Meningitis B at Princeton and the University of California at Santa Barbara: Postscript

In an earlier post, “Meningitis B at Princeton and at the University of California at Santa Barbara” (https://academeblog.org/2013/12/10/meningitis-b-at-princeton-at-the-university-of-california-at-santa-barbara/), I reported on the outbreaks of the disease among students at the two campuses and on the decision by the Centers for Disease Control to allow a vaccine not yet approved for use in the U.S. to be administered to at-risk students and staff at Princeton.

That vaccine, called Bexsero, is produced by the Swiss pharmaceutical company Novartis AG, and although vaccines for other strains of meningitis are available in the U.S., Bexero is the only vaccine for meningitis B available anywhere. It has already been approved for use in the European Union and in some nations outside Europe, but it has not yet even been submitted to the U.S. Federal; Drug Administration for approval. The company has provided the FDA and CDC with studies done in Europe that demonstrate the effectiveness and safety of the vaccine. But the company is apparently working on some modified version of the vaccine for eventual distribution in the U.S. (Why a modified version of the vaccine would be deemed necessary is not specified in any of the news reports that I have read.)

It was somewhat incongruous that the CDC gave special approval for the vaccine to be administered on the Princeton Campus and not on the UC Santa Barbara campus because the most serious case of the disease involved an athlete at the Santa Barbara campus who had to have his legs amputated. There was a larger number of cases on the Princeton campus, eight cases to the four at UC Santa Barbara, but I am not sure what significance there might be in the difference between four and eight cases. When pressed on the delay in making the vaccine available on the Santa Barbara campus, officials at the CDC explained that they were waiting to see if additional cases of the disease would be reported there beyond the four initial cases. And then when no additional cases were reported, the CDC decided to make the vaccine available there. (This explanation seems somewhat counterintuitive to me, but I am not a scientist, and I am assuming that there is a reasonable explanation for the sequence of events, that some sort of well-established protocols were being followed.)

In any case, without calling into question how either university has handled the outbreak of this infectious disease, I think that it is clear that what was done at the universities needs to be reported in detail, analyzed by experts in crisis management, and used as a basis for developing considerably improved strategies. Despite the consternation caused by the reported cases of avian flu in Asia in this last decade and the focus on developing protocols for managing potential pandemics, it is fairly clear that even a relatively small-scale outbreak of an infectious disease has seriously challenged the responsiveness both of the two affected universities and of the agencies with which they have been working. One wonders how a much larger volume of cases and the resulting demand for appropriate answers and interventions might have been handled, even if the cases originated on and were confined to a campus or two. Moreover, imagine how much more complex the management of such an outbreak would be if it originated off-campus and then affected not just the campus but many other nearby locations as well.

At the time that the outbreaks of avian flu were being reported, I recall that one of the upper-level administrators at our university was fairly obsessed with the idea that online versions of the courses in each discipline needed to be developed so that the university could survive a prolonged period in which on-site classes could not be held because any sizable concentration of people would raise the specter of rampant infection. At the time, I thought that it was a rather extreme rationale for the accelerated development of online courses. Now it seems reflective of a somewhat simplistic way of looking at the potential complexity of even just the institutional issues that would be involved in dealing with such an eventuality.

If an epidemic or, worse, a pandemic were to occur, the notion that professors and students might sustain their work simply by remaining isolated in their homes seems fancifully antiseptic at best. It is all too reminiscent of most of the post-apocalyptic stories written during the early years of the Cold War. In those stories, the individuals who had fortuitously managed to survive a nuclear holocaust roamed across landscapes depopulated but not otherwise significantly changed, except perhaps for the sheaves of paper blowing about the eerily deserted streets. It was as if the neutron bombs developed much later in the Cold War era had been judiciously exploded, instead of the impossible-to-imagine concentrations of first- or second-generation thermo-nuclear warheads that almost certainly would have been deployed. But, even so, there weren’t any heaps of decaying corpses, either human or animal. Instead, the survivors would come upon a corpse only here and there, in an isolated dwelling that had somehow been penetrated, presumably, by the radiation but that did not cause radiation disease among those who not long afterwards entered the dwelling.

We need to get beyond the mentality of the families featured on increasingly popular shows such as Doomsday Preppers. I am sure that at some point, an epidemic or a pandemic would become too extensive to manage. But surely there is some considerable space between an outbreak affecting four to eight cases and the ceiling in our capacity to manage highly infectious diseases. If any institutions should have the brainpower to develop flexible and multi-faceted strategies to confront such fundamental challenges to the social order, to economic continuity, and to political stability, it should be our universities.

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