The Children of the Anti-Vaccination Movement Are Going to College. Are Universities Ready for Them?

In 1998, Andrew Wakefield, a British gastroenterologist, and 12 colleagues published a research paper in a prestigious medical journal asserting that the vaccine to prevent measles, mumps, and rubella (MMR) predisposed children to autism. The now-debunked findings were widely publicized in Britain and consequently gained traction in the United States, although several studies were published shortly afterward refuting Wakefield’s conclusion.

Over the next two decades, the number of unvaccinated children quadrupled. And in April, measles cases reached a 25-year high, according to the Centers for Disease Control and Prevention. Misinformation about vaccines, fueled by parental fears and the absence of federal immunization laws, have made the current generation of children more susceptible to infectious diseases, said Tara C. Smith, a professor of epidemiology at Kent State University.

Children born in the early 2000s — at the vanguard of the anti-vaccination movement — are now starting to enter college. The risk of a measles outbreak last week, which led to hundreds of people quarantined at two Southern California colleges, should serve as a warning for colleges amid the disease’s resurgence, immunization experts say.

For starters, they say, institutions should institute clear and uniform vaccination requirements, which are now a nationwide hodgepodge that one expert described as “a mess.”

Varying Standards

While all 50 states have legislation requiring vaccines for students attending public elementary and secondary schools, the laws vary by state and by postsecondary institution. Some universities allow for only medical exemptions (California, Mississippi, and West Virginia are the only states that ban personal-belief exemptions in public schools). Other institutions allow for exemptions on religious or philosophical grounds.

The University of California system, whose Los Angeles campus quarantined more than 500 students when the health-risk alert went out last week, began requiring all incoming students to submit immunization documents in the fall of 2016, said Sarah McBride, a spokeswoman for the system.

Since the requirement has been in place for three academic years, UCLA has records for roughly 75 percent of its students, McBride said. It was only this year that campuses started holding registration for those students who either didn’t have the required vaccinations or didn’t turn in their paperwork. But before 2016, students in the UC system were not required to show any documents.

At some universities, most staff and faculty members do not have to provide immunization records for employment. More than 100 employees at California State University at Los Angeles were quarantined last week, and although most have been cleared, health experts warn against having a different set of standards for students and employees.

“It’s wrong that staff and faculty do not have as strict requirements,” said James D. Cherry, a research professor who specializes in pediatrics and infectious diseases at UCLA. If some staff members are not vaccinated, he said, this affects “herd immunity,” or the resistance to the spread of infectious diseases within a population. At least 90 percent of the population must have the measles vaccination for herd immunity to be effective, Cherry said.

The UC system’s now-strict immunization requirement for students, especially around personal-belief exemptions, is rare, Smith, of Kent State, said. Even when institutions appear to have rigid rules, it’s common for students to seek nonmedical exemptions.

“The varying vaccine requirements are a mess, and they vary from institution to institution,” she said. Immunization standards vary even among public universities in the same state, Smith said.

More than 90 percent of colleges nationwide require at least one vaccine for incoming students, but only 48 percent require three or more, according to a 2018 study in the Journal of Adolescent Health.

At Kent State, students are required to have only the MMR vaccine, while Ohio State University requires five different vaccines.

Ohio also allows for philosophical and religious exemptions, which harm herd immunity. Ohio State began requiring proof of vaccination after a mumps outbreak in 2015, but its incoming students were still able to seek medical and nonmedical exemptions, Reuters reported.

Enforcing those requirements is another issue, Smith said. University officials have not made proof of vaccination a priority, in her opinion, leading some campuses to hesitate to hold students’ class registrations.

Seventeen percent of the universities in the 2018 survey had no vaccine-enforcement strategies, researchers wrote in the Journal of Adolescent Health article. About two-thirds of colleges used registration holds, but only 3 percent dismissed noncompliant students.

‘A Tipping Point’

Measles outbreaks on college campuses were relatively rare in the 2000s, Smith said. They occurred frequently in the 1980s and 1990s, with large outbreaks at Boston and Villanova Universities, according to CDC data.

The disease is a good indication of how vaccinated the population is, since measles is very contagious, said Peter J. Hotez, co-director of the Texas Children’s Hospital Center for Vaccine Development.

Mumps cases are more common on college campuses, since the vaccine is less effective than its measles counterpart, Hotez said. The disease is also more benign, and universities can generally stop the spread of mumps by issuing vaccines on campus.

With the measles threat at UCLA and Cal State-Los Angeles, Hotez sees this as a wake-up call for colleges nationwide, especially those with lax immunization requirements.

“The anti-vaccination movement is reaching a tipping point where it’s starting to affect public health,” Hotez said. It’s imperative, he added, that colleges not only ensure that students are up to date on their shots but also have access to a database of immunization records in case of an epidemic.

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All University of California campuses maintain and keep track of students’ immunization records, said McBride, the system’s spokeswoman. At Cal State-Los Angeles, only students who live on campus or are pursuing health-related majors have to turn over documents, said Robert Lopez, a spokesman. Most of the university’s students matriculate from California public schools, which require immunization.

Quarantines are disruptive, Hotez said, and an electronic database can help colleges identify which students are at risk of contracting an infectious disease. Measles can easily proliferate within close settings, and college campuses are especially susceptible, he said.

The disease’s resurgence should prompt administrators to rethink their immunization requirements, Smith said.

“They need to ask, Are these vaccines enough to protect students?” she said. “Or should more steps be taken to stop these very preventable diseases?”

Follow Terry Nguyen on Twitter at @terrygtnguyen, or email her at terry.nguyen@chronicle.com.