A total of 7 students at Princeton University have come down with bacterial meningitis since March. While 6 of those students have recovered and the 7th is expected to recover, the mortality associated with this disease is typically 10%. Adolescents seem to be particularly susceptible, making it a serious issue for colleges and universities.
Our current policy at Virginia Tech is that students are required to be vaccinated for bacterial meningitis unless they sign a waiver. It seems reasonable to present recommendations and to let students choose not to follow those recommendations as long as long as they release the university from any liability, right?
Herd health is my job. The system described above only works when the prevalence of the disease is very low and when the efficacy of the vaccine is nearly 100%. Problems arise when a) the unvaccinated population grows to be of significant size relative to the vaccinated population, and b) the vaccine doesn’t completely protect those who chose to be vaccinated. At that point, the unvaccinated group actually increases the risk of disease for the vaccinated group. Should students have the right to refuse vaccination?
Ever since the autism scare, routine vaccination has come under scrutiny by society. It’s more and more common for parents to pick and choose vaccinations for their children or to omit vaccination altogether. I don’t have access to the number of waivers signed over the past 10 years, but it would be interesting to know if and how the numbers of unvaccinated students have changed.
The other piece of information that I don’t have is whether or not anyone who was vaccinated against a strain of bacterial meningitis has ever contracted that strain. There are certainly reports of students who were vaccinated for one strain contracting a different strain of the disease. In fact, the strain infecting the students at Princeton is not one that we currently have an approved vaccine for in the US. The CDC is looking into importing a product approved in other countries. But as long as I’m vaccinated, I don’t care if you aren’t, right? Not so fast. Fundamentally, even the best vaccines can be overcome by enough exposure. It is possible that if there are enough unvaccinated individuals in a population and an outbreak occurs, a higher number of individuals will contract the disease. The increased shedding into the environment might be enough to overcome the immune systems of even the vaccinated individuals. Right now the choice to remain unvaccinated appears to be a personal one; that could change.
I am not insisting that everyone be forced to go under the needle, so to speak. But with the current trends in our society, vaccination and the way we approach “herd health” on college campuses may have to change if more and more students choose to omit vaccination.