Colin Powell, a former chairman of the Joint Chiefs of Staff, national security adviser and secretary of state, has died of complications of COVID-19 at age 84, according to numerous news reports.

Powell was fully vaccinated against COVID-19, but he had recently undergone treatment for multiple myeloma, a type of blood cancer. People with blood cancers are both at greater risk for severe COVID-19 and are less likely to respond to the vaccines. Powell’s death underscores the ongoing risk to cancer patients and other immunocompromised people despite vaccination.

A recent study from the Leukemia & Lymphoma Society found that antibody production after COVID-19 vaccination varies widely across blood cancer types. Vaccine response largely depends on the type of treatment a person is receiving. Those taking medications that suppress B-cell function—or undergoing therapy that wipes out all types of immune cells—may be unable to produce enough antibodies. What’s more multiple myeloma affects anti-body producing B cells themselves.

Recent guidelines from the National Comprehensive Cancer Network recommend that people with blood cancers should receive a third dose of the Pfizer-BioNTech or Moderna COVID-19 vaccine. In August, the Food and Drug Administration (FDA) authorized third doses for immunocompromised people. More recently, the agency authorized boosters for a broader range of Pfizer vaccine recipients, including cancer patients on active treatment and people with advanced or untreated HIV, and an FDA advisory committee recommended the same for Moderna and Johnson & Johnson recipients.

In some cases, immunocompromised people who do not respond well to vaccines may benefit from monoclonal antibodies for COVID-19 prophylaxis or early treatment.

In addition, experts stress that everyone should get vaccinated to help protect people who do not respond to the vaccines themselves.

“Multiple myeloma disproportionately impacts Black patients, who are at twice the risk of developing the disease as compared to white Americans,” Paul Richardson, MD, of the Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute, told CNN. “COVID-19 has been a considerable challenge in the multiple myeloma community. Patients are not only vulnerable to infection but, once infected, they are more prone to serious complications including vascular effects and profound immune dysfunction. As the world continues to grapple with the pandemic and we prepare to meet the challenges of new variants, we urge individuals to get vaccinated to not only protect themselves and their loved ones, but to protect the health of others as well.”

A Life of Service

Powell was born in New York City to Jamaican immigrants of limited means and grew up in the South Bronx, he said in his biography, My American Journey. He graduated from City College of New York in 1958 and soon joined the Army. He was sent to South Vietnam as a military advisor, where he was injured stepping on a spike trap, according to the Washington Post. Over the years his honors included the Soldier’s Medal, the Legion of Merit, the Bronze Star Medal and two Purple Hearts.

Powell earned an MBA at George Washington University, led an infantry battalion in South Korea, studied at the National War College, was assigned to the Pentagon during President Jimmy Carter’s administration and assumed command of the Fifth Corps in Germany in 1986. He was appointed national security adviser during the Reagan administration.

Powell rose to the rank of four-star general, and President George W. Bush appointed him chairman of the Joint Chiefs of Staff in 1989—the youngest and first Black person to hold the position. He was the nation’s top military leader during the 1991 Persian Gulf War. During the Clinton years, he challenged the president’s pledge to end the ban on gays and lesbians in the military, instead favoring the “Don’t Ask, Don’t Tell” policy. He later supported the inclusion of LGBT people in the military and same-sex marriage.

In 2000, Bush appointed Powell secretary of state, also the first Black person to hold that position. After the September 11, 2001, terrorist attacks, Powell urged Bush to stay focused on al-Qaeda in Afghanistan. In the run-up to the 2003 invasion of Iraq, he told the United Nations Security Council that Iraq possessed weapons of mass destruction. The claim was later proven to be erroneous, and he said he regretted the military action.

After serving under both Republican and Democratic administrations—and considering a run for the Republican presidential nomination himself—he supported President Barack Obama in the 2008 election. He later came out as a critic of President Donald Trump and endorsed President Joe Biden in the 2020 race. Following the January 6 storming of the U.S. Capitol, he said he no longer considered himself a Republican.

“Colin embodied the highest ideals of both warrior and diplomat. He was committed to our nation’s strength and security above all,” Biden said in a statement. “Having fought in wars, he understood better than anyone that military might alone was not enough to maintain our peace and prosperity…Time and again, he put country before self, before party, before all else—in uniform and out—and it earned him the universal respect of the American people.”