Andrew Wakefield’s discredited 20-year campaign to link the MMR vaccine to autism has been sustained by a simple scientific fact: it is impossible to prove a negative, writes Jeremy Laurence in The Independent.
He says after Wakefield made his controversial claim at the press conference to launch his 1998 paper in The Lancet, scores of researchers attempted to confirm his observations – without success. The scare nevertheless took hold and has been sustained through two decades since.
Laurence writes, the possibility that the childhood vaccination programme was causing harm to children is one of the most emotive in medicine. Parents wondering whether to vaccinate their children have to make a leap of faith. Once undermined, that faith is extraordinarily hard to rebuild.
Throughout this time Wakefield has portrayed himself as a campaigner on behalf of the children brought to him by desperate parents searching for the cause of their offspring’s suffering. His suggestion that it might be linked with MMR vaccine chimed with parents’ deepest fears about the safety of exposing babies’ developing immune systems to potentially toxic drugs.
From the start he claimed to be driven by a passion to protect children. Laurence writes that in an interview published in 1998, Wakefield said: “If I am wrong, I will be a bad person because I will have raised this spectre. But I have to address the questions my patients put to me. My duty is to investigate their stories. It is a moral issue with me.”
But his attempt to colonise the moral high ground turned out to be a sham. It was revealed that he accepted payments from the Legal Aid Board (for his patients who were suing the vaccine manufacturers) in what The Lancet called a “fatal conflict of interest”, failed to disclose details of the way the patients were collected and, most importantly of all, conducted invasive and unpleasant investigations on vulnerable children which were of no benefit to them but only to his research.
Laurence writes that Wakefield lost the scientific argument in 2004 when The Lancet announced a partial retraction of his 1998 paper (it was fully retracted in 2010 after the General Medical Council verdict). He lost the moral argument in 2010, when he was found guilty of gross professional misconduct by the GMC and struck off the medical register. Yet he remains defiant.
The MMR vaccine has been available in the US since 1963, and the US believed it had eliminated measles more than a decade ago. That meant any cases occurring in the country would have been imported from abroad, and there was little or no danger of domestic transmission. But in 2015 an outbreak in southern California that started at Disneyland rapidly spread to infect more than 50 people. The Los Angeles Times reported that the percentage of nursery schools where fewer than 92% of children were fully vaccinated had more than doubled between 2007 and 2014.
Laurence writes that medicine needs its mavericks. The history of scientific advance is littered with individuals who held out against major political and commercial interests. Think of smoking and cancer – a link that took decades to establish against the carefully orchestrated obfuscations of the tobacco industry.
But these brave and gifted individuals are hugely outnumbered by those who believed they were on to something and whose hypotheses later died. The problem for Wakefield is that although a handful of studies appeared to offer him support, scores failed to do so.
Laurence writes that every major medical organisation believes there is no safety issue over the MMR vaccine. His research has been discredited; he lost his job in the NHS; his licence to practise medicine was withdrawn and his reputation is in tatters. Yet still he criss-crosses America – and the world – spreading his baleful messages.
Measles, which had virtually disappeared in the UK and much of the developed world, is returning with a vengeance, despite the fact that there has been a cheap and effective vaccine for it since the 1960s, reports The Daily Telegraph.
Cases quadrupled in Europe in 2017 and at least 35 people died, according to the World Health Organisation. The countries worst affected have been Ukraine, Romania and Italy – where poorly funded health systems and cultural beliefs among some groups mean take-up of the vaccine is patchy.
But, the report says, the modern pace of migration and foreign travel has seen the disease spreading across the continent, including to Belgium, Portugal, France and Germany; measles is also on the rise in the US and even Australia. In England and Wales there have already been 696 suspected cases of measles so far this year – nearly twice as many as reported in the whole of 2017 – with outbreaks from Birmingham to London, Leeds, Liverpool and Cardiff.
Technically, measles has been eradicated in the UK, but, the report says, the disease is being imported as a result of unvaccinated children and adults travelling to countries with large outbreaks, including Italy where the vaccination schedule and supply is less robust. Health authorities are now on high alert and governments are so concerned about the return of measles that laws have been recently passed in France, Germany and Italy making it mandatory that all parents give their children the combined measles, mumps and rubella (MMR) jab, or at least consult their doctor about it.
