In late July, the New Jersey Department of Health provided a detailed news release on Meningitis B and the outbreak of cases at Princeton University. The news release included this summary of the first five cases, which had been reported between March 13 and July 24, 2013:
“As of July 24, there have been a total of five (5) cases of invasive meningococcal disease associated with Princeton University:
• The first case was a female student who was away from campus for spring recess in March and developed symptoms of meningitis when returning to the area and went directly to the hospital. This student has recovered.
• The second case was a visitor on Princeton University campus from April 6-8, who was diagnosed with bacterial meningitis after returning to another state. This case is being followed by another state’s health department.
• The third case is a male student diagnosed with bacterial meningitis on May 7. This student has recovered.
• The fourth case is a male student who resides out of state. The case developed symptoms on May 19 on his way home for summer recess. This case has recovered.
• The most recent case is a male student who developed symptoms on June 29 while traveling abroad. This student has fully recovered.“
Between July and November, three additional cases were reported at Princeton, with all of those afflicted with the illness recovering.
But then, at the other end of the country, the University of California at Santa Barbara announced that four students enrolled there had contracted Meningitis B, and although all had survived, one, a lacrosse player, had had to have his feet amputated because of complications caused by the illness.
Although the California case was the first to involve serious complications from the illness, those complications were actually not anomalous among those afflicted with the illness. According to a news report from NPR, Meningitis B leaves “about 20 percent of those who survive with severe disabilities, including limb loss, deafness and mental retardation.” So the California case greatly escalated the level of public concern at Princeton.
But the response to the outbreaks of this disease were complicated by the fact that although vaccines for four other types of meningitis are available in the U.S., the vaccine for Meningitis B is not. So, the Princeton administration needed to request that the CDC to approve the targeted use of the vaccine for Meningitis B, which is available in Europe and elsewhere. That approval was expedited, and over the last week, several thousand Princeton students have received vaccinations. Since teens and young adults seem most susceptible to the disease, recipients of the vaccine have been limited to the following groups: “all Princeton University undergraduate students (those who live in dormitories or off campus) and graduate students who live in dormitories,” as well as other members of the University community with functional and anatomic asplenia (including sickle cell disease) and late complement component deficiencies.” Those who are receiving the vaccinations this month will need to get a second vaccination in February in order to be fully protected.
The CDC has confirmed that the cases at Princeton and at the University of California at Santa Barbara are not related—that is, they involve different strains of Meningitis B. Although health officials in California have confirmed that more than 500 people had close contact with the four confirmed cases at UC-Santa Barbara, thus far those 500 people have simply been advised to take antibiotics as a precautionary measure. Some of those 500 contacts, their parents, and other family members have been very vocal in asking why the vaccine being distributed at Princeton is not also being made available at Santa Barbara. The explanation at this point seems to be that the number of reported cases at Santa Barbara does not yet warrant special approval to make the vaccine available.
As far as I can tell, that’s just about the only troubling aspect in how these outbreaks have been handled administratively. In fact, although it becomes somewhat repetitive, the FAQ distributed by the New Jersey Department of Health (available at: http://www.state.nj.us/health/cd/documents/faq/meningococcal_faq.pdf) and the announcements distributed by Princeton University (http://www.princeton.edu/main/news/search/?q=Meningitis+B&x=-1402&y=-118&filter=0) have been quite good and do seem to provide a model for how to be responsive to such a crisis in a responsible way.
Nevertheless, the real issue is how this response to a small-scale outbreak of a serious disease on several of our university campuses at opposite ends of the country has exposed limitations or deficiencies in our capacity to deal with much larger-scale outbreaks of illnesses such as very deadly strains of influenza. Several years ago, when the media focus on outbreaks of the bird-flu in Asia fueled much speculation about possible worldwide pandemics, there was much discussion of the potential impact on higher education in related publications and blogs. But then the season changed, the media moved on to other sensational topics, and the focus on this issue seemed to evaporate.
I don’t wish to sound overly cynical, but this seems to me to be indicative of what occurs with maddening regularity at most of our institutions. Despite all of the continual emphasis on “planning,” there are seldom any plans in place to deal with predictable, if not imminent, crises. That is, “planning” never seems to require having anything approaching a fully developed plan in place. Instead, we are largely content with what amounts to planning to plan—or worse, with hiring additional planners who will be available when actually having a plan can no longer be avoided.