On April 25, 2019, the Los Angeles County Department of Public Health announced public health powers impacting dozens of students infected with, or exposed to, measles at the University of California, Los Angeles (UCLA) and California State University, Los Angeles (Cal State LA).
The County issued isolation and quarantine orders, the latest in a string of emergency measures among states and localities responding to the greatest measles epidemic since the disease was eliminated from the U.S. in 2000. Since January, the Centers for Disease Control and Prevention has reported over 700 measles cases, with the prospect of many more to come. It’s the worst measles outbreak in 25 years.
Nationally, we have forgotten how serious measles, and other childhood diseases like mumps, rubella and pertussis can be. Community protection against measles requires a 95% vaccination rate, with a national average well below that level.
The LA County Health Department has ordered the home isolation of any person known to be infected with measles. Measles is among the most contagious of all infectious diseases. A single person with active measles can infect dozens in minutes or hours, especially in the close confines of classrooms, dorms, and dining facilities.
The County also ordered the quarantine of hundreds of students and faculty who were exposed to measles at UCLA and Cal State LA, unless they can provide evidence of prior vaccination. Isolation of active measles cases and quarantine of exposed persons are fully lawful and medically necessary. State and local laws permit confinement of persons who pose immediate risks of contagion. Isolation should last only during the time the person is actively contagious. Quarantine should be limited to the measles incubation period of 8-12 days. Measles can be contagious up to 4 days before symptoms appear. Exposure to a case carries a 90% risk of acquiring the disease among the unimmunized.
Temporary isolation and quarantine are necessary to protect the public’s health. No person has a “right” to place others at risk of a serious infectious disease. The LA County order is measured and reasonable, designed to prevent measles from spreading explosively across college campuses and well beyond.
Quarantines, of course, can be abused such as occurred in San Francisco in the early 1900s when health authorities discriminated against Chinese American residents. Isolation and quarantine are not designed as punitive measures. Consequently, humane conditions and access to medical treatment are essential components.
Isolation and quarantine are necessary but insufficient to prevent dangerous outbreaks. Los Angeles and many other heavily-populated jurisdictions are fighting an uphill battle against vaccine hesitant parents, often based on misleading and false information on social media. Measles outbreaks on college campuses are unsurprising.
For two decades, vaccination rates among day-care and school-age children have been declining. Many parents took advantage of generous state exemptions based on religious or conscientious objections. In 2014-2015, Disneyland experienced a major measles outbreak infecting more than 125 people, all from a single index case. California’s legislature took action in 2018 eliminating all non-medical vaccine exemptions. Vaccination rates among school-age kids in California have increased ever since. Left behind, however, was a generation of children who never got vaccinated and are now showing up on campuses across the state and nation.
Campuses are prime breeding grounds for infectious diseases. Student’s intimate social behaviors are conducive to disease spread. They eat, sleep, and congregate in close quarters. Their classes held in large halls and small seminar rooms are perfect incubators for contagious diseases like measles. Shared spaces subject students to constant risks of exposures.
During weekends or spring breaks, students travel home or on vacation, potentially acquiring or spreading infections along the way. Many college students travel internationally through semester-abroad programs. Large campuses like UCLA attract many foreign-born students. These factors help fuel the national upsurge of measles, mumps, and meningitis.
Against this backdrop, you might think every college would require students to be fully vaccinated against an array of preventable diseases. However, this is not always the case. Administrators often fail to require the same vaccinations for their students that their states already mandate for school-age kids. California is an exception. Since February 2016, students must be vaccinated for measles, mumps and rubella (MMR) or prove their immunity. Now administrators need to enforce these mandates.
Incubating environments, lax policies, lapses in vaccine monitoring, and a virtual absence of campus disease protocols all contribute to serious outbreaks of preventable diseases. Higher-ed institutes in California and nationally must do more. Preventing future outbreaks requires strict adherence to standardized vaccination requirements. Every campus must have outbreak preparedness plans in place and should undertake realistic simulation exercises annually.
Some parents believe they have an absolute right to decide whether to vaccinate their children. But no parent has a license to endanger their children or the community at large. Colleges have a duty to protect their students, faculty, staff, and surrounding communities. Upholding this duty starts with vaccines, which are among the safest, most effective health measures in modern medicine.
Lawrence O. Gostin is the Founding O’Neill Professor and Director, O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. He also directs the World Health Organization Center on Global Health Law.
James G. Hodge, Jr. is Professor and Director, Center for Public Health Law and Policy, Sandra Day O’Connor College of Law, Arizona State University.
Jonathan Fielding is former Los Angeles County Health Officer and Director of the Los Angeles County Department of Public Health. He is currently on the faculty at UCLA.
Scott C. Ratzan is a Senior Fellow, Mossavar-Rahmani Center for Business and Government, Harvard Kennedy School.
Barry R. Bloom is the Joan L. and Julius H. Jacobson Research Professor of Public Health, Harvard T.H. Chan School of Public Health.