DEATH PUTS FOCUS ON BREAKTHROUGH CASES

Experts: Powell had several significant risk factors for virus

The death of former Secretary of State Colin Powell from complications of COVID-19 has provided fuel for vaccine skeptics and opponents, who immediately seized on the news that Powell had been vaccinated to stoke doubts about the effectiveness of the vaccines.

But Powell’s immune system had quite likely been weakened by multiple myeloma, a cancer of white blood cells. Both the disease and the treatment can make people more susceptible to infections.

His age, 84, may also have increased his risk, scientists said.

Powell received his second dose of the Pfizer-BioNTech vaccine in February, said Peggy Cifrino, his longtime aide. He had been scheduled for a booster last week but fell ill before he received it, she said.

Powell had also undergone treatment for early-stage Parkinson’s disease, she said.

Scientists emphasized that Powell’s death should not undermine confidence in the COVID vaccines, which drastically reduce the odds of severe disease and death.

“Nothing is 100 percent effective,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia. “The point of getting a vaccine is that you want to know that the benefits clearly and definitively outweigh the risks. And we know that for this vaccine.”

The vaccines are highly effective, even against the more contagious Delta variant, which is now responsible for nearly all coronavirus infections in the United States. People who are fully vaccinated are roughly one-tenth as likely to be hospitalized and even less likely to die from COVID than those who are unvaccinated, according to a recent study from the Centers for Disease Control and Prevention.

Among the more than 187 million Americans who have been fully vaccinated, there have been 7,178 deaths, according to the CDC. Eightyfive percent of those deaths have been in people 65 or older.

“Breakthrough deaths with vaccinated individuals do occur,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. “But there are certain groups that are at greater risk.”

Since the beginning of the pandemic, it has been clear that older adults are the most likely to develop severe COVID. They also have less robust immune systems in general and mount a weaker immune response to the vaccines.

In one recent study, which has not yet been reviewed by experts, researchers found that residents of Canadian long-term care homes, who had a median age of 88, produced levels of neutralizing antibodies roughly fivefold to sixfold lower after vaccination than did staff members, who had a median age of 47.

Powell had also undergone treatment for multiple myeloma, a cancer of plasma cells, which are a type of white blood cell. Plasma cells make antibodies and thus play a critical role in the immune system.

Both the disease and the treatment — which may include chemotherapy, immunotherapy and steroids — can leave patients more vulnerable to infections.

Vaccines are also likely to be less effective in people with multiple myeloma.

“The treatments we’re using are indiscriminately knocking off both the malignant and the normal immune cells,” said Dr. James Berenson, medical and scientific director of the Institute for Myeloma and Bone Cancer Research in West Hollywood.

That puts patients “at double risk for getting no response to a vaccination and also not responding as well once they get the disease,” he added.