Jeremy Laurance: The three sentences that unleashed MMR scare
Thursday 28 January 2010
The last three sentences of Andrew Wakefield’s now infamous Lancet paper published in February 1998 read as follows: “We have identified a chronic enterocolitis [bowel disorder] in children that may be related to neuropsychiatric dysfunction [autism]. In most cases, onset of symptoms was after measles, mumps, and rubella [MMR] munisation. Further investigations are needed to examine this syndrome and its possible relation to this vaccine.”
With that conclusion he and his colleagues at the Royal Free Hospital London triggered the biggest health scare of the decade. Hundreds of thousands of parents rejected one of the most basic safeguards for children - vaccination against three childhood diseases which have the capacity to kill and maim. Despite extensive efforts to confirm the link between MMR and bowel disease and autism since, none has succeeded.
It is often said that the health scare over MMR vaccine was got up by the media. As the sentences quoted above show, this is false. The scare was started by the scientists, not the reporters - including myself - who covered the ill-starred press conference called by the Royal Free Hospital to launch their paper.
The biggest puzzle of the saga is not how the scare started but what has sustained it over so many years. Here the media unquestionably played a major role. This was a classic scare story - and it involved children. Editors were not going to let it go easily.
Unlike most scientific controversies which flare up and die away, however, this one has simmered for a decade - and may now be fired up again by the preliminary verdicts in the GMC case.
Dr Wakefield is unrepentant about his research and remains convinced that some children are vulnerable to damage by the MMR vaccine. But he has remained almost a lone voice with little in the way of scientific support. Why did so many prominent commentators continue to champion his ideas for so long?
The GP and author Michael Fitzpatrick, father of an autisitc son, expressed the puzzlement of many when he wondered in his book “MMR and Autism: What Parents Need to Know” how the scare was sustained in the face of overwhelming evidence that it was unfounded.
"Intelligent people chose to reject mainstream science and listen to far less authoritative sources," he said. Why? And what could be done to tackle future scares?
Richard Horton, editor of The Lancet that published Wakefield’s paper, said in his account of the affair that it revealed a society “unable to come to terms with dissent”, and called it a “crisis of rationality” in which the nation had lost the ability to resolve disputes reasonably.
The possibility that the childhood vaccination programme might be causing damage to some 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 hard to rebuild. Concern about MMR has been sustained by a mix of public anxiety, mistrust of government health policy after the BSE debacle, sympathy for a lone doctor and anger at the Government’s refusal to sanction parents’ right to choose single vaccines.
Public suspicion about the incursions of science into our everyday lives is widespread - whether it be over the risks of mobile phones, water fluoridation, GM foods, stem cell research, nuclear power, global warming or gene therapy. People do not trust the government to place the safety of individuals above the interests of big business or the economy.
Mistrust was dramatically fuelled during the 1990s by the BSE scandal, when ministers withheld information about the potential risks of beef for fear of triggering a national panic. Television footage of John Gummer, former Tory agriculture minister, feeding a beefburger to his daughter, Cordelia, to demonstrate that beef was safe came to symbolise the Government’s cynical approach to public safety. As Lord Phillips inquiry revealed, the petfood industry had acted sooner to protect its customers - the nation’s cats and dogs - by requiring manufacturers to remove the brain and spinal cord from carcasses before processing for petfood, than had the Department of Health. The health department was reluctant to act because beef serum was used to grow vaccines and it feared any admission of risk could provoke a scare over its newly introduced (in 1988) MMR vaccine. This, arguably, is the real - and unreported - scandal of MMR.
Undoubtedly a key factor in the persistence of the later MMR and autism scare was what many saw as ministers’ bullheaded refusal to provide the three components as single vaccines, as Wakefield had recommended. To MMR refuseniks this exemplified the patronising arrogance of government. Tory MP Julie Kirkbride caught the mood when she said in 2001, as the mother of a then two-month old son: “I fully accept that there is no scientific evidence against MMR, but this is a question of a parent's right to choose. Those who are unhappy with MMR should be able to give their children that protection. It is very patronising to say 'we know best'. Parents should not be bullied that way.”
Wakefield had argued that giving the vaccines separately, at intervals of at least a few weeks, would lessen the impact on the immune system. Other scientists disputed the claim, pointing out that children are frequently infected with more than one virus at a time, without suffering permanent damage. Single vaccines would leave more children unprotected, both while they were waiting for the next jab and because many would fail to complete the course. In Japan, the only country where single vaccines were recommended, regular measles outbreaks occurred, and between 1992 and 1997 there were 79 deaths compared to none in the UK.
Despite the rationale of the official position, many in the media saw this as Government intransigence and evidence of a cover up. Ministers were protecting the pharmaceutical industry rather than the people. Consumer choice was being denied and the NHS was treating “ordinary parents” as “second class citizens”. Wakefield was a lone dissident, bravely defying the mighty medical establishment.
One further factor fuelled this heady mix. Tony Blair declared in 2004, after details of Wakefield’s conflict of interest over the payment from the Legal Aid board emerged, that there was “absolutely no evidence of a link between MMR and autism” and that parents should ensure their children “have the triple jab because it is important to do it.”
Fatally, however, he and Cherie refused to say whether their own son Leo had had the jab. In the fevered atmosphere of the time, that was enough to confirm sceptical parent’s worst fears.
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