told DailyMail.com in an email.
‘His death is exceptional, in general, because he was fully vaccinated.
‘However, his age and comorbidities remind us that vaccination is never 100 percent protective, and people at special risk (and those around them) are wise to take special precautions that we know to be effective. ‘
No COVID-19 vaccine prevents every single infection, thus so-called ‘breakthrough’ cases – in which a fully vaccinated person contracts the virus – are bound to occur, but they rarely result in hospitalization or death.
As of October 12, the Centers for Disease Control and Prevention (CDC) reports 24,717 out of 187 million fully vaccinated people, or 0.013 percent, have been hospitalized.
An even smaller number – 7,178 fully vaccinated people, or 0.003 percent – have died, and 85 percent of those are aged 65 and older.
This means that it is very rare for fully vaccinated people to contract COVID-19 and die, and those who do are mostly elderly.
‘As you become older, your ability to mount an immune response is affected just by virtue of their age,’ Dr Abhijit Duggal, of the department of critical care at the Cleveland Clinic in Ohio, told DailyMail.com.
However, people suffering from underlying conditions such as cancer are at an elevated risk.
A spokeswoman said Powell had successfully undergone treatment for multiple myeloma in the past.
Patients suffering from hematologic cancers – including related to the bone marrow, and other blood-related tissues like Powell – are at especially high risk.
Hematologic cancer patients’ immune systems don’t tend to produce antibodies to fight off diseases the way they should be.
What’s more, many commonly used treatments for these cancers affects parts of the immune systems, such as B cells, which fight bacteria and viruses.
This also prevents the immune system from being able to mount a full response when a patient gets vaccinated.
Powell was immunocompromised from being treated for multiple myeloma, meaning he didn’t likely mount an immune response when he was vaccinated. Studies have shown cancer patients mount less of an immune response to vaccines (left) compared to healthy patients (right)
Older people, like Powell, are also at risk for severe infection due to having less robust immune systems than older adults. COVID-19 vaccines are still more than 90% effective against severe disease and death and fewer than 0.01% of those with breakthrough infections have died. Pictured: Powell and his wife Alma on their wedding day in August 1962, left, and at the 2019 Ford’s Theatre Gala in Washington, DC, June 2019
‘What you have to realize is that multiple myeloma and other disease conditions decease the immune system’s response,’ said Duggal.
‘When we give them a vaccination, we hope the immune system will get ramped up to develop antibodies.
‘But the fact is. because the immune system is depressed, the capability to generate immunity from vaccination is not as good as someone who has an intact immune system.
‘The effectiveness of the vaccine is not going to be as good as in someone who has a robust immune system.’
A CDC report in August found that between 40 and 44 percent of people hospitalized with breakthrough COVID-19 infections are immunocompromised despite making up only three percent of the U.S. population.
One Israeli study from May found 10 percent of cancer patients who got two doses of the Pfizer-BioNTech vaccine did not develop a high level of antibodies compared to everyone in a group of healthy patients.
And another July study found only 45 percent of patients with active multiple myeloma ‘developed an adequate response’ after getting either the Pfizer or Moderna vaccines.
‘It’s fully possible that Colin Powell was fully vaccinated but never developed a full immune response,’ Chin-Hong said.
But Powell had another condition that weakened his immune system: Parkinson’s disease, a central nervous system disorder that affects movement, often including tremors.
Studies have found that the loss of brain neurons in Parkinson’s could be due to an attack by the person’s own immune system.
‘Parkinson’s is more of a contributing factor than a main reason, but it could be that Parkinson’s patients have more intensive home care needs,’ Chin-Hong said.
‘It puts them in touch with more people to take care of them, which could introduce them to infection or make it harder to clear the respiratory system.’
The doctors say that, despite evidence suggesting waning efficacy of the vaccines against infection, they are still highly effective against severe disease and death.
New CDC data found that, in August 2021, unvaccinated people were 11 times more likely to die of COVID-19 than vaccinated people.
And, even if a vaccinated person contracts COVID-19, at least 98 person do not fall severely ill.
‘The message isn’t that someone got the vaccine and died, but that there are people in the society that need to be protected by us getting the vaccine,’ Dr Ali Mokdad, an epidemiologist with the University of Washington’s Institute for Health Metrics and Evaluation, told DailyMail.com
‘He got COVID-19 because someone around him was not vaccinated, not wearing a mask or not paying attention.’
Experts have said that reaching herd immunity, which is when a large proportion of a community becomes immune, so that spread of a disease is unlikely, is key to stopping COVID-19 in its tracks.
Estimates suggest 85 percent of the U.S. population needs to be vaccinated, but only 66 percent of Americans have received at least one dose so far, according to the CDC.
‘Colin Powell could have been more protected if more people in that community had been vaccinated,’ Chin-Hong said.
‘We get vaccinated not to just protect ourselves but to protect people like Colin Powell and that’s the real issue. We should not use him as the poster child for vaccines not working.’
Duggal agreed: ‘The best thing for somebody like General Powell is if everyone around him is immunized; then this risk of infection goes down.’
The experts recommend that immunocompromised people get COVID-19 vaccine boosters as soon as possible, as seen with other popular vaccines, to shore up protection.
Ray from Johns Hopkins said three doses are often given for the hepatitis B vaccine to provide long-lasting protection and Mokdad pointed out that kids received boosters for the measles, mumps, rubella (MMR) vaccines.
‘The breakthrough infections are normal. You need immunity today and then you need a booster. This happens all the time,’ Mokdad said.
‘However, if the end game is to prevent hospitalization and death, then the vaccines are very effective.’