Measles is one of the most contagious diseases known, but experts warn that the elimination of the disease in large regions of the world has caused many to become dangerously complacent about the need for widespread immunisation. “Twenty years ago, people queued up to have the whooping cough jab because it was killing children – the risk was obvious and present,” says Adam Finn, professor of paediatrics at the University of Bristol. “Now, no one is dying from these things. “The main driver of people buying into a vaccine is fear, and without that fear it opens people up to doubt.”
The report says all this is compounded by persistent anti-vaccine movements, which have a long history in the UK and Europe. This year marks two decades since Wakefield published a paper linking the MMR with autism, prompting a wave of hysteria across the world, and a dramatic fall in the rate of parents vaccinating their children.
The reporter says: “When my daughter had her first dose recently, I was struck by the number of friends and family members – rational and well-educated people – who expressed vague suspicion about it; I know at least one couple who chose not to give their baby the jab.”
Though coverage of the MMR among babies in the UK is now high, the latest figures from NHS Digital showed it fell in England last year for the third year in a row and is still below the WHO target of 95%. “Wakefield has to carry some responsibility for what’s going on here,” says Finn. “A lot of people still see the MMR jab as controversial. There’s a question mark. There’s an element of doubt which didn’t really exist before, in my view.”
The report says take-up of the MMR is now back to pre-Wakefield levels, but a generation of children who were born at the height of the controversy and didn’t have the jab are now at university age, when close contact means diseases like measles can spread quickly. “There are still a significant number of people who didn’t get the vaccination historically because of the MMR scare,” says Finn. “Measles is incredibly infectious, and if you’ve never had it and you didn’t get the vaccine, it’s a bit like being in a forest of dried trees waiting for someone to strike a match.”
And if you think getting measles is no big deal, the report says it is worth listening to Andrew Wilson whose 19-year-old daughter caught measles in February, having just started her second term at university. “We got a phone call about 10 o’clock at night from her housemate saying they’d just called an ambulance because her heart rate was through the roof, she’d come out in a rash and her temperature was over 40 degrees,” says Andrew, 48, who lives in the Isle of Wight.
“She was in hospital for a week, being sick constantly and unable to eat. She lost a stone in weight, only being slight to begin with. I was shocked. I had no idea measles was so serious.”
The report says she has thankfully made a full recovery, having provided details to the hospital of every person she had been in touch with in the previous days to prevent further infection. But Andrew remains haunted by his decision not to vaccinate her as a baby. “Around the time she was born there were all these scare stories about autism,” he recalls. As a parent, a little bit of information can be dangerous. I was concerned about having a child with a new immune system being bombarded with all these vaccines. So, we took the decision not to. Which, in hindsight, was not a good decision.”
Andrew and his wife agreed they would vaccinate their children when they got older, and he arranged for his daughter to have the MMR jab, with other vaccinations, before university. The family are now uncertain about whether she was actually given the injection, or whether she was, but still caught measles because she was under-vaccinated, having only had one jab and not the follow up booster needed for the best level of protection.
“I suppose people will hear this and think we were stupid and it’s our own fault – and yes, I feel stupid,” says Andrew. “It was an extremely upsetting experience. It’s not something I would ever want to put my children through again, and if it comes to grandkids later down the line, I would want them to be vaccinated.”
The report says the MMR is safe and effective at any age, and experts are urging anyone who missed having the vaccination to have it – especially anyone who is planning to travel to countries suffering measles outbreaks, such as Italy. Also, they should check that they have had their booster – which usually comes two years after the first MMR vaccination.
“The (current) cases of measles are often older teens who didn’t have the MMR as babies because of the concerns in the press,” says Helen Bedford, professor of children’s health at University College London. “You can completely understand why, 20 years ago, parents were concerned about the jabs. Now they think, ‘My child is too old to have it’, and never have it done.”
Today, the anti-vaccine movement remains small but vocal, with a strong presence on social media; it was bolstered by the election of Donald Trump, who has shown support for the theory that vaccines cause autism. And, the report says, Wakefield, unable to practise in the UK, continues to promote his agenda in the US; he attended President Trump’s inaugural ball in 2017. In Texas, where Wakefield now lives, vaccination rates are reportedly falling.
