Former Secretary of State Colin Powell died from complications of COVID-19. Although he was fully vaccinated, he was also 84 years old and was a cancer patient who had undergone treatment for multiple myeloma — factors that put him at higher risk of a serious breakthrough illness. His death does not mean the COVID-19 vaccines don’t work, as many social media posts suggest.
How effective are the vaccines?
Colin Powell’s family announced his death on Oct. 18 due to “complications from Covid 19.” Few details were immediately given, but the family noted that the former secretary of state and chairman of the Joint Chiefs of Staff had been fully vaccinated.
Hours later, it emerged that Powell, who was 84 years old, had multiple myeloma, a rare blood cancer that weakens the immune system, increases the risk of severe COVID-19 and reduces vaccine effectiveness.
“Fully vaccinated, Colin Powell, is dead at 84 from covid. Trust the science!” reads one suggestive Facebook post that was shared more than 500 times.
“Colin Powell died from COVID and he was fully vaccinated. So what’s the point of the vaccine?” another person on Twitter asked.
Fox News anchor John Roberts also chimed in on the platform, writing in a later-deleted tweet, “The fact that Colin Powell died from a breakthrough COVID infection raises new concerns about how effective vaccines are long-term.”
In a subsequent tweet that is also now deleted, Roberts said he deleted the tweet because “many people interpreted it as anti-vax,” adding that it was not and that he had encouraged people to be vaccinated and planned on getting a booster shot “as soon as possible.”
But rather than showing that COVID-19 vaccination does not work, experts say Powell’s death underscores the need for more people to be vaccinated to help protect not only themselves but also others, especially the most susceptible.
“The continued vulnerability of multiple myeloma patients (and many other immunocompromised patients) to severe COVID19 even after vaccination is one reason why it’s so essential for healthy individuals to get vaccinated,” said Dr. Alfred L. Garfall, a multiple myeloma expert at Penn Medicine’s Abramson Cancer Center, in a statement to FactCheck.org. “Even a mild infection in a healthy, unvaccinated person can transmit a fatal infection to a vaccinated, immunocompromised patient. The best way to protect our immunocompromised neighbors is for the general population to receive these remarkably safe and effective vaccines.”
Protecting the immunocompromised by getting vaccinated is also in the best interest of everyone, scientists say, because chronic infections in people with weakened immune systems may be one way new variants of the virus evolve.
Powell served as a national security adviser for President Ronald Reagan, as chairman of the Joint Chiefs of Staff under Presidents George H.W. Bush and Bill Clinton and as secretary of state for George W. Bush. He was the first Black man to hold each position. He was also a four-star general in the U.S. Army.
COVID-19 Vaccines Are Effective
Any single death from COVID-19 after vaccination — even a high-profile one — is not evidence that the vaccines don’t work. No vaccine is foolproof, and some number of breakthrough infections, even some leading to death, are expected. Vaccination greatly reduces the risk of infection and disease, but cannot eliminate it.
Data show that the vaccines are doing a remarkably good job at protecting people from infection, severe disease and death, including against the highly contagious delta variant.
According to the latest Centers for Disease Control and Prevention figures, in the month of August, during which the delta variant accounted for nearly all infections, unvaccinated people were 6.1 times more likely to test positive for infection with the coronavirus and 11.3 times more likely to die from COVID-19 than the fully vaccinated.
While there is likely some waning vaccine immunity to infection, the bulk of evidence at this time shows that the vaccines remain highly protective against severe illness.
There is data, however, to suggest that some immunocompromised people — including those in treatment for blood cancers such as multiple myeloma — do not mount an effective immune response following the standard vaccination regimen, and that some fraction of them can benefit from an extra dose.
Powell received his second dose of the Pfizer/BioNTech vaccine in February, but had not yet gotten a booster. Cifrino told multiple news outlets that he was scheduled for one last week, but by that point he had already started to feel sick.
Powell at Heightened Risk
Experts say Powell, as a multiple myeloma patient, was at higher risk of not responding effectively to the vaccine and of developing severe COVID-19 if infected.
“These patients have two strikes against them,” said Dr. Edward A. Stadtmauer, the section chief of hematologic malignancies at Penn Medicine, in a phone interview.
