Two young people have tragically lost their lives, and 20 others are undergoing treatment following a meningitis outbreak at the University of Kent. This alarming situation has brought to light a significant gap in the UK’s vaccination strategy, as the affected students belong to a generation that has not been routinely vaccinated against the meningococcal group B strain responsible for the outbreak.
The vaccine, known as Bexsero, has been available since 2013 and was added to the UK’s national immunisation schedule in September 2015. However, this was only for infants. Every current university student was born before July 2015, meaning they missed the vaccination cut-off. As a result, an entire decade of students has passed through higher education without routine protection against this common form of bacterial meningitis.
Understanding the Vaccine Policy
The decision to limit the Bexsero vaccine to infants reflects a broader tension within vaccine policy. The UK’s Joint Committee on Vaccination and Immunisation (JCVI) determined that while the vaccine’s benefits are real, they did not meet the economic threshold required to justify extending the program beyond infants. Unlike other vaccines, Bexsero does not contribute to herd immunity, as it does not reduce the bacteria’s presence in carriers’ throats.
Thus, vaccinating a baby protects the individual but does not prevent the bacteria from circulating in the population. The JCVI judged the benefit too narrow, given the lack of a ripple effect, to warrant a broader vaccination program.
The University Environment: A Unique Risk
What the JCVI’s calculation did not fully account for was the particular risk posed by university life. Meningococcal bacteria spread through close contact, such as kissing, sharing drinks, and coughing in crowded spaces. Universities, with their communal living arrangements and social activities, are prime environments for transmission.
A study tracking students during their first week at a UK university found the proportion carrying the bacteria in their throats jumped from less than 7% on day one to over 23% by day four.
In the United States, research has shown that first-year undergraduates face a risk of meningococcal B disease nearly 12 times higher than their non-student peers. This risk is further amplified for those living in dormitories.
Economic and Social Implications
Parents who wished to protect their children privately could do so, albeit at a cost. A full course of Bexsero for those over 11 years old requires two doses, with each dose costing around £110 at most UK pharmacies. This creates a disparity where access to protection is contingent on financial capability, a situation starkly highlighted by the current outbreak.
Following the Kent outbreak, bookings for private meningitis B vaccinations at Superdrug surged to 65 times their normal level.
This economic inequality is now playing out in real-time, leaving those unable to afford the vaccine hoping the outbreak does not reach their children.
Long-term Costs and Policy Reevaluation
Vaccine policy involves complex trade-offs, with public health resources being finite. However, the economic rationale for limiting the Bexsero program to infants has weakened since 2015. A re-analysis published in the journal Value in Health in 2021 suggested that when considering the broader burden of the disease, such as long-term care and loss of earnings, the cost per healthy life year gained falls below the NHS’s threshold for approving treatments.
The short-term savings from not vaccinating teenagers may be incurring long-term costs not initially captured. The outbreak itself has prompted a costly emergency response, with over 30,000 people in the Canterbury area contacted by health authorities and thousands of antibiotic doses distributed.
Looking Ahead: Policy Changes on the Horizon?
In response to the outbreak, Health Secretary Wes Streeting announced to parliament that he would request the JCVI to revisit the eligibility criteria for meningitis vaccines. This review is both welcome and overdue. The first cohort of infants vaccinated in 2015 will not reach university age until 2033, leaving a significant gap unless policy changes are implemented.
As Philip Broadbent, a Wellcome Multimorbidity PhD Fellow and Public Health Registrar at the University of Glasgow, emphasizes, the current situation underscores the need for a reassessment of vaccine strategies to ensure equitable access and protection for all students.
The tragic events at the University of Kent serve as a stark reminder of the complexities and consequences of vaccine policy decisions. As the UK grapples with this outbreak, the hope is that lessons learned will lead to more inclusive and forward-thinking public health strategies.