In the era of fake news, Finn says public health bodies must rethink how they communicate to the public. “I hear people saying how destructive and awful the anti-vaccine movement is, but all we’re doing is putting leaflets into GP waiting rooms, while the rest of the world gets their information from social media. We’ve got to pull our socks up.”
Depressingly, experts warn that the consequences of Western paranoia about vaccinations will be felt most sharply in lower income countries, where malnutrition and poor healthcare mean the disease is much more likely to kill.
The report says only two years ago, Latin America declared measles eradicated, after a massive, decades-long campaign by the WHO. Now, it’s back again: a virulent outbreak in Venezuela has already killed at least 54 children. Proof, if it were needed, that vaccination is an act for the greater good.
And now the anti-vaccine movement has come for the pets. The New York Times reports that a spreading fear of pet vaccines’ side effects has prompted the British Veterinary Association to issue a startling statement this week: Dogs cannot develop autism.
The implicit message was that dog owners should keep vaccinating their pets against diseases like distemper and canine hepatitis because any concerns that the animals would develop autism after the injections were unfounded.
The report says the warning has a long tail. It grew out of an anti-vaccine theory that rippled across the US and Europe as networks known as “anti-vaxxers” claimed that childhood vaccinations could cause autism. The belief, promoted by some celebrities like the television personality Jenny McCarthy, who says her son has autism, spurred many parents to begin boycotting traditional vaccines.
The theory gained prominence in 1998, after Wakefield’s study and, the report says, the theory has jumped species. It is increasingly being applied to pets in the US and is gaining momentum in Britain – raising concerns that the already low vaccination rates in this country could fall further. Those who fear vaccine side effects in their dogs claim the animals could develop canine autism, thyroid disease and arthritis.
Then, on Monday, the television show “Good Morning Britain” on ITV put out a call on Twitter to hear from dog owners who believed their pets showed symptoms of autism after receiving vaccinations, and from others who had stopped getting their pets vaccinated against dangerous diseases.
The next day, the veterinary association put out a statement on Twitter. “We are aware of an increase in anti-vaccination pet owners in the US who have voiced concerns that vaccinations may lead to their dogs developing autism-like behaviour. There’s currently no reliable scientific evidence to indicate autism in dogs (or its link to vaccines),” the association said.
It added: “Potential side effects of vaccines are rare and outweighed by the benefits in protecting against disease. BVA would be happy to provide evidence-based information on the issue.”
The report says many dog owners criticised the TV programme for reporting what they called baseless anti-vaccine conspiracies. But others were intrigued: “I can’t believe I’m saying this but, how could you even tell your dog had autism?” one Twitter user asked.
The support for vaccinating pets was echoed by other agencies.
Britain’s independent Veterinary Products Committee, which reviewed all authorised dog and cat vaccines in the UK between 1999 and 2002, concluded that the “overall risk/benefit analysis strongly supports the continued use of vaccines.”
“It is extremely rare for any serious side effects to follow vaccinations,” the British Veterinary Medicines Directorate said. “Any adverse effect is generally far outweighed by the benefit of protection against serious disease.”
The report says for a time, the anti-vaxxer movement in the US gave rise to a public health crisis in at least 14 states, as outbreaks of measles, a disease that health officials had long declared beaten, reappeared in alarming numbers. In 2017, Minnesota reported the largest outbreak of measles in almost 30 years.
Fear of vaccines spread to Europe, and cases of measles rose in 2017, with the virus finding its way into areas with unvaccinated children from Romania to Britain. At least 35 children died of the disease in 2017, according to the World Health Organization. Italy had 5,006 cases of measles and three deaths last year; 88% of those cases were in people never vaccinated, the European Centre for Prevention and Disease Control said.
[link url="https://www.independent.co.uk/voices/andrew-wakefield-mmr-vaccine-autism-theory-a8337731.html"]The Independent report[/link]
[link url="https://www.telegraph.co.uk/health-fitness/body/measles-back-vengeance-anti-vaccination-movement-blame/"]The Daily Telegraph report[/link]
[link url="https://www.nytimes.com/2018/04/27/world/europe/britain-dogs-autism-vaccine.html"]The New York Times report[/link]