California quarantine

A generation of under-vaccinated students at a time of unprecedented international study is a recipe for the spread of serious disease. So it has proven, but what can the rest of the world learn from California’s response to a measles outbreak? Paddy Smith finds out

Institutional life should perhaps come with a health warning. Many people breathing the same air, touching the same door handles, standing and sitting in close proximity to each other, living in close quarters and eating en masse – it’s a recipe for the spread of germs and viruses. It’s not news: crêches full of streaming noses and schools plagued by head lice are commonplace. But, in the developed world, at least, we have forgotten to expect the transmission of life-threatening illnesses in such environments. So when two Los Angeles universities announced they were quarantining dozens of students following an outbreak of measles, it made headlines around the globe.

It’s 19 years since the United States declared the virus had been eliminated, so the 695 cases confirmed across the country at the time of writing is a worry. And while many of those are in Washington (state, not DC) and New York (38 were in California), the reaction of the University of California, Los Angeles (UCLA) and California State University, Los Angeles (Cal State) should give academic leaders around the world pause for thought. The fingers of blame have been pointed in two directions, both of interest to decision-makers in higher education.

Although it seems contrary to the freedoms afforded to and by tertiary education, it begs the question of whether universities – individually or collectively – might look to immunisation as a criterion for entry

The first, and more emotive, issue is that of bad science. Scare stories about the safety of vaccines have led to a (broadly) Western movement against the practice, effectively derailing the guiding principle of much immunisation (which is based on a defensive herd, rather than individual inoculation). Anti-vaxxers, as they are known colloquially, are disliked by bona fide mainstream science and by educated members of the public who see them as a threat to themselves and their families. The Italian government has introduced legislation to prevent unvaccinated children attending state-funded schools. Although it seems contrary to the freedoms afforded to and by tertiary education, it begs the question of whether universities – individually or collectively – might look to immunisation as a criterion for entry.

Interestingly, that is the sort of defence adopted by UCLA and Cal State in the face of the outbreak. UCLA quarantined 119 students and eight members of staff; Cal State initially said it had isolated some 200 employees. The latter figure was quickly revised downwards to 156 people. The quarantined were those who had both been likely exposed to the virus and could not prove they had been immunised. And while that is after the fact, it suggests that the reach of public officials can – and will – extend to demanding medical certification.

Less headline-worthy, but equally (or more) concerning for higher education, is the second area of culpability: globalisation. At a time when British universities are clamouring to attract foreign students, along with their more lucrative fee packages, have they considered the hidden costs of a potential endemic disease brought into their house by overseas students? Uncontained lethal illness does not look good on a Wikipedia page; deaths from such diseases would certainly provoke uncomfortable questions from the press. And yet the idea that an institution might have in place the ability to determine which countries had robust immunisation practices seems far fetched. The resources to police fraudulent certification around the world effectively seems laughable, or would if the matter at hand were not so serious. And it must be remembered that it is not only overseas students who can bring disease from afar. In the cases in California, 14 of the infected patients had travelled abroad to countries including India, the Philippines, Thailand and the Ukraine.

The more telling statistic is that about lack of vaccination, though. According to the California Department of Public Health, over three-quarters of the patients had either not been vaccinated, or had not received the recommended second dosage of the vaccine. And that brings us full circle to the anti-vaxxers, and the reason higher education providers should be giving this matter thought now, when the risks are pronounced.
It’s a problem at the moment because the current crop of students are the so-called Wakefield generation (whose parents were deceived by Dr Andrew Wakefield into believing there was a link between the MMR jab and autism). And those woods are not behind higher education for the future: the charity Unicef estimates the number of children who have failed to get their first dose of the measles vaccine at 169 million globally between 2011 and 2017. The figure includes half a million children in the UK and around 2.6 million in the US. The World Health Organisation says 95% of children need to be vaccinated to ensure herd immunity. Despite 2016 and 2017 figures achieving this figure in the UK for the first round of MMR, the follow-up dose only went to 88%. Again, that could be a time bomb for university intakes of the future.

And there is the risk that distracted by bad press around mental health on campus (which is less of a problem than in the population at large), a blind eye is turned to the dangers of physical health outbreaks, which are all too easily spread in an institutional environment and which may ultimately represent a larger potential catastrophe.

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