Speed Up the Vaccine Process

I am the mother of a UCSB freshman. My son Jacob received a dose of the meningitis B vaccine Bexsero in London, UK, over winter break. How did I come to this drastic decision to send my son to a foreign country for this vaccine? And why not just keep this personal decision to ourselves?

I first heard that this was a meningitis B outbreak, and that Princeton was getting Bexsero, from my sister-in-law, a pediatric ICU doctor. I talked to a research scientist (who wants to remain anonymous) who told me the name of the meningitis B strain at UCSB, ST32, and that it was indeed sensitive to the Bexsero vaccine. I consulted with several other experts in the field, namely Dr. Michael Apicella at Iowa, Dr. Steven Black at Cincinnati, and Dr. Cody Meissner at Tufts. Additionally, I talked to a CDC epidemiologist, Dr. Amanda Cohn, who confirmed what the anonymous researcher told me, gave me valuable additional information, and who even encouraged me to continue to advocate for vaccination.

The CDC waited until the 6th case, seven months into the outbreak at Princeton, to file with the FDA for “compassionate use” of Bexsero. Eight weeks elapsed between the CDC’s request and the first vaccination, during which time two more of their students contracted meningitis B. Luckily, there were no deaths; however, one of their students may suffer permanent deafness.

What should we have learned from this experience? Waiting too long to act can lead to more students contracting an often fatal illness.

The four cases at UCSB occurred in rapid succession, between November 11 and November 21. UCSB freshman lacrosse player Aaron Loy lost his lower legs due to the ravages of meningococcal disease. Health officials responded by giving prophylactic antibiotics to contacts and by educating the community about hygiene. Although necessary, these same interventions proved to be insufficient to halt the Princeton outbreak, and yet officials kept insisting that there was no need for vaccination at UCSB. Instead they were “poised to act if the circumstances of this outbreak warrant [Bexsero’s] use.” After the fourth case at UCSB, Greek social events were cancelled. Finally, on December 23, the CDC changed course: “ … additional cases are likely to occur at UCSB. Based on that conclusion, the request will be made to FDA to gain access to the vaccine.”

My husband talked with Dr. Tom Clark of the CDC on January 3. We were pleased to hear him say that the CDC and UCSB are united in their goal of getting Bexsero to all the undergraduate students at UCSB. He confirmed to us that the UCSB strain is, without question, susceptible to the vaccine. He assured us that he did not envision the FDA denying the CDC’s request. Dr. Clark also confirmed to us that the UCSB strain is the same strain that lingered in Oregon for over a decade beginning in 1993.

Additionally, Dr. Clark expressed concern that student apathy and/or misguided concern about the vaccine may cause the UCSB vaccination campaign to fall short. He was very pleased with the greater than 90 percent vaccination rate achieved at Princeton University.

While I am happy that the decision has been made to pursue Bexsero for the students at UCSB, I am still concerned that this decision has taken much too long, despite the recent Princeton experience.

The threat is real. Hygiene measures and antibiotics were not enough at Princeton, and they may not be here at UCSB. The vaccine is safe and effective. I believe we need a robust educational campaign here similar to the one at Princeton, so that UCSB students will choose to protect themselves and get vaccinated.

After becoming educated on this issue, the choice to send my son Jacob to London for the vaccine was easy. Meningitis B disease is a vaccine-preventable illness with a 10 percent kill rate and a 20 percent permanent disability rate. And the government’s decision process is too slow. We are weeks away from a vaccination program at UCSB, time in which more students could sicken, become permanently damaged, or even die.

There will be more meningitis B outbreaks on U.S. college campuses in the future. We should not be satisfied with the current plodding procedure. Despite the teachable moments from the Princeton experience, bureaucracy is still getting in the way of what our students need. The time is now to streamline the approval process, so that more promising young lives are not put unnecessarily at risk.

Cristina Lete, MD, of Newton, Massachusetts, is an obstetrician. Jacob is the oldest of her five sons.