Fatal breakthrough Covid-19 infections among people who have been fully vaccinated, like former Secretary of State Colin Powell, are rare. But experts say such deaths show the need for society as a whole to protect its most vulnerable: those of advanced age and those with compromised immune systems.
Powell, who died Monday of Covid complications, met both criteria. The trailblazing public servant was 84 years old and had multiple myeloma, a blood cancer in which malignant plasma cells overtake the space usually reserved for normal plasma cells that fight off infections.
His cancer may have left him particularly susceptible: Not only does multiple myeloma rob the body of its ability to resist infections, but it also can interfere with a vaccine's efficacy. Research on multiple myeloma patients published in the journal Nature in July found that only 45 percent developed an “adequate response” to Covid mRNA vaccines.
"Covid has been our worst nightmare," said Dr. Paul Richardson, the clinical program leader and director of clinical research at the Jerome Lipper Multiple Myeloma Center at the Dana-Farber Cancer Institute.
"Patients are not only vulnerable to being infected in the first place even despite vaccination, but when they become infected, their immune system is so dysfunctional that they get the worst of both worlds," he said.
Compared to the number of deaths among unvaccinated people across the U.S., which tops more than 722,000, breakthrough deaths are just a sliver. Among the more than 187 million people who have been fully vaccinated across the U.S., there have been 7,178 deaths, according to the Centers for Disease Control and Prevention, with 85 percent of the deaths occurring in people 65 and older.
Age has always been a contributing factor to the severity of Covid and many other infections, said Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University School of Medicine and the medical director of the National Foundation for Infectious Diseases.
"As we get older, our physical cells become less robust. They become more frail, and that can also happen to our immune systems," he said. "If you add on to that, of course, the underlying illness, that’s a double blow to the immune system."
The hope, Schaffner said, is that Covid booster shots among those ages 65 and up will increase the number of antibodies they have, providing longer protection. At the moment, booster shots are available for people 65 and older and others at high risk who received the Pfizer-BioNTech vaccine; boosters for other 65-and-up vaccine recipients are expected to be approved soon.
It was not clear whether Powell had had a booster shot. The experts said he most likely would have qualified for the additional dose of the vaccine, which the Food and Drug Administration authorized for use in certain immunocompromised people in August.
'We have a responsibility'
Powell's death reflects why the onus is on everyone to do their part to end the pandemic, said Dr. Khalilah Gates, an associate professor in pulmonary and critical care at Northwestern University Feinberg School of Medicine.
"When we talk about vaccinations, it's not just about us as individuals. It's about those of us in our communities and in our society who are more vulnerable: That’s our elderly and our children," she said, referring to children under 12 for whom the vaccines have not yet been authorized. "We have a responsibility to protect those who can't protect themselves."
Schaffner said the function of vaccines is not only to protect the individual but also to create a "cocoon of protection" around viruses so they can't find vulnerable people.
Not getting vaccinated "is akin to someone coming to a traffic light and driving through the red light," he said, adding, "Yes, they assume a certain degree of risk to themselves, but they put others at risk."
Powell's death should not dissuade people from getting vaccinated if they haven't already, Schaffner said, adding that more than 90 percent of people admitted for Covid at his hospital are unvaccinated.
"The vaccines are not perfect," he said. "But the vaccine shifts the odds in your favor for severe disease into being protected against severe disease."