What Scientists Know About the Risk of Breakthrough Covid Deaths

Deaths among people who have been fully vaccinated remain rare, but older adults and those with compromised immune systems are at much higher risk.,

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Here is what scientists know about the risk of breakthrough Covid deaths.

Vaccines are critical in reducing severe disease and death from the coronavirus. Still, such outcomes are not unexpected, health experts say.Credit…Patrick T. Fallon/Agence France-Presse — Getty Images

By Emily Anthes

Oct. 18, 2021Updated 4:16 p.m. ET

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

But Mr. Powell’s immune system had most 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.

Mr. 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.

Although Mr. Powell’s death is a high-profile tragedy, scientists stressed that it should not undermine confidence in the Covid-19 vaccines, which drastically reduce the odds of severe disease and death.

“Nothing is 100 percent effective,” said Dr. Paul Offit, the 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 infections in the United States. People who are fully vaccinated are roughly 10 times less likely to be hospitalized and 11 times less likely to die from Covid-19, according to a recent study from the Centers for Disease Control and Prevention.

A New York Times analysis of data from 40 states found that fully vaccinated people have accounted for 0.2 to 6 percent of Covid-19 deaths.

Among the more than 187 million Americans who have been fully vaccinated, there have been 7,178 deaths, according to the C.D.C. Eighty-five 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. “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-19. 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 five- to sixfold lower after vaccination than did staff members, who had a median age of 47.

“This puts them at risk for not only getting infected by Covid but also having severe consequences,” said Anne-Claude Gingras, a senior investigator at the Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital in Toronto and the lead author of the study.

Mr. 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.

What to Know About Covid-19 Booster Shots

The F.D.A. authorized booster shots for a select group of people who received their second doses of the Pfizer-BioNTech vaccine at least six months before. That group includes: vaccine recipients who are 65 or older or who live in long-term care facilities; adults who are at high risk of severe Covid-19 because of an underlying medical condition; health care workers and others whose jobs put them at risk. People with weakened immune systems are eligible for a third dose of either Pfizer or Moderna four weeks after the second shot.

Regulators have not authorized booster shots for recipients of Moderna and Johnson & Johnson vaccines yet. A key advisory committee to the F.D.A. voted unanimously on Oct. 14 to recommend a third dose of the Moderna coronavirus vaccine for many of its recipients. The same panel voted unanimously on Oct. 15 to recommend booster shots of Johnson & Johnson’s one-dose vaccine for all adult recipients. The F.D.A. typically follows the panel’s advice, and should rule within days.

The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.

The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.

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

“Colin was undergoing treatment for multiple myeloma but seemed to be responding well,” Kathy Giusti, who founded the Multiple Myeloma Research Foundation and met Mr. Powell when he spoke at a foundation event, said in a statement. “Immunosuppression is a well-known side effect of cancer treatment and a reminder that as patients, we are at high risk, especially if also over 65 years of age.”

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

“Unfortunately, the cancer itself suppresses the normal immune system,” said Dr. James Berenson, the medical and scientific director of the Institute for Myeloma and Bone Cancer Research in West Hollywood, Calif.

In a study published in July, Dr. Berenson and his colleagues found that just 45 percent of those with active multiple myeloma “developed an adequate response” after receiving the Pfizer or Moderna vaccines.

People who received the Pfizer vaccine had lower antibody levels than Moderna recipients, on average, the researchers found. Older patients and those who were not yet in complete remission also had lower antibody levels.

It is unclear what kind of treatment Mr. Powell received for his multiple myeloma or whether he was in full remission. But even patients who are in remission may have compromised immune systems, Dr. Berenson said.

“They usually — not in all cases, but usually — maintain an immune-suppressed state even if they’ve had a good response to their treatment,” Dr. Berenson said.

Eric Schmitt and Christine Hauser contributed reporting.

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