The cancer affects a particular type of B cell known as a plasma cell, which is a cell in the bone marrow that fights infections by churning out lots of protective antibodies. Multiple myeloma patients are therefore more susceptible to all sorts of infections because the uncontrolled growth of cancerous plasma cells crowds out other plasma cells that would otherwise spring into action once a person is infected.
“This is a disease by definition where patients are immunocompromised because the normal antibody-producing cells are abnormal,” Stadtmauer said.
On top of that, he said, the standard treatments for multiple myeloma suppress the immune system, since they target plasma cells but are not good at discriminating between healthy ones and the cancerous ones.
It is unclear what treatment Powell had received or was receiving, but the Washington Post reported that he “had been successfully treated … for two or three years,” according to Cifrino.
Kathy Giusti, the founder of the Multiple Myeloma Research Foundation, has said Powell was diagnosed in 2019 and told the New York Times that he “was undergoing treatment for multiple myeloma but seemed to be responding well.”
While not able to comment on Powell’s specific case, Stadtmauer said that even if a multiple myeloma patient is in remission, the likelihood that their immune system would be completely normal is “very low.”
“One of the hallmarks of the therapy of myeloma is more and more we give what we call continuous therapy … to continue to chip away at the last few abnormal cells in their system,” he said. “I certainly consider someone who has myeloma to be immunocompromised, really, for the rest of their lives.”
Fortunately, he said, the disease is increasingly treatable, but it remains incurable.
Preliminary research bears out the notion that multiple myeloma patients fare less well with COVID-19 than others.
An international survey of outcomes for 650 patients with plasma cell disorders, published in the journal Blood in December 2020, found that a high percentage of multiple myeloma patients hospitalized for COVID-19 died, ranging from 27% to 57%, depending on the country.
Other preliminary work also demonstrates that patients with multiple myeloma and other blood cancers are less likely to mount strong immune responses to vaccination.
Just 45% of 96 multiple myeloma patients with active disease developed an “adequate” antibody response to two doses of one of the mRNA vaccines, according to a paper published in the journal Leukemia in July, with 22% of such patients partially responding.
As that paper put it, “the same mechanisms that impede [multiple myeloma] patients’ ability to fend off infections also reduce their capability to generate immunity from vaccination.”
Other studies have found less drastic, but still concerning results. For example, a paper published in Cancer Cell in June found that 15.8% of the 260 patients with multiple myeloma failed to produce detectable coronavirus-specific antibodies following full vaccination — and that antibody levels in the rest of the patients could vary widely.
A limited study of 49 patients with various B cell malignancies also showed that while boosters can help some patients develop an antibody response, 35% did not make detectable antibodies even after the booster.
Stadtmauer said that in his clinic, about two-thirds of multiple myeloma patients produced coronavirus-specific antibodies after vaccination. That’s lower than the general population, he noted, but still a decent fraction of people — and all the more reason for them to be vaccinated.
“If there’s any group of patients who should get COVID vaccine and boosters and stay vigilant and seek medical attention early if they have symptoms consistent with COVID, it’s patients with myeloma,” he said.
In addition to myeloma, Powell’s advanced age and even his sex gave him higher odds of having a bad outcome.
Figures from the CDC show that when serious breakthrough infections occur, they primarily involve older people and are more likely in males. Of the breakthrough infections reported to the agency by Oct. 12 in those who died, for example, 85% were in people 65 years of age and older and 57% were in males.
In recognition of the increased risk for older people, the FDA, in the last two months, authorized a third booster shot of the Pfizer/BioNTech and Moderna vaccines for people 65 years or older, along with other higher-risk groups.
A second Johnson & Johnson dose is also authorized for all adults, given evidence that the single-dose shot, while effective, is less so than either of the two-dose mRNA vaccines.
Editor’s note: SciCheck’s COVID-19/Vaccination Project is made possible by a grant from the Robert Wood Johnson Foundation. The foundation has no control over FactCheck.org’s editorial decisions, and the views expressed in our articles do not necessarily reflect the views of the foundation. The goal of the project is to increase exposure to accurate information about COVID-19 and vaccines, while decreasing the impact of misinformation.
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