High Price of Prevention

Johns Hopkins researchers have calculated that requiring all college students to be vaccinated against meningitis B would not be cost-effective.

December 20, 2018
 
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Requiring every college student to be vaccinated against a relatively uncommon strain of meningitis would not be cost-effective, a new Johns Hopkins Medicine study has found, an assertion that has angered activists who have lobbied colleges and universities to require the immunization.

The Hopkins analysis was published recently in the American Journal of Preventive Medicine. Researchers found that the universal immunization against serogroup B of meningococcal disease, or meningitis B, for college-aged students would only be beneficial if the vaccine cost less than $65. The average price for it is $324. The authors calculated the cost per “quality-adjusted life year,” which is a metric used to quantify the value of a medicine -- essentially how long a person lived after being treated and the quality of their health. The researchers developed a computer algorithm that would track the cost-effectiveness and cost per case prevented by universal vaccination of incoming students at a midsize, four-year institution.

The dangers of meningitis B on campus became widely known about five years ago, following outbreaks at Princeton University and the University of California, Santa Barbara, although it remains rare. The Centers for Disease Control and Prevention estimated there are fewer than 300 cases in the country per year. Meningitis B is more common among college students, as it is spread through coughing, sneezing and kissing, and those who drink alcohol are more susceptible to it. It can be fatal.

Most recently, an outbreak was announced in the fall at San Diego State University, where officials urged students ages 23 and younger to be immunized against meningitis B after three cases were reported. Most colleges already require students to receive a vaccine that protects against meningitis strains A, C, W and Y, which can be covered with a single shot.

“Despite the poor prognosis of meningitis B infection and the fairly reasonable cost of meningitis B vaccination, the extreme rarity of this infection even amongst its peak in college-age individuals makes universal vaccination cost-ineffective,” Ira Leeds, the study’s lead author, and a postdoctoral research fellow in the Department of Surgery at the Johns Hopkins School of Medicine, said in a statement. “Vaccinating 100,000 college students, for example, would prevent less than five cases of MenB.”

Earlier this year, medical professionals and other advocates launched a campaign called Beware the B, asking that 14 institutions that are a part of the Big Ten Conference mandate the vaccine, with the hope that other colleges and universities would follow.

Two of those activists were Patti Wukovits and Alicia Stillman, two mothers whose teenage daughters died from meningitis B. They helped create a group called the Meningitis B Action Project. In a statement -- a response to the study -- the women said that “it is time we stop looking at the meningitis B vaccine strictly from a cost-effectiveness perspective.”

“As parents, we cannot underestimate the threat of meningococcal bacteria to our children,” their statement reads. “What parent is willing to put a price on their child's life? We see it as our responsibility to educate students and parents about Men B and the Men B vaccine so they have the information they need to proactively talk to their doctor about whether the vaccine is right for them. People deserve to know that the vaccine is out there to help protect them.”

The Advisory Committee on Immunization Practices (ACIP), which provides the government advice on vaccinations, states that traditional college-age students or teenagers may be immunized against meningitis B, but that it is not always necessary unless a student is at risk or they are suffering from a condition, such as a weak immune system, that could complicate the disease.

The American College Health Association does not advocate for colleges to require the meningitis B vaccination and includes the ACIP recommendations on the vaccine in the organization’s guidelines.

Susan Even is the executive director of the Student Health Center at the University of Missouri, chairwoman of ACHA’s Vaccine Preventable Diseases Advisory Committee and its liaison to ACIP.

Even said in an interview that the Hopkins study backed ACIP’s approach: that a universal immunization is not necessarily endorsed because meningitis B is so rare. She noted that there are always limited health resources.

But this shouldn’t deter medical professionals from discussing options with students and their families, Even said. Parents should be aware the vaccine exists, she said. This fits in with the discussion that every family should be having with their physicians: how high-risk behaviors, such as drinking, or other ways to catch diseases, can affect their students.

“Knowing about it truly is important and knowing [how] devastating it could be,” Even said.

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