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Some might need 4th COVID-19 vaccine dose: Novant Health doctor

The death of Colin Powell from COVID-19 highlights the importance of extra doses for those with weak immune systems. One doctor says some might even need a fourth.

CHARLOTTE, N.C. — The death of former U.S. Secretary of State Colin Powell from COVID-19 is shining a light on the importance of an additional vaccine dose for some patients.

On Monday, Powell's family revealed that the 84-year-old had lost his battle with coronavirus complications, even after being fully vaccinated. However, Powell had a blood cancer called multiple myeloma, a disease that doctors warn could make a person at greater risk for infection due to its impact on the body's immune system.

Dr. Charles Bregier, medical director of Novant Health Employee Occupational Health and Corporate Health, said multiple myeloma can reduce the body's response to the COVID-19 vaccines.

"It affects one's blood cells," Bregier said. "It affects white blood cells, both the T cells and B cells, which affects the immunity we get from vaccines, as well as natural immunity."

Powell's family stated that he had been fully vaccinated, and a longtime assistant told the Washington Post he received his second Pfizer dose in February. He had been scheduled to receive a booster shot last week and missed the appointment when he fell ill.

Bregier says, with a weakened immune system, Powell might have benefitted from getting a third dose.

"It certainly is possible, very possible, that if Colin Powell had received that third dose of vaccine, that third dose might have triggered enough of an antibody response, and that might have put him in a better place to fight off that COVID infection," Bregier said.

Third doses of the mRNA vaccines, Pfizer and Moderna, are authorized for immunocompromised people at least 28 days after their second dose.

Compared to their share of the population, people with compromised immune systems have been seeing breakthrough cases at higher rates, which is why health leaders prioritized additional doses for them first. According to the CDC, immunocompromised people make up less than 3% of the U.S. adult population, but in small studies have made up around 40% of breakthrough cases requiring hospitalization. 

In its guidance for additional doses, the CDC says a person should not receive more than three mRNA doses, but it does not have any specific recommendations for getting a booster shot and then getting an additional dose.

Bregier says, with each dose in an extended vaccine series boosting a person's chances of making antibodies, there are even some people who might consider getting a fourth dose.

"It's even recommended for some people who are significantly immunocompromised that they go and get a fourth dose of vaccine 30 days after the third dose if they're thought to be significantly immunocompromised or have their blood checked and find out they have zero or low antibody levels," Bregier said.

Contact Vanessa Ruffes at vruffes@wcnc.com and follow her on FacebookTwitter and Instagram