OAKLAND, Calif. - The death of Colin Powell, 84, Monday raised questions for some about how the four-star general who became the first Black secretary of state and chairman of the Joint Chiefs of Staff, could have succumbed to COVID-19 complications when he was fully vaccinated.
Medical experts say Powell's death is a sad reminder that no vaccine is 100% effective. Despite getting vaccinated against COVID-19, Powell remained vulnerable to the virus because of his advanced age and history of cancer, highlighting the continued risk to many Americans until more of the population is immunized.
Powell had been treated over the past few years for multiple myeloma, a blood cancer that impairs the body's ability to fight infections.
"Myeloma is actually a type of bone marrow cancer which involves the immune system so there is a immune suppression, as part of the disease," said Dr. Brian Durie, chair of the International Myeloma Foundation and one of the world's top myeloma experts.
Durie says cancer treatments also suppress patients' antibody response, so when they receive the COVID vaccines they are less effective than for other people.
"These patients they get the vaccination, but the antibody responses are blunted, and only goes to like half the level that's necessary to have immunity," said Dr. Durie.
Recent studies indicate cancer patients' response to the vaccine is much lower than the general population.
"In our own practice we've seen about maybe 80% of the patients do mount that antibody response. Some studies have stated that it's maybe, you know 60%...it ranges," said Dr. Alfred Chung, a hematology, and oncology expert at UCSF.
Chung says has seen the COVID vaccines helping his cancer patients, by leading to milder disease and symptoms instead of hospitalizations or death. That's why Dr. Chung and other doctors are urging cancer patients to take a booster shot that was approved by the FDA.
"Despite all the controversy that we see publicly in the U.S,, I think that there's absolutely no doubt that for the immunocompromised for everyone that vaccination is really the way forward," said Durie.
The U.S. government has authorized an extra dose of the Pfizer or Moderna vaccines for people with weakened immune systems to try to improve their response.
And last month U.S. health authorities urged booster doses of the Pfizer vaccine for everyone 65 and older once they are at least six months past their initial vaccination, along with other people at high risk. Boosters also are being considered for recipients of the Moderna and Johnson & Johnson vaccines.
It was not clear if Powell had received an extra dose.
Powell's death is sad news for some cancer patients.
"I was surprised to know he had multiple myeloma," said Jack Aiello of San Jose, who runs a myeloma support group.
"It's bad enough we've got cancer but now, we've got this vaccine that isn't exactly controlling COVID like we'd like to see it controlled," said Aiello.
But Aiello says this case highlights the importance for cancer patients to be extra cautious, even when vaccinated. He says it's important for cancer patients to continue taking precautions such as masking and to encourage those around them to get the shots.
"I've personally had a couple of friends that were really on the fence about getting the vaccine. I don't know if it was wanting to maintain our friendship and such that caused them to get them," said Aiello.
The COVID-19 vaccines are highly effective against hospitalization and death, and the unvaccinated are about 11 times more likely to die from the coronavirus. But they are not perfect, and experts stress that widespread vaccination is critical to give an added layer of protection to the most vulnerable.
"The more people that are vaccinated, the less we have viral spreading in the community, the less chances of people like him getting infected to begin with," said Dr. Mangala Narasimhan, chief of critical care at Northwell Health in New York.
Age also is a risk, especially months after someone is first vaccinated. The Centers for Disease Control and Prevention has tracked dips in protection, especially among older Americans who were among the first people vaccinated last winter. The reduced protection is the result of either waning immunity or the extra-contagious delta variant.
Dr. Ed Lifshitz, medical director of the Communicable Disease Service at New Jersey's Health Department, took issue with those who might point to Powell's death to argue against getting vaccinated.
"My answer is really just the opposite," he said. "The way that you help those who are most vulnerable is by not letting the virus get to them in the first place, and the best way to do that is to go out there and get vaccinated."
Kathy Giusti, founder of the Multiple Myeloma Research Foundation, recalled meeting Powell when he spoke to the advocacy group about his diagnosis in 2019, and he "connected with every patient, caregiver and doctor in the room."
The Associated Press contributed to this report.
Jana Katsuyama is a reporter for KTVU. Email Jana at email@example.com and follow her on Twitter @JanaKTVU or Facebook @NewsJana or ktvu.com.