The Margin: Colin Powell’s death is a reminder that we desperately need herd immunity against COVID-19

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Gen. Colin Powell’s fatal, breakthrough COVID infection shouldn’t spark questions about whether the vaccines work, health officials say. Quite the opposite. 

In fact, the death of the first Black U.S. Secretary of State should serve as a somber reminder that it’s important for Americans to get vaccinated, so that the country can reach herd immunity and protect the most vulnerable from catching the novel coronavirus that causes COVID-19. 

After Powell’s family revealed on Monday that he died from COVID complications despite being vaccinated, enough people expressed their concerns about the effectiveness of the Pfizer

and Johnson & Johnson

vaccines that “fully vaccinated” began trending on Twitter. 

It should be noted that while the three COVID vaccines being administered across the U.S. are highly effective against developing severe illness, hospitalization and death from the virus, no vaccine is ever 100% effective. And immunity also wanes over time, which is why the U.S. may soon authorize boosters for all three COVID-19 vaccines.

“The primary purpose of the vaccine is really to make sure that, even if there is a rare possibility that you get COVID-19, that you don’t get seriously ill from it,” Dr. Shobha Swaminathan, associate professor at the Rutgers New Jersey Medical School, and the medical director of the infectious diseases practice at University Hospital, previously told MarketWatch. “And it significantly reduces your risk of getting hospitalized or having serious complications or death.” 

Coronavirus Update: U.S. may soon authorize boosters for all 3 in-use vaccines, as experts renew plea for unvaccinated to get their shots

“The vaccines are still working very well,” added Dr. Leana Wen, an emergency physician and public health professor at George Washington University. She likens each of the COVID vaccines to a good raincoat. Each will protect you from getting wet if there’s drizzle, but if you are in constant thunderstorms — such as, in this case, being immunocompromised, or living in an area where COVID transmission rates are high and vaccination rates are low — then you could still get wet through no fault of the raincoat itself.

“We know that the vaccines protect you six times from getting infected with COVID, and 11 times from dying from COVID, compared to the unvaccinated,” Wen said. “But nothing is 100% effective. And that’s why, even if we’re vaccinated ourselves, it matters if other people around us are also vaccinated.” 

The takeaway message here shouldn’t be that the vaccines are worthless for cancer patients or other immunocompromised people, such as organ transplant recipients. Rather, it’s that reaching herd immunity by getting everyone fully vaccinated is crucial.

While so-called “breakthrough” COVID infections do happen — aka when someone vaccinated against COVID becomes infected with the virus anyway — these cases are usually not severe. When several Yankees players and HBO host Bill Maher reported breakthrough infections this past spring, for example, most of them were asymptomatic.

And deaths from breakthrough COVID infections have been extremely rare. More than 187 million Americans were fully vaccinated as of Oct. 12, according to the Centers for Disease Control and Prevention (CDC), and the number of breakthrough cases among the vaccinated that resulted in death at that time was numbered at more than 7,000. That’s a tragic figure — but that also breaks down to one fatal breakthrough case out of every 26,000 fully vaccinated people, or 0.004%, as CNN reported

Read more: Do breakthrough COVID-19 infections seen in the Yankees and Bill Maher mean vaccinated people should still wear masks?

Most of the fatal breakthrough cases among the fully vaccinated (85%) were in people ages 65 and older, and 57% were men, per the CDC data. Powell was an 84-year-old man, putting him among the most vulnerable population. What’s more, he had been treated for multiple myeloma, which compromises the immune system and puts one at higher risk for severe COVID.

A July study found that just 45% of those with active multiple myeloma developed an “adequate” immune response after receiving either the Pfizer or Moderna vaccines, and 22% had a “partial” response. And a recent research preprint documented the case study of another myeloma patient who died following a breakthrough COVID-19 infection, and who had been fully vaccinated against the coronavirus, writing that “the patient failed to generate antibodies” to protect against the virus.

“Cancer patients have a very difficult time fending off COVID, even when vaccinated,” Dr. Arthur Caplan, director of NYU Langone’s Division of Medical Ethics, told MarketWatch. “There are many treatments for cancer that negatively impact your immune system. And if your immune system doesn’t work, then a vaccine isn’t going to be that helpful.” 

Breakthrough infections might also occur if a person is immunocompromised from another disease, or for taking immunosuppressives for an organ transplant, or if their age or medications might also weaken their immune system. “Which is why the CDC authorized booster shots for this group in August,” Wen said, “and even with the booster, they are still particularly vulnerable. This is the reason why we need to achieve herd immunity.” 

Indeed, the takeaway message here shouldn’t be that the vaccines are worthless for cancer patients or other immunocompromised people, such as organ transplant recipients. Rather, it’s that reaching herd immunity by getting everyone fully vaccinated is crucial. A small number of breakthrough cases was always expected, and there is no need to panic over them. But it is important to get vaccinated and to follow public health guidelines in order to prevent catching and spreading the virus to those for whom the vaccines might not be a magic bullet.

“If there ever was a bottom line, it’s making sure that caregivers, medical staff, people taking care of cancer patients at home — whether that’s family or hired help coming in — making sure everyone is vaccinated,” Caplan said. “The best chance we’ve got to help people with cancer and autoimmune disease is for the rest of us to be fully vaccinated